AIDS not over: International Conference on AIDS, STIs in Africa declares

HIV Experts—policymakers, HIV key populations, pharmaceutical companies into the manufacture of HIV medications and institutions connected to the HIV fight, among others—last week, gathered in Harare, Zimbabwe, for what is considered to be the largest AIDS conference in Africa.

The International Conference on AIDS and STIs in Africa (ICASA), the 22nd edition which was hosted in Zimbabwe from December 4 to 9, was organised by the Society for AIDS in Africa (SAA). 

This year’s conference was attended by over 8,000 delegates, both in person and virtually, and was on the theme ‘AIDS is not over: Address inequalities, accelerate inclusion and innovation. 

Strong delegation

Ghana was fully represented at the conference by a strong delegation led by the National AIDS/STI Control Programme. Others included officials from the Ghana Health Service, Ghana AIDS Commission, Ghana office of the World Health Organisation and John Snow Incorporated (JSI). Some of Ghana's delegation made presentations on specific areas of the HIV fight in the country during the sessions while others also moderated some of the sessions. JSI mounted a booth at the conference.

As various health experts addressed different sessions of the conference with emphasis on country experience, it became apparent that although significant progress has been made in the HIV/AIDS fight, AIDS is not over, as the theme for this year’s conference rightly resonates.

 Unfortunately, Africa is considered to be the continent that carries the highest burden of HIV and AIDS. To end it requires that we identify the challenges and deal with them so that together, Africa can join the rest of the global community to end AIDS by 2030, as has been targeted. 

Challenges

One of the main challenges to ending AIDS on the continent is financing. As rightly put by the ICASA President, Dr Pagwesese David Parirenyatwa, a significant portion of HIV-related programmes on the continent had historically relied on eternal donors rather than on the government. Should the external donors decide to pull out funding, it will create a huge setback. 

Ghana is a typical example of this. The Global Fund has been the single largest donor to the country’s HIV/AIDS response since 2002. When it cut back on its support to the country, particularly in the supply of free ART medications and other essential commodities required in the fight against HIV/AIDS, there was a problem. In what was known as co-funding, the Government of Ghana was required to increase its domestic funding for commodities such as ART. This, however, led to delays, sometimes, and for that reason, a stock of the ART medication.

If governments have funds set aside for contingency measures, it would go a long way to help, especially when the external donors decide to pull out.Abuja declaration

That is why the Abuja declaration seeks to allocate 15 per cent of the annual budget of member states of the African Union to enhance the health sector was good. Unfortunately, according to Dr Parirenyatwa, fewer than 10 per cent of the 55 African Union member states were fulfilling this commitment.

We should bear in mind that if there is a lack of financing for HIV, there will be a shortage of drugs, and once that happens, PLHIV will go off it, which can lead to an increase in viral load and eventually a spread of the HIV infection. This will make it difficult to achieve the 95/95/95 global target.

Global targets 

Another challenge that the continent, including Ghana, needs to address if it wants to achieve the global target of ending HIV by 2030 is inclusion. Inclusion here means getting those affected by the disease—the communities who are recipients of care—to be part of the decision-making process. The communities include key HIV populations such as risk groups, vulnerable groups, PLHIV and civil society groups. Nobody can tell the story better than them. 

Their opinions can go a long way to effectively shape policies, programmes and research, which is what the theme for this year’s World AIDS Day, ‘Let communities lead’, encourages. Building the capacities of the communities to play key roles in the care and response of the fight to end HIV is very important. Ghana deserves commendation for letting the communities lead in some of their interventions, including the campaign on the HIV self-test kit.

Stigma

The challenges confronting the HIV fight will be inconclusive without the mention of stigma. It is very obvious that PLHIV are highly stigmatised both by the general population and healthcare workers. At one of the sessions of the conference, Omar Syarif of the Global Network of People Living with HIV provided findings of the first-ever global report on the stigma index which pointed to the fact that one out of eight people experienced HIV stigma and discrimination from healthcare workers when accessing HIV care while for non-HIV care, the number doubled with 24.9 per cent. 

Among transgenders living with HIV, he said the number was almost 32 per cent; for sex workers, it was almost 13 per cent and among people who used drugs, it was 27.8 per cent.

Because of stigma, PLHIV are reluctant to go to health facilities to take their medication and once they do that, it means they would not be able to achieve viral suppression of the virus, which could lead to re-infecting people with the virus if they are sexually active.

Ending AIDS also means the need to address the issue of inequalities. There should be easy accessibility for PLHIV, especially adolescents, to access healthcare services. Special corners should be created for them at health facilities where they could seek HIV care and services. There is also the need to bring them on board in the various interventions.

The ability to adopt innovative ways in the HIV fight is also important.

All must bear in mind that AIDS is not over. Let us all play our part to end it in 2030, just as we did with the COVID-19 pandemic.