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Africa Getting to Zero HIV by 2020

Yoliswa Dube

THE fight against HIV/Aids has not been a fight that Zimbabwe has been battling alone — Africa and the entire globe has been at war with the pandemic as well.

The Aids scourge has brought untold suffering among families leaving scores of children orphaned hence the increased number of child-headed families. This has also seen an upsurge in cases of child marriages. The global goal is to achieve a zero percent HIV prevalence rate by 2020.

The Joint United Nations Programme on HIV/Aids, UNAIDS, leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero Aids-related deaths. Africa aims at reaching this goal through the 90-90-90 target which entails that 90 percent of the population knows its status, 90 percent are on antiretroviral treatment and 90 percent have a suppressed viral load.

Southern Africa is the region most affected by HIV worldwide with HIV prevalence rates peaking between 10 and 40 percent of the adult population. Zimbabwe is the only country in this region in which HIV prevalence has declined substantially at national level.

The country has recorded a 34 percent reduction in new HIV infections between 2005 and 2013. “Getting to zero is the aspiration that UNAIDS, Zimbabwe and other countries have embraced. It’s a long term vision, that no-one dies of Aids and that there’re no new infections. Our actions should be towards achieving this vision,” said Michael Bartos, UNAIDS Zimbabwe country director.

He said there were a number of things that were necessary in getting HIV prevalence to zero percent.

“This will entail getting people on effective HIV treatment such that they can have a normal life span. There’s still progress to be made to put people on treatment. The effectiveness of treatment is very important; if treatment fails it should be adjusted so that someone doesn’t develop Aids. We need to make sure there’re no new infections and young women are not involved in risky sex,” said Bartos.

Making sure condoms are readily available and keeping a social dialogue about HIV/Aids rolling is important, Bartos said. He said preventing mother to child transmission of HIV by administering antiretrovirals was also vital to the vision of getting to zero. “Male circumcision, although it doesn’t eliminate the risk of contracting HIV, reduces it. Intensive work is being done among sex workers, there’s considerable sex work taking place in the country,” he said.

Added Bartos: “Interventions are much larger with regards to infection prevention. We’re trying to make sure that those infected with HIV get treatment and make sure its effective. Zimbabwe has multi-sectorial response to HIV and these different sectors need to play their part.” Zimbabwe has been enthusiastic, Bartos said, such that getting to zero is achievable through the renewal of support.

“If the country doesn’t make this decision then this will become a dominant health problem. People need to decide to do better. This is something one partner can’t do alone. We need to make decisions to accelerate efforts in the next few years and it has to be done in solidarity and as a global whole,” he said.

According to UNAIDS statistics, there were 24.7 million people living with HIV in sub-Saharan Africa in 2013. Women account for 58 percent of the total number of people living with HIV in this part of the continent. Statistics show that in 2013, there were an estimated 1.5 million new HIV infections in sub-Saharan Africa and new HIV infections declined by 33 percent between 2005 and 2013.

Sub-Saharan Africa accounts for almost 70 percent of the global total of new HIV infections. Statistics also show that 1.1 million people died of Aids-related causes in 2013. Between 2005 and 2013, the number of Aids-related deaths in sub-Saharan Africa fell by 39 percent with treatment coverage of all people living with HIV in sub-Saharan Africa standing at 37 percent.

Statistics show that 67 percent of men and 57 percent of women were not receiving antiretroviral treatment in sub-Saharan Africa in 2013. Three out of four people on antiretroviral treatment live in sub-Saharan Africa and in Nigeria, 80 percent of people do not have access to treatment.

UNAIDS executive director Michel Sidibé said treatment should be made available to everyone who needs it. “Every person living with HIV should have immediate access to life-saving antiretroviral therapy. Delaying access to HIV treatment under any pretext is denying the right to health,” said Sidibé.

Since 2009, there has been a 43 percent decline in new HIV infections among children in the 21 priority countries of the Global Plan in Africa. Countries participating in this plan are Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, Tanzania, Zambia and Zimbabwe.

Global targets for 2015 are to reduce the number of new HIV infections among children by 90 percent and reduce the number of HIV-associated deaths of women during pregnancy, delivery or puerperium by 50 percent. Child targets include reducing under-five deaths due to HIV by at least 50 percent and provide antiretroviral therapy for all children with HIV.

Additional evidence shows that starting antiretroviral therapy at a higher CD4 (a measure of immune system health) level has a positive effect on the health and well-being of people living with HIV.

The National Institute of Health funded international randomised clinical trial START (Strategic Timing of Antiretroviral Treatment) has found compelling evidence that the benefits of immediately starting antiretroviral therapy outweighs the risks.

Data from the study showed that the risk of Aids, other serious illnesses or death was reduced by 53 percent among people who started treatment when their CD4 levels were 500 or above, compared to the group whose treatment was deferred to when their CD4 levels dropped to 350.

Deputy national ART co-ordinator (Aids and TB Programmes) in the Ministry of Health and Child Care, Dr Regis Choto said HIV prevalence in Zimbabwe had declined from a peak of 28 percent in 1997 to 15 percent in 2013 due to different reasons.

“The HIV decline is attributed to successful implementation of prevention strategies especially behaviour change, high condom use and reduction in multiple sexual partners. HIV has plateaued due to improved survival linked to improved ART coverage,” said Dr Choto. Dr Choto commended the country’s condom distribution strategy noting it was largely contributing to the decline of new infections in the country.

“Zimbabwe has high levels of condom use especially among non-regular partners. The success of the programme is attributed to effective partnerships across different levels of intervention. However, the main challenges to date are the low uptake of female condoms and low condom use in long term relationships.”

Dr Choto said a substantial increase in the number of pregnant women and people above 15 years tested for HIV and the Provider-Initiated Testing and Counselling approach offered at public institutions contributed to this positive reduction in HIV infections.

Data from UNAIDS indicates that if all interventions are scaled up and Global Plan targets are achieved, there would be 2,300 new child infections in 2015 — an 87 percent decline in the number of new child infections from 2009.

The HIV Global Plan believes that by 2015, children everywhere can be born free of HIV and their mothers remain alive. Though Zimbabwe’s response to Aids is among the most successful, the pandemic remains a public health threat and much more needs to be done.

Published: June 8 2015. By Yoliswa Dube
Copyright © The Chronicles

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