On World AIDS Day, the international community is focusing on how to end the HIV/AIDS epidemic by 2030.
Experts believe it is possible to overcome barriers to HIV care and treatment by focusing on priority populations and supporting them throughout their lives. The emphasis must be on identifying the remaining “last mile” barriers and focusing on the unique needs of vulnerable populations, including teenage girls, who are the most affected of all.
“One of the first things we can do to overcome barriers to HIV care is to move away from the ‘tyranny of the aggregate,'” said Nkosi Tshabalala, co-host of a webinar (https://bit.ly/3V1RAsr) with top African HIV experts and BroadReach Health Development’s Acting District Director of Gert Sibande in Mpumalanga, South Africa – one of the health districts where BroadReach (https://bit.ly
“That means instead of just looking at general HIV numbers and adopting a one-size-fits-all approach to prevention and care, we must focus on the specific communities that have the highest HIV prevalence. We must determine what we can do for them in a human-centric, caring way to address their specific health needs so that they can reach viral suppression. This is the key to stopping further transmission of HIV in society by 2030.”
Reaching adolescent women, Africa’s most vulnerable HIV population
“Today, the face of HIV in Africa is a young girl with a baby on her back, who will always sacrifice her own health for her child when faced with the difficult choice of self-care versus child-care,” said panellist Thanduxolo Doro, People Living with HIV (PLHIV) Civil Society Leader and Project Management Specialist for USAID (https://bit.ly/3GHFMqE) South Africa.
Doro’s vivid assessment is supported by statistics. Women and girls accounted for 63% of all new HIV infections in Sub-Saharan Africa, according to the recent UNAIDS “In Danger” report (https://bit.ly/3B4czTx). Six of the region’s seven new infections among 15-19-year-olds were among females. In Uganda, for example, adolescent girls were four to five times more likely than the rest of the population to be HIV positive, according to Dr Andrew Kambugu, Executive Director of the Uganda Infectious Disease Institute (IDI) (https://bit.ly/3OwGFUS), who oversees the country’s large-scale PEPFAR-funded HIV programmes. IDI is an infectious diseases capacity-building organisation based at Makerere University, as well as a CDC-funded HIV implementing partner.
According to Dr. Veni Naidu, HIV Community Services Lead at BroadReach Health Development, who oversees their DREAMS programme for young women, adolescent girls and young women are disproportionately vulnerable to HIV infection due to socioeconomic circumstances. DREAMS is a USAID initiative that supports and mentors at-risk adolescent girls and young women across Africa.
Girls are more likely to contract HIV if they begin having sex at a young age, lack the power to negotiate condom use, have multiple sexual partners, are repressed by patriarchal culture and gender-based violence (GBV), and have transactional relationships with sexual partners. All signs of the current economic situation.
“Orphanhood is also a risk factor, because of a lack of guidance and higher risk of GBV,” said Naidu. “Girls are often reluctant to get tested or treated for HIV as they fear judgment from their parents, caregivers, peers and health workers”. Annah Sango, Advocacy Officer with Global Network of People Living with HIV (https://bit.ly/3ECDyWY) in Zimbabwe, said it is very important to provide a choice to young women so that they can find the preventions or treatments that will work best for their personal situation. This includes pills, injections, vaginal rings, or access to male and female condoms. “Choice means agency, which means more protection. We need to solve issues of accessibility, availability, affordability, convenience, and community buy-in around HIV prevention and care for our most vulnerable populations.”
Providing for the needs of priority HIV/AIDS communities
Priority must be given to key populations such as men who avoid seeking medical help, vulnerable young girls, commercial sex workers, and members of the LGTBQI+ communities who find it difficult or even dangerous to seek help.
Adult men are a frequently overlooked and blamed group because they find it difficult or embarrassing to come to clinics for HIV testing, treatment, and care. Adult men account for 37% of HIV-positive adults in South Africa (https://bit.ly/3VrWsH3).
Men, who are often breadwinners and cannot afford to spend the day in a clinic, are part of the one-in-five Ugandans who are HIV positive but are unaware of it. “The greatest barriers to HIV prevention and care are stigma, shame, criminalization, and economic challenges,” Kambugu said.
Doro, who leads USAID’s Mina (“Men” in isiZulu) initiative focused on men’s health and well-being, stressed the importance of cultural context. “African men are frequently pressured to be virile, strong, respected providers and protectors, and clinics can be stressful environments.” They may feel robbed of their power as a result of one-sided counselling that uses terminology they don’t understand, such as ‘viral load,’ ‘transmissibility,’ or ‘prophylaxis.’ We must approach our work with empathy and inclusivity.”
The message U=U (Undetectable = Untransmittable) is critical for World AIDS Day 2022, highlighting the important message of hope that people who achieve viral suppression through adherence to their HIV/AIDS medications can live long and healthy lives. This is due to the fact that viral suppression results in an undetectable viral load, allowing HIV+ people to live freely without fear of transmitting HIV to others.
“I am living proof of this message of hope,” said Doro, who champions the MINA campaign (https://bit.ly/3V5r9lo) to reach men at risk. “I’ve lived with HIV for 33 years, not only surviving but thriving, with a happy, virally suppressed life with my HIV-negative family. It is possible.”
This message is also important for sex workers and their clients, men who have sex with men, people who inject drugs, and transgender people and their sexual partners. According to UNAIDS, they accounted for 70% of HIV infections globally and 51% of new infections in Sub-Saharan Africa. These priority populations face access barriers ranging from stigma and education to language barriers, social injustice, criminalization (particularly in countries where homosexuality is illegal), and economic and transportation issues that make getting to clinics difficult.
To overcome these obstacles, the healthcare community had to be creative. “We need to think outside the box to reach key populations, such as through moonlight or drop-in clinics,” Kambugu says. “For example, we were able to reach remote fishing communities on Lake Victoria using drone-powered drug deliveries.”
There is genuine hope of overcoming HIV/AIDS in our lifetime
According to Kambugu, the data demonstrated that epidemic control was truly possible in our lifetime. “Viral suppression has already been achieved by 75% of all people living with HIV in Uganda; it is also possible in other countries.” For context, according to a UNAIDS report, 59% of people living with HIV have reached viral suppression globally, while South Africa has reached 89%, according to Health Minister Joe Phaahla.
To achieve 100%, Kambugu believes Uganda should decriminalise transactional and homosexual sex, allowing these populations to freely access HIV prevention and care. “We must embrace the spirit of Ubuntu and incorporate empathy into our policymaking.”
Better communication, more personalised care models, and public-private partnerships, according to Naidu, must become the standard for all HIV prevention and care in Africa. In addition, Sangoh believes that all African governments should include sex education in school curricula. “On all fronts, we must work tirelessly against inequality and a lack of knowledge,” she said.
