Augustina Tawiah (left), a journalist of the Daily Graphic, interviewing Dr Stephen Ayisi Addo

Funding major challenge in HIV prevention campaigns

Augustina Tawiah Jan - 14 - 2023 , 08:51

On August 24, last year, the Daily Graphic published the new infections for HIV in the country from January to June 2022 as 23,495. There was an awakening in the country following the publication that indeed the disease is still around.

The Programme Manager of the National AIDS/STIs Control Programme, Dr Stephen Ayisi Addo (SAA), paid a courtesy call on the Editor, Graphic of the Graphic Communications Group Limited and used the occasion to speak to the Daily Graphic’s Augustina Tawiah (AT) on the HIV/AIDS fight in the country. The conversation is captured below:

Augustina Tawiah (AT): How far have we come with the HIV/AIDS fight in the country?

Dr Stephen Ayisi Addo (SAA): The first case of HIV in Ghana was identified in 1986 and it was in 1987 that the National AIDS/STIs Control Programme (NACP) was established.

We started paying attention to the trend of infection on a yearly basis from 1992 when we were conducting what is known as the sentinel survey among pregnant women. We used that survey as a proxy to be able to determine the prevalence of HIV in the country.

Since that time, we have come very far from three or four per cent prevalence among pregnant women to two per cent prevalence as of 2021.

When we talk of the whole population (that is including children, adults, non-pregnant women and males), the prevalence of HIV in the whole country is 1.7 per cent. For a number of years now, we have kept the national prevalence among the adult population below two per cent.

Despite the change in the population of Ghana, we are saying that when you take 1,000 people, 17 are positive for HIV, which for us is an achievement because some of our neighbouring countries are recording a prevalence of around five, 11 per cent or more. In Eastern and Southern Africa, the prevalence is higher.

Achievements

AT: What have been some of the achievements made in the fight against HIV in the country?

SAA: First is the institutional framework put in place within the Ghana Health Service programme of work, which made it possible to be able to deliver a package of services to combat HIV.

Through this framework, we have developed a national strategic plan, which has formed the basis for continued monitoring of trends and also to mobilise resources for HIV. So over time, we’ve had increased funding for HIV in the country to support the national response.

The Global Fund, the United Nations (UN) systems and the World Health Organisation (WHO) have continued to support the country’s HIV fight.

The other achievement is that we started HIV testing in a few facilities and as we speak now, there are over 4,000 facilities that are offering HIV testing in the country.

We started treatment in 2003 and as we speak, there are over 600 facilities across the country that deliver antiretroviral therapy. This is a massive scale-up from a few facilities in the Eastern Region.

When it comes to Physical Management Therapy (PMT) services, we’ve increased the number of sites that are offering PMT services from less than 100 to over 4,500. If you take HIV prevalence, it’s 1.7 per cent in the general population, two per cent in women attending antenatal care, 4.6 per cent in female sex workers and 18 per cent among men who have sex with men.

Through our efforts, we are now able to engage these communities. We have engagement with the sex worker community and the gay community and we are able to roll out services such as testing services, lubricant distribution, pre-exposure prophylaxes and condom promotion services for them.

Part of this engagement is with the military and security services. We have trained and provided orientation for the police and the other security services on how they can handle military and security troops involving sex workers so that it does not lead to them going underground and spreading the disease.

One of our greatest achievements is that when it comes to HIV legislation, the AIDS Act has been promulgated. There is an LI that provides a context within which HIV should be managed to minimise stigma and discrimination.

So today, people living with HIV can openly come out to declare their status and sometimes demand treatment without feeling shy.

Previously, people stigmatised PLWHIV, abused them, discriminated against them, people denied them employment and livelihood, while some were thrown out of their homes, but through all our efforts now, all these are minimised.

The gender-based violence associated with HIV has been reduced. We are now able to protect the rights of PLWHIV and they are able to come out to declare their status. Now, we say that HIV is not a death sentence.

One of our biggest achievements is discordant couples — people who are positive that get married but have given birth to babies who are negative; this is because of the PMT programme.

People used to think that if you are HIV positive, you can automatically give it to your baby, but through the PMTs, mother-to-child transmission has been reduced.

We have also been able to integrate HIV services with other health services such as TB care and maternal and child health issues.

Funding

AT: What have been your challenges?

SAA: One of our challenges is funding. When the country achieved middle-income status, the Global Fund, which is a major donor, changed their mechanism of engagement with the country. With the funding they give us now, Ghana must compliment it and that has led to a big difficulty and strain on the government’s budget and with the current challenges in the fiscal space, it’s been difficult to purchase commodities such as test kits and ART medication.

These are big challenges, coupled with the fact that there is no dedicated money now for prevention campaigns. The AIDS Fund is one of the areas we are looking at to be able to fund these areas.

When it comes to the health sector, although training is continuous, there is attrition. The workforce to take care of the general population is limited for general care, so when you train people for HIV, they also move on and there is a gap.

AT: What measures are the NACP taking to address the challenges?

SAA: We are talking to the NHIS to ensure there is no barrier and that treatment and testing of HIV is free in Ghana. This year, we will be applying for the new funding model of the Global Fund.

This will ensure that we get some money to support the national response. We are also developing strategies to manage HIV within any new threats of epidemics and pandemics that might occur.

Furthermore, we intend to provide pre-exposure prophylaxis to high-risk groups like men who sleep with men, sex workers and those in a syro-discordant relationship in order to minimise the risk of infection.

With regards to achieving the three 95s, we intend to shore up our advocacy campaign and social mobilisation, so we have now come up with a plan, which is aimed at vigorously engaging the media to support us to tell our story.

AT: Any advice to Ghanaians regarding the HIV fight?

SAA: I want Ghanaians to know that the countries that have a high prevalence of HIV were some time ago free of HIV, but due to complacency they got high figures. Ninety- eight per cent of Ghanaians are negative; however, if we don’t prevent transmission to this 98 per cent, the disease will gradually spread and the two per cent who have the disease will increase.

I, therefore, want to establish that HIV is still real. Everybody must make an effort to know their status. If you know your status and you are positive, there is treatment.

We want the youth to know that transmission is occurring among them, so they should shun all risky behaviours. We appeal to educational institutions to give us the opportunity to engage students.

Let us always support those who are positive and on treatment. I call on the private sector and financial institutions to contribute to the AIDS Fund. If we don’t take control of our own health and support the HIV response, it will be a national security threat, meaning that our destiny will be in the hands of other people.