Conquering the HIV/Aids pandemic

With only a few days to the 2020 deadline, Uganda has only one per cent of the people living with HIV/Aids status to be diagnosed to meet the 90-90-90 global goals.

The joint United Nations Programme on HIV/Aids (Unaids) 90-90-90 goals were launched at the International Aids Conference in 2014 in Melbourne, Australia, as part of global efforts to end the HIV/Aids pandemic by 2030.

These were set to have by next year 90 per cent of all people living with HIV/Aids know their HIV status, 90 per cent of all people with diagnosed HIV infection receive sustained antiretroviral therapy, and 90 per cent of all people receiving antiretroviral therapy have viral suppression.

Dr Nelson Musoba, the director-general of the Uganda Aids Commission (UAC), says the country has achieved the last two targets, while the first one stands at 89 per cent.

“We have not achieved the first 90 targets largely because we rely on people to come to the health facility. But we have almost surpassed the third goal at almost three per cent,” Dr Musoba explains.
By the end of 2020, Mr Musoba says the government expects the country to have achieved the remaining one per cent to achieve the first target.

“Our planning period is July to June but the global calendar runs up to December. So, we hope to have hit all the targets by the end of 2020,” he assures.
At this point, Dr Joshua Musinguzi, the head of HIV/Aids programme at the Ministry of Health, says:

“We have changed our target to 95-95-95 HIV/Aids treatment target. The gap is in men, children and young people. We are doubling our effort in the fight and hope by December next year, we shall be measuring up.”
Several other campaigns have been stepped up at a national level, which has largely contributed to the positive progress on meeting the targets.

At its peak in the 1980s, Uganda pioneered the “ABC” prevention model of Abstinence, Be faithful, and use a Condom, which is considered the cornerstone for Uganda’s success in combatting HIV/Aids.

Under the campaign, young people were encouraged to wait until marriage before having sex and to abstain. All sexually active people were given the message of ‘zero-grazing’, which meant staying with regular partners and not having casual sex.
Those who did not abstain were encouraged to use condoms, which were promoted to the population as a whole.

In 2017, President Museveni launched an ambitious five-point plan to end HIV/Aids in the country by 2030, with the main focus on voluntary testing for men.
Code named “Presidential fast-track initiative on HIV and Aids in Uganda,” the blueprint aimed at engaging men in HIV-prevention to close the gap on new infections, particularly among adolescent girls and young women.

“I am now calling upon all men, all of you to go for voluntary testing…if you find you are sick (positive), take the drugs. They will not cure you, but when the virus is suppressed, you will live longer and not infect others,” President Museveni said while delivering his speech at an event held in Kampala then.

The Five-Point Plan includes engaging men in HIV-prevention and closing the tap on new infections, particularly among adolescent girls and young women, and accelerating the implementation of Test and Treat and attainment of 90-90-90 targets, particularly among men and young people.

Others are consolidating progress on eliminating mother-to-child transmission of HIV and ensuring financial sustainability for the HIV-response and ensuring institutional effectiveness for a well-coordinated multi-sectoral response.

Mr Museveni’s remarks were triggered by the latest Uganda Demographic and Health Survey (UDHS) 2016, which indicate that 60 per cent of the men in Uganda had tested to know their HIV status compared to 83 per cent of the women.

Last year, the government launched the free-to-shine campaign, an initiative that seeks to reduce HIV/Aids among children, adolescents and young women by 2020.
The project is being implemented by the Organisation of African First Ladies Against HIV/Aids.

The numbers

Living with the virus 1.38m
On ARVs 1.2m
New infections annually 53,000
Deaths annually 23,000
Prevalence rate 6.1 per cent
Drug resistance 17 per cent
Government expenditure on ARVs Shs160b
3rd line treatment 1000 people
2nd line treatment 80,000 people
1st line treatment 1,110,000 people
Government monthly expenditure per person
1st line Shs50,000
2nd line Shs250,000
3rd line Shs800,000
Source: Uganda Aids Commission

WHO recommends 3-way HIV/Aids test

The World Health Organisation (WHO) has directed that countries adopt a standard HIV-testing strategy, which uses three consecutive reactive tests instead of two for more efficient diagnosis.

“Previously, most high-burden countries were using two consecutive tests but the new approach can help countries achieve maximum accuracy in HIV-testing,” Dr Tedros Adhanom, the WHO director general, said in a press statement on Wednesday.

Dr Adhanom also said the face of HIV epidemic has changed dramatically over the past decade. He added that many patients are not yet getting the much needed help.
According to WHO, 8.1 million people living with HIV/Aids have not yet been tested and are unable to obtain the life-saving treatment of ARV.
“More people are receiving treatment than ever before, but many are still not getting the help they need because they have not been diagnosed,” he said.

Ways to reach those not tested
WHO recommends that “countries should embrace HIV self-testing as the gateway to diagnosis based on the new evidence that people who are at higher risk and not testing in clinical settings are more likely to be tested if they can access HIV self-test.”
WHO also recommends that social networking-based HIV/Aids testing should reach key populations like sexworkers and people in prison.

According to WHO, the use of peer-led, innovative digital communications such as short messages (SMS) and videos can build demand and increase uptake of HIV testing.
The world commemorate World’s Aids Day today under the theme “Communities make the difference.”

Additional reporting by TONNY ABET

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