Opinion & Columnist

HIV prevention, research vital

Roselyne Sachiti
Features, Health & Society Editor

On Tuesday, Zimbabwe joined the world in commemorating World Aids Day (WAD) 2020.

This year’s theme of “Global Solidarity, Shared Responsibility”, came at a critical time when global attention has been shifted towards the race to find a vaccine for the novel coronavirus.

Despite Covid-19, the 2020 World Aids Day comes at time when Zimbabwe continues to make commendable progress in reversing the course of the AIDS pandemic through prevention of new HIV infections and the provision of treatment to those infected despite economic challenges being faced by the country.

As President Mnangagwa rightly pointed out in his State of the Nation Address on HIV and Aids on the eve of the World Aids Day 2020, Zimbabwe has indeed progressed in reversing the course of the AIDS pandemic particularly through the prevention of new HIV infections and provision of treatment to those who are infected in line with the pursuit of the 90-90-90 by 2020 target.

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“Ninety percent of people living with HIV should know their status by 2020, 90 percent of all HIV positive people should receive treatment by 2020, 90 percent of all people on treatment should have their viral load suppressed by 2020.

“I am glad that in the context of the 90-90-90 targets, our country is now closer than ever to the goal of ending the AIDS pandemic by 2020,” he said.

Interventions

While the country continues to make strides towards reaching the 90-90-90 targets, it is important to continue preventing HIV transmission using the available interventions even with limited resources.

These include consistent and correct use of both the female and male condoms for those who indulge in casual sex with multiple partners, and even among couples.

If anything, condoms do not only prevent HIV, but also offer protection from other sexually transmitted infections (STIs), and are a form of contraceptive in preventing unplanned pregnancies.

Abstinence also plays a critical role in preventing HIV.

The prevention of mother to child transmission (MTCT) of HIV programmes introduced in Zimbabwe in 2001 have been successful in reducing vertical transmission.

It has been a journey worth celebrating.

By 2012 Zimbabwe had made substantial progress towards the elimination of MTCT and in 2013, the country adopted WHO guidelines which recommended the provision of lifelong Antiretroviral Therapy (ART) to all HIV positive pregnant and breastfeeding women (Option B+).

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Since 2015, WHO has recommended ART for all people living with HIV, because early treatment enables them to live longer and healthier lives and reduces the potential for transmitting the virus.

According to a Ministry of Health and Child Care document titled “Implementation Plan for HIV Pre-Exposure Prophylaxis in Zimbabwe 2018-2020”, in 2015 WHO recommended that oral pre-exposure prophylaxis (PrEP) containing Tenofovir (TDF) based regimens should be offered as an additional choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches.

PrEP is the use of antiretroviral (ARV) drugs before HIV exposure by people who are not infected with HIV in order to prevent the acquisition of HIV.

Science

Thanks to science, prevention remains the cornerstone to winning the battle globally and Zimbabweans are among women from African countries that have participated in both the HPTN 084 and dapirivine ring studies.

Dapivirine ring studies have been conducted in Belgium, Kenya, Malawi, South Africa, Tanzania, Uganda, the United States and Zimbabwe. Women in Rwanda also participated in early studies of a gel-based form of dapivirine.

The HPTN 084 also enrolled 3,223 cisgender (heterosexual) women at research sites in Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda, and Zimbabwe.

Last month, a study HPTN 084, led by the HIV Prevention Trials Network (HPTN), found a pre-exposure prophylaxis (PrEP) regiment of long-acting cabotegravir (CAB LA) injections once every eight weeks was safe and superior to daily oral tenofovir/emtricitabine (FTC/TDF) for HIV prevention among cisgender women in sub-Saharan Africa.

Great news as such a long-acting PrEP product could also offer a better choice for women at substantial HIV risk who either do not want to take or struggle with taking a daily tablet. This long-acting injectable formulation also has the potential to improve the prevention effect without relying on adherence to a daily oral PrEP regimen, and to increase prevention choices and acceptability among women who carry the heaviest burden of HIV and Aids.

