Hands up for HIV prevention

With renewed focus on preventing HIV infection, the world observes World AIDS Day today under the theme ‘Hands up for #HIV prevention,’ which speaks to the very real need to continue and expand on HIV prevention education, especially among young people, the vulnerable and those at risk.

While several advances have been made in the treatment of this disease in the approximately 35 years that the world has been fully aware of it, the best approach is the old adage: ‘prevention is better than cure’. The advances made to date include neither a cure nor a vaccine—though there have been encouraging signs in these directions—therefore halting the spread of the infection can only be accomplished if everyone establishes what his or her status is, by getting tested and then protects him/herself by employing tried and tested prevention methods. As simple as it seems, achieving this has proven to be extremely difficult for various reasons, hence the spread of HIV.

According to recent statistics published by the World Health Organisation, since the beginning of the epidemic, more than 70 million people have been infected with HIV and about 35 million people have died. Globally, 36.7 million people were living with HIV at the end of 2015. An estimated 0.8% of adults aged 15 to 49 years (the most productive years) worldwide are living with HIV. WHO also estimates that only 54% of people with HIV know their status and in the last year, 1.1 million people have died from AIDS-related illnesses.

Meanwhile according to UNAIDS, of the 36.7 million people living with HIV, 1.8 million are children under the age of 15, most of whom were infected during pregnancy, birth or breastfeeding by their HIV-positive mothers.

It is universal knowledge that sub-Saharan Africa is the region most affected and that the majority of people living with HIV are in middle and low-income countries, which brings us to Guyana.

Guyana is a low income country and while there have been some strides made over the last ten to fifteen years as regards testing, care and treatment, these are being overtaken by the number of new infections being seen. According to figures quoted by Minister of Public Health Dr George Norton in May this year, there are approximately 500 new infections reported every year and 200 deaths from AIDS-related illnesses. While the minister was upbeat about Guyana being on track to eliminate mother-to-child transmission of HIV, the new infection rate should be cause for concern. Women and girls are among those vulnerable to contracting HIV, owing to the high prevalence of domestic violence and rapes. The renewed focus on prevention therefore must be holistic and incorporate strategies that address gender-based violence and offer protection to vulnerable groups.

Meanwhile, despite programmes and policies put in place, stigma and discrimination remain key drivers of both the spread of HIV and the inability to access treatment by those infected. According to WHO, globally more than 18 million people with HIV are using antiretroviral therapy. However, the organisation also estimates that a similar number is unable to access treatment; many of them are among the high-risk and vulnerable population, which includes men who have sex with men, sex workers and transgender people.

The Sustainable Development Goals, which have replaced the Millennium Development Goals, call on countries to commit to ending the AIDS epidemic by 2030. For this to be achieved, the stamping out of stigma and discrimination must remain on the front burner along with prevention. In support of the 2030 HIV elimination goal, the WHO last year issued new treatment guidelines for HIV, which would see people who test positive being placed on treatment immediately as is the case with every other disease. Previously, treatment only began when HIV-positive people became ill or if further tests revealed a high viral load. The new test and treat strategy captures people who may not have returned to clinics after testing positive.

A huge recent advancement is the at home test kit which allows people to use oral fluid or blood from finger pricks to discover their status in a private setting. Those who test positive can then visit hospitals/clinics for confirmatory tests, counselling and treatment. The Ministry of Public Health should add making these kits widely available in Guyana to its current HIV testing strategies.

Stepping up prevention will come at a cost, particularly with donor funding for the HIV fight being scaled back, but not doing so will be even more expensive in the long run. There was no specific reference to HIV prevention in the 2017 budget presentation, but one hopes that the estimates for public health cater for giving a hand up to preventing HIV.

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