Eyes on triple 90 goals

HE REMEMBERS it clearly.
“I will always remember how I felt the moment I was told of my diagnosis as HIV-positive,” Osward Siame of Lusaka’s Matero township says. “It was May 12, 2008 and I thought that was it for me.”

Mr Siame thought he was a risk to others and on a countdown to death.

He is certainly not unique in that position.
“I have grown old with HIV, I don’t fear the virus any more, I fear the stigma,” Mr Siame says.
When he was diagnosed HIV-positive, Mr Siame was terrified and anxious that he could and would infect someone.
In fact, meeting a new partner was out of the question.
With research on HIV, Mr Siame came across the word “undetectable”. It was not a cure but this seemed to be the light at the end of the tunnel: effective HIV treatment control that suppresses the virus so that the traces of HIV in the blood can no longer be detected.
Getting to “undetectable” became Mr Siame’s goal. He knew it would save his life.
Two months after he started taking ARVs, Mr Siame’s viral load was undetectable and it was like he had been handed his life certificate.
In a quest to ensure many people reach viral suppression, the Zambia Medical Association (ZMA), National AIDS Council (NAC) and The Joint United Nations Programme on HIV/AIDS (UNAIDS) partnered to hold a one-day public diplomacy dialogue on ending AIDS as part of the Sustainable Development Goals (SDG) agenda 2030.
The public dialogue was aimed at sharing ideas and looking at new ways in which the country can attain the 90-90-90 goals.
This goal aims at ensuring that 90 percent of the people living with HIV and AIDS know their status; of those living with the virus, 90 percent should be on antiretroviral therapy; and 90 percent should have a suppressed viral load.
When a person is virally suppressed, the level of HIV that remains in the body is so low that their ability to transmit the virus to others is significantly reduced.
Mr Siame is now healthy and virally suppressed and cannot pass on the virus.
“I am enjoying every moment life brings,” he says.
These are the benefits of adhering to treatment.
UNAIDS country director Medhin Tsehaiu says Zambia has attained outstanding results in the attainment of the 90-90-90 strategy in the last few years.
Out of the estimated 1.2 million people living with HIV, 70 percent know their status, 67 percent are on treatment and 59 percent have a suppressed viral load.
Dr Tsehaiu says the existing high-level political commitment to ending AIDS, an inclusive and ambitious National AIDS Strategy Framework (NASF 2017-2021) aligned to the political declaration, has been guiding the fast-track response at all levels.
But despite the gains, Dr Tsehaiu says a lot remains to be done to address some of the barriers towards achieving the fast-track goals targeting those left behind and vulnerable key populations, including adolescent girls and young women.
She suggests that particular attention should be channelled at ensuring adolescents and girls have the knowledge and negotiating power to demand safe sex.
Currently, 34,000 adolescents aged between 15 and 17 are living with HIV with some of them suffering the negative health outcomes of untreated HIV.
Public Private Sector co-ordinator at NAC Ellen Mubanga says the council’s focus areas include treatment, care and support to people on antiretroviral therapy (ART), elimination of mother-to-child transmission and HIV testing services.
“To enhance condom usage, we also do comprehensive condom programming, social and behavioural change communication and treatment of sexually transmitted infections,” Ms Mubanga says.
A number of issues were discussed during the dialogue centred on how efforts can be galvanised to enhance the attainment of the 90-90-90 targets.
Zambia is said to be at an unprecedented moment in the fight against HIV and AIDS because for the first time in modern history, an opportunity has been accorded to change the course of an epidemic without a vaccine or cure.
The latest data from the United States-funded Zambia Population-Based HIV Impact Assessment (ZAMPHIA) report shows that the country is already approaching control of the HIV epidemic, something that seemed impossible a decade ago.
Zambia is among the 13 high-burden countries under the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Strategy for Accelerating HIV/AIDS Epidemic Control for 2017-2020.
The strategy sets a bold course for accelerated PEPFAR-supported implementation in the 13 countries, which have the greatest potential to achieve HIV/AIDS epidemic control by 2020.
Zambia was identified as one of the 13 countries that PEPFAR would support to reach the 90-90-90 strategy by 2020.
Back to dialogue.
ZMA director Lottie Hachaambwa, in his presentation titled ‘HIV service delivery with a focus on how to reach populations and promotion of better inclusion of vulnerable populations’, noted that the benefits of HIV treatment and prevention include healthier and productive lives and reduced morbidity and mortality.
Dr Hachaambwa said all communities affected by HIV need treatment and prevention services, which the organisation has been offering.
Ministry of Health (MoH) national HIV treatment co-ordinator Lloyd Mulenga’s presentation was on the legal framework of health service delivery in Zambia and how to address the HIV response in order to leave no-one behind and ensure that everyone’s right to health is respected.
Dr Mulenga said one of the initiatives being implemented in ending AIDS is focused at cities, which bear a large share of global HIV.
He said the city-level action is likely to influence national outcomes.
“The initiative aims at attaining the 90-90-90 target and also eliminating stigma and discrimination,” Dr Mulenga said.
The MoH now offers full ART in the prevention of mother-to-child transmission and nurses are being trained into HIV nurse practitioners by the General Nursing Council.
But while Government is playing its role in the attainment of the 90-90-90 targets, civil society organisations are also playing their part.
Treatment Advocacy and Literacy Campaign (TALC) director Felix Mwanza says there is need to refocus the HIV response from emphasis on a biomedical approach to a more comprehensive approach that strengthens the capacity of community systems that create demand, deliver services and monitor progress.
“There is need to commit to resourcing and strengthening community systems, leadership and the continued involvement of people living with HIV, and key populations and communities affected by HIV in the development, implementation and monitoring of HIV-related policies and programmes,” Mr Mwanza says.
However, to sustain the gains made in the attainment of the 90-90-90 goals, each person in Zambia must make the decision to know their status and, if positive, start treatment immediately if they are to enjoy a positive life like Mr Siame is doing.


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