On World AIDS Day, the global community is concentrating on how to eradicate the HIV/AIDS epidemic by 2030.
Professionals are optimistic about dismantling obstacles to HIV care and treatment by concentrating on priority groups and assisting them throughout their lifetimes. The focus should be on identifying the remaining “last mile” challenges and addressing the distinct needs of at-risk populations, including adolescent girls, who are the most impacted overall.
“One of the initial steps we can take to dismantle obstacles to HIV care is to shift away from the ‘tyranny of the aggregate,’” remarked Nkosi Tshabalala, co-host of a webinar (https://bit.ly/3V1RAsr) with leading African HIV specialists 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) operates.
“This means instead of merely examining overall HIV statistics and employing a one-size-fits-all strategy for prevention and care, we need to focus on the particular communities suffering from the highest HIV prevalence. We must figure out what we can do for them in a human-centered, compassionate manner to meet their specific health requirements so that they can achieve viral suppression. This is crucial for ceasing further HIV transmission in society by 2030.”
Reaching young women, Africa’s most at-risk HIV population
“Currently, the representation of HIV in Africa is a young girl with a baby on her back, who often sacrifices her own health for her child when confronted with the tough decision of self-care versus childcare,” stated panellist Thanduxolo Doro, Civil Society Leader for People Living with HIV (PLHIV) and Project Management Specialist for USAID (https://bit.ly/3GHFMqE) South Africa.
Doro’s striking observation is backed by statistics. Women and girls comprised 63% of all new HIV infections in Sub-Saharan Africa, according to the recent UNAIDS “In Danger” report (https://bit.ly/3B4czTx). Six out of seven new infections in the region among 15-19-year-olds were found in females. In Uganda, for instance, adolescent girls were four to five times more likely than the broader population to be HIV positive, as noted by Dr. Andrew Kambugu, Executive Director of the Uganda Infectious Disease Institute (IDI) (https://bit.ly/3OwGFUS), who oversees the nation’s extensive PEPFAR-funded HIV initiatives. IDI is an infectious diseases capacity-building organization based at Makerere University, in addition to being a CDC-funded HIV implementation partner.
Dr. Veni Naidu, HIV Community Services Lead at BroadReach Health Development, who supervises their DREAMS program for young women, states that adolescent girls and young women are disproportionately at risk for HIV infection due to socioeconomic factors. DREAMS is a USAID initiative that supports and guides at-risk adolescent girls and young women throughout Africa.
Girls are more susceptible to HIV if they start engaging in sexual activities at an early age, lack the ability to negotiate condom use, have multiple sexual partners, are constrained by patriarchal norms and gender-based violence (GBV), and have transactional relationships with sexual partners. All indicators of the prevailing economic climate.
“Orphanhood is also a risk factor, as it leads to a lack of guidance and increased susceptibility to GBV,” said Naidu. “Girls often hesitate to get tested or treated for HIV due to fears of judgment from their parents, guardians, peers, and healthcare professionals.” Annah Sango, Advocacy Officer with the Global Network of People Living with HIV (https://bit.ly/3ECDyWY) in Zimbabwe, emphasized the significance of providing choices to young women so they can find the preventions or treatments that best suit their own circumstances. This includes pills, injections, vaginal rings, or access to both male and female condoms. “Choice equates to agency, which results in enhanced protection. We need to resolve issues of accessibility, availability, affordability, convenience, and community buy-in concerning HIV prevention and care for our most at-risk populations.”
Addressing the needs of priority HIV/AIDS communities
Priority should be given to key populations such as men who hesitate to seek medical assistance, vulnerable young girls, sex workers, and members of the LGBTQI+ communities who find it challenging or even perilous to seek aid.
Adult men are frequently a marginalized and blamed group, as they often find it difficult or embarrassing to visit clinics for HIV testing, treatment, and care. Adult men constitute 37% of HIV-positive adults in South Africa (https://bit.ly/3VrWsH3).
Men, who are often the primary earners and cannot afford to spend an entire day at a clinic, belong to the one-in-five Ugandans who are HIV positive but remain unaware of their status. “The leading barriers to HIV prevention and care include stigma, shame, criminalization, and economic hardships,” Kambugu stated.
Doro, leading USAID’s Mina (“Men” in isiZulu) initiative aimed at men’s health and wellness, emphasized the significance of cultural context. “African men often feel compelled to be vigorous, strong, respected providers and protectors; clinics can be stressful settings.” They may feel stripped of their power due to one-sided counseling that employs terms they find perplexing, such as ‘viral load,’ ‘transmissibility,’ or ‘prophylaxis.’ We must approach our work with empathy and inclusivity.”
The message U=U (Undetectable = Untransmittable) is crucial for World AIDS Day 2022, underscoring the hopeful message that those who attain viral suppression through adherence to their HIV/AIDS medications can lead long and fulfilling lives. This is because viral suppression results in an undetectable viral load, allowing HIV+ individuals to live freely without the fear of transmitting HIV to others.
“I am a living testament to this hopeful message,” noted Doro, who advocates for the MINA campaign (https://bit.ly/3V5r9lo) to reach at-risk men. “I have lived with HIV for 33 years, not merely surviving but thriving, enjoying a happy, virally suppressed life alongside my HIV-negative family. It is feasible.”
This message is equally significant for sex workers and their clients, men who have sexual relations with men, people who inject drugs, as well as transgender individuals and their partners. According to UNAIDS, these groups accounted for 70% of global HIV infections and 51% of new infections in Sub-Saharan Africa. These key populations encounter access challenges ranging from stigma and education to language barriers, social injustice, criminalization (especially in nations where homosexuality is outlawed), and economic and transportation difficulties that hinder access to clinics.
To overcome these challenges, the healthcare community needs to be innovative. “We have to think creatively to reach key populations, such as through nighttime or drop-in clinics,” Kambugu states. “For instance, we were able to connect with isolated fishing communities on Lake Victoria utilizing drone-assisted medication deliveries.”
There is real hope of conquering HIV/AIDS in our lifetime
Kambugu asserts that the data illustrates that epidemic control is indeed achievable within our lifetime. “Viral suppression has already been attained by 75% of all individuals living with HIV in Uganda; this is also feasible in other countries.” For context, a UNAIDS report notes that 59% of individuals living with HIV have achieved viral suppression globally, while South Africa has attained 89%, according to Health Minister Joe Phaahla.
To achieve 100%, Kambugu argues that Uganda ought to decriminalize transactional and homosexual sex, permitting these groups to access HIV prevention and care with ease. “We must embrace the essence of Ubuntu and weave empathy into our policymaking.”
Improved communication, more customized care models, and public-private collaborations, according to Naidu, must become the norm for all HIV prevention and care initiatives throughout Africa. Additionally, Sango believes that all African governments should incorporate sex education into school curricula. “On every front, we must relentlessly combat inequality and ignorance,” she stated.