On November 30, 2020, non-profit International Partnership for Microbicides (IPM) announced the World Health Organization’s (WHO) prequalification of the dapivirine ring, a monthly vaginal ring to reduce women’s HIV risk.

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The product’s addition to the WHO’s list of prequalified medicines will help guide national and global procurement decisions, pending country regulatory approvals for its use. The ring’s prequalification follows a positive scientific opinion for the product in July 2020 from the European Medicines Agency (EMA) under Article 58.

The ring is designed to provide women with a discreet and long-acting option for HIV prevention. It contains the anti-retroviral drug dapivirine, which is released slowly to reduce the risk of HIV infection locally in the woman’s private parts with few effects elsewhere in the body.

These two interventions lock out the HIV virus as a prevention tool to achieve zero new HIV infections.

Community Working Group on Health director, Itai Rusike, said numerous efforts, investments of resources as well as research and development have led to immense progress in prevention, treatment and care to defeat HIV.

“The very recent study results showing the effectiveness of long-acting injectable medicines for preventing HIV among women; the positive opinion on the effectiveness of the Dapivirine vaginal ring to reduce the risk of HIV infection for women add to the progress made towards defeating the disease,” he said.

Added Rusike: “According to UNAIDS, globally, increased access to HIV treatment has averted around 12.1 million AIDS-related deaths since 2010. This victory calls for celebration as it has led to significant reduction of HIV transmission and related deaths. The progress though remarkable, has been unequal, notably in expanding access to antiretroviral therapy.”

In Zimbabwe, approximately 1,4 million people are living with HIV. Around 40 000 new HIV infections occurred in 2019 and there were about 20 000 AIDS related deaths, according to UNAIDS.

Regarding testing and treatment, the results from the second Zimbabwe Population based HIV Impact Assessment survey (ZIMPHIA) released this week show that 86,8 percent of adults living with HIV know their status. Of these, 97 percent are on treatment while of those on treatment, 90,3 percent virally suppressed.

Women are disproportionally affected by HIV in Zimbabwe.

According to the survey, the rate of annual new HIV infections among adults in Zimbabwe is 0,38 percent (0,54 percent among women and 0,20 percent among men) or approximately 31 000 persons over a year. The prevalence of HIV among adults was 12.9 percent, which corresponds to approximately 1,23 million adults in Zimbabwe living with HIV in 2020. Generally, the survey found that HIV prevalence was higher among women than men (15,3 percent vs. 10,2 percent).

Challenges

Stigma and discrimination, together with other social inequalities and exclusion, remain key barriers. Marginalised populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention.

More work should be done in changing the attitudes of society towards HIV and Aids. The role of the church and traditional leadership in changing these attitudes is critical.

“The leadership and engagement of communities is necessary for a successful HIV response. Community involvement and solidarity have been paramount in providing people affected by HIV with information, services, social protection and hope. There is need for this kind of solidarity by all stakeholders to defeat HIV,” Rusike pointed out.

Youth engagement

Youth engagement should also continue if the country is to fully achieve its 90-90-90 goals.

With improved access to treatment, children, adolescents and young women living with HIV can aspire to full and healthy lives. Youth friendly facilities or corners in various health facilities dotted around the country also play a safe space for youths as they actively address the sexual and reproductive health (SRH) needs of young people

“Adolescent girls and young women continue to face unacceptably high risks of HIV infection in high-burden countries. Data from UNAIDS shows that, every week, globally, around 5 500 young women aged 15–24 years become infected with HIV.

During the Covid-19 pandemic, this has been exacerbated by lock downs and prolonged periods being out of school, which has led to early marriage, female genital mutilation, gender based violence and reduced enrolment of girls in school increasing their vulnerability,” Rusike explained.

As we celebrate the country’s achievements, it is also important to continue testing for HIV and also for communities to understand that an HIV negative status is not permanent hence the need to adhere to preventative measures.

Feedback: roselyne.sachiti@zimpapers.co.zw roselyne.sachiti33@gmail.com

 

HERALD