Inequalities derail anti-AIDS crusade

FORTY years since the first cases of HIV were reported, a lot of progress has been made in the anti-AIDS campaign, albeit undermined by many social, cultural, economic and political inequalities. As the world was commemorating World AIDS Day yesterday, what struck me as the major strides is the roll-out of anti-retroviral therapy (ART) or availability of HIV/AIDS generic medications, coupled with the remarkable reduction of mortality due to AIDS and the drop in new HIV infections. As you may be well aware, “End Inequalities. End AIDS. End Pandemics’ is the theme for this year’s commemoration. Notwithstanding the structural inequalities that hinder the desired outcomes of HIV prevention and treatment efforts, we cannot turn a blind eye to the huge successes that we have scored in the anti-AIDS campaign. Of course the COVID-19 pandemic has taken us years back in our quest to end HIV by 2030. The global pandemic has compounded social, economic and cultural inequalities, but it cannot water down the achievements scored over the years in the anti-AIDS crusade.
One landmark development is that HIV/AIDS is no longer the death sentence that it used to be before Zambia and other countries rolled out free HIV treatment. For example, out of about 37.7 million people that were living with HIV at the close of 2020 globally, 27.5 million people were on ART, up from 7.8 million in 2010, according to UNAIDS statistics. This means that people living with HIV and AIDS (PLWHA) have the right to live normal, healthy and fulfilling lives like any other person because of the life-prolonging anti-retroviral drugs (ARVs) on offer. As a result of this, UNAIDS tells us that AIDS-related deaths have reduced by 64 percent since the peak of the pandemic in 2004 and by 47 percent since 2010. Deaths due to AIDS-related illnesses went down to 680,000 last year from 1.9 million in 2004 and 1.3 million in 2010. Females seem to be doing better than their male counterparts in terms of HIV treatment, given the 53 percent reduction in AIDS-related mortality among women and girls around the world, whereas men and boys were trailing at 41 percent. This is a significant AIDS mortality reduction, although the loss of 680,000 lives to the AIDS pandemic is way too much. Ordinarily, we shouldn’t be talking of the loss of thousands of lives due to AIDS-related illnesses given the advancement of medical science and the roll-out of generic HIV medicines around the world. However, people have continued dying in large numbers because of certain socio-economic inequalities that put many nations off-track the global target of eliminating HIV and AIDS by 2030. What are these inequalities? Before I get to that, I would like to state that the reduction in new HIV infections globally is another incredible achievement. There has been a 100 percent reduction in new HIV infections around the world in 23 years. As at 2020, about 1.5 million people were newly infected with HIV compared to 3 million people in 1997. And between 2010 and 2020, new HIV infections declined by 31 percent from 2.1 million to 1.5 million. The reduction is heart-warming because it gives us the assurance that the 90-90-90 targets for HIV epidemic control are bearing fruit, and the elimination of HIV and AIDS is achievable. The triple 90 campaign entails that 90 percent of PLWHA must know their status; 90 percent of them must have access to treatment and 90 percent of those on treatment must be virally suppressed. According to experts, virally suppressed individuals are unlikely to infect their partners with HIV.
As a country, having met the 90-90-90 targets, we are on the road to ending AIDS, perhaps not in 2030 due to many derailments, but obviously in the years to come. However, the COVID-19 pandemic has dealt us a blow in this campaign. Complaints are already being made by PLWHA about how the pandemic has triggered a shrinkage in HIV prevention and treatment services. Medical staff, who in developing countries like Zambia are already understaffed, are now responding to the global pandemic at the frontline. This has eroded services rendered to those on ART, such as routine reviews with experts and access to health technologies. HIV prevention efforts have also been adversely affected, and some people fear that we may just end up with a spike in new infections, especially among adolescents. More so, there has been a notable reduction in HIV testing services and referrals for treatment because of COVID-19-related interruption of HIV services. Some young people I once interacted with last July during an online workshop organised by GIZ lamented about the disruption of youth friendly corners in health facilities at the peak of the COVID-19 third wave. Moreover, when schools were closed on the heat of the second and third waves of COVID, schoolgirls were said to be at higher risk of sexual violence and getting pregnant than when they were in school. And long before the coronavirus pandemic started, women and girls were already more vulnerable to getting infected with HIV than their male counterparts. Around the world, 5,000 young women aged 15-24 get infected with HIV weekly, says UNAIDS. And in our region, sub-Saharan Africa, six in seven new HIV infections among adolescents aged 15-19 are among girls. And young women aged 15-24 years are said to be twice at risk of living with HIV than men and boys. Inequalities bordering on cultural factors put women at risk of sexual violence, and consequently HIV infection. Further, from what we have seen in this COVID-19 era, being out of school puts girls at greater risk of getting pregnant and infected with sexually transmitted infections, including HIV. In that vein, schools are safe places that keep girl children from harm’s way and also give them the ammunition to fight sexual violence through comprehensive sexuality education. So the COVID-19 pandemic brings inequitable access to HIV prevention and treatment services as aforementioned. In some situations, access to ARVs is not as good as before the advent of COVID-19 when people were given drugs to last them a good three months. Here it means the poor who solely depend on public health facilities for their ART services and cannot afford to go to private health facilities are negatively affected. The situation is more desperate in resource-poor countries whose economies have been badly battered by the COVID-19 pandemic, than wealthy countries that could comfortably weather the coronavirus storm. Inequitable access to HIV medicines, coupled with the COVID-19 vaccine injustice in Africa, presents a double- edged sword to PLWHA and every other person. Already experts tell us that PLWHA stand a higher risk of experiencing severe COVID-19 outcomes because they have higher comorbidities than HIV-negative people. This means that we need fair play in the distribution of COVID-19 vaccines globally to reduce the risk of PLWHA dying from the pandemic. Unfortunately, while Africa bears a heavy HIV burden, only 7 percent of its population are vaccinated, compared to, for example, 70 percent of the European Union’s population. UNAIDS says, and I quote: “Sub-Saharan Africa is home to two thirds (67 percent) of people living with HIV. But the COVID-19 vaccines that can protect them are not arriving fast enough.” While rich nations are stockpiling COVID-19 vaccines, as of October 2021, only 5 out of 54 African countries had met the World Health Organisation (WHO) benchmark of fully vaccinating 40 percent of their populations. This is according to Amref Health Africa, an international organisation that has launched a campaign to end vaccine injustice in Africa. On the other hand, COVID-19 also comes in to worsen economic disparities. For instance, the shrinking of economic opportunities due to the pandemic means lack of access to quality medical services for some, poor nutrition for others, and a high rate of school dropouts for others still.
All these factors serve to perpetuate structural inequalities that could derail HIV prevention and treatment efforts. These are some of the inequalities that anti-AIDS activities are trying to address in this year’s theme of World AIDS Day. Their message is loud and clear – ‘End Inequalities. End AIDS. End Pandemics’. Individual governments and the international community must play their part to address these concerns. Email:eshonga@daily-mail.co.zm/emeldashonga@yahoo.com Phone:0211-221364/227793

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