HIV Treatment

This story was first published by News24.com

Eswatini is one of the countries which has been most affected by HIV. At the peak of the epidemic in 2015, almost one out of three people were living with HIV. In 1995, when there was no antiretroviral treatment for people living with HIV, 73 000 people were living with HIV. 2400 people died of AIDS that year. Worried about the rising number of infections and deaths, communities of people living with HIV mobilized to press that antiretroviral treatment be made available for people living with HIV.

One of the key campaigners for access was Hannie Dlamini. Dlamini is now 50 years old and has been living with HIV for 32 years, after finding out about his HIV positive status at the age of 18. He was one of the first people in Eswatini to publicly declare his positive HIV status in 1995 at a time when the stigma and misinformation around HIV was rife.

Dlamini rallied together other people living with HIV as well as non-governmental organizations working to end AIDS in Eswatini, to ensure that everyone living with HIV and in need of treatment had access to it. They formed a community-led organization called Swaziland AIDS Support Organization (SASO) as a support group for people living with HIV. SASO also provided healthy living information for people living with HIV.

“When we asked the government [in 2002] for ARVs in Eswatini we did a pilot project with NECHA [National Emergency Response Council on HIV/AIDS], to see if people would use the drugs.” Dlamini says the response was overwhelming, with many people keen to start the lifesaving treatment. “We initially planned to enrol 200 people on treatment but the demand was 630.” said Dlamini.

Today, Eswatini is one of the countries which has achieved the ambitious 95-95-95 targets (95% of people living with HIV who know their HIV status, 95% of people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed). This achievement has put the country a step closer to ending AIDS as a public health threat, thanks to the work of community-led organizations, authorities and global partners like UNAIDS, the United States President's Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, TB and Malaria who are working with the government and local communities to end AIDS.

Eswatini’s HIV response strategy includes ongoing nationwide testing and treatment campaigns, use of self-testing kits to encourage more people to take up testing at the comfort of their homes, antiretroviral treatment, male circumcision and pre-exposure prophylaxis (medicine to prevent HIV) and other prevention measures. Community organizations such as Kwakha Indvodza are also key in encouraging men to take full responsibility for their wellbeing and reducing toxic masculinity and gender-based violence which are some of the drivers of HIV.

The driving role of communities in Eswatini to end AIDS is acknowledged by the health authorities. According to Dr. Michel Morisho, HIV management specialist at Mbabane Government Hospital, the government “could not have achieved the 95-95-95 without communities.”

Dr. Morisho says as part of the country’s strategy to end AIDS, HIV testing and treatment are part of disease management for every patient who presents at health facilities for any illness. “When people come to the hospital for whatever, or check up, we offer an HIV test to allow them to know their HIV status,” he said. Dr. Morisho added that treatment is important to bring down viral load and is helping people living with HIV to stay healthy. Eswatini is striving to achieve 100-100-100 [in the number of people who know their HIV status, are on treatment and are virally suppressed].” People who are virally suppressed cannot transmit HIV, thus helping in HIV prevention efforts.

Young women living with HIV have also stepped up to fight the spread of HIV in the country, volunteering their time as peer educators to educate young people about HIV and supporting people newly infected to stay on treatment to live healthily and long lives. Ntsiki Shabangu is a 28-year-old young woman living with HIV. She was diagnosed with HIV in 2015, at the age of 19. She opened up about her status in 2017 and is now working with the Eswatini Network of Young Positives, a local non-governmental organisation working to end AIDS among young people providing counselling and HIV awareness training . Ntsiki believes that: “When you share your story, you bring hope to young people.”

While Eswatini is on the path to end AIDS, the country is facing other health burdens associated with aging, including non-communicable diseases such as diabetes and cancer. People living with HIV are not often more affected by these illnesses. Some people living with HIV in Eswatini have developed these comorbidities, which presents the need for the strengthening of the healthcare system to provide easily accessible holistic disease management and treatment along with HIV services to improve the quality of life for people living with HIV. As Thembi Nkambule, a woman who has been on HIV treatment for more than 20 years said: “Most of us are sick. Most of us are presenting with kidney issues. We are presenting with hypertension; we are presenting with sugar diabetes. We have a lot of issues.”

To protect the gains that have been made against HIV in Eswatini, the government should invest more resources in building a resilient healthcare infrastructure to strengthen the system to better meet the health needs of people living with HIV and to prepare for future pandemics. Community-led organisations should also be placed at the centre of HIV response and supported, both financially and politically, to reach more people who need HIV services to end the epidemic by 2030 as a public health threat.

13 March 2024—A new report, HIV Prevention: From Crisis to Opportunity shows that HIV infections continue to decline in countries that are part of the Global HIV Prevention Coalition (GPC) faster than in the rest of the world.

Eleven GPC focus countries have reduced their annual number of new HIV infections by at least 66% since 2010. By comparison, the average reduction in new HIV infections since 2010 globally is 38%. The GPC is a coalition of 38 countries working together to accelerate declines in new HIV infections to achieve the target of having 95% of the people who are at risk of HIV accessing effective combination prevention options.

The GPC countries that have prioritised primary prevention and treatment and that have focused on reaching people most at risk have secured the strongest consistent declines in new HIV infections.

Globally, progress in HIV prevention has been highly uneven and a majority of the world’s countries are not currently on track to achieve the 2025 targets. Indeed, several countries are experiencing prevention crises with low access to services and face record rising new HIV infections.

“The findings of this report offer crucial lessons for action,” said Angeli Achrekar, Deputy Executive Director Programme, UNAIDS. “The report shows that sustained political leadership, investment in effective HIV prevention programmes, and an enabling policy environment are crucial to end AIDS as a public health threat by 2030.”

Declines in new HIV infections have been boosted by the cumulative impact of combination HIV prevention options and increased access to antiretroviral treatment which has also increased viral suppression in people living with HIV. People who are on treatment and are virally supressed cannot transmit HIV.

“It’s remarkable to see what has been achieved in the AIDS response in the past 20 years. But the progress to date has not been equitable and is not yet sustainable, and we must never confuse progress with being sure of success,” said Mitchell Warren, GPC co-chair and Executive Director, AVAC. “Our progress is fragile, and what we’ve achieved today could slip away even more quickly than it was achieved if we let complacency take hold.”

Key populations and adolescent girls and young women are still at high risk of new infections

HIV incidence remains unacceptably high among populations where gaps in HIV prevention investments persist. This includes key populations in all regions globally and adolescent girls and young women in parts of sub-Saharan Africa.

Around 3100 young women and girls aged 15-24 became newly infected with HIV every week in sub-Saharan Africa in 2022 and HIV incidence declined less rapidly than it has among young men. Only 43% of the sub-national areas in which there is elevated HIV incidence among young women are being reached with dedicated prevention programmes for young women.

Although GPC countries have shown solid gains in reducing new HIV infections, challenges remain worldwide in reaching key populations most at risk of new HIV infections including men who have sex with men, sex workers and people who inject drugs. Every week, more than 11 000 new HIV infections occur among key populations and their sexual partners globally.

Only 44% of sex workers, 28% of gay men and other men who have sex with men, and 37% of people who inject drugs accessed two or more HIV prevention services in the previous three months according to median values reported by GPC countries ––against a target of 90%.

HIV prevention is being obstructed by shortfalls in prevention financing, and by punitive laws. Social stigma, violence, discrimination and social exclusion are barriers to key populations’ access to health-care services and information, exacerbating their risk of acquiring HIV. Law reform is a crucial enabler of prevention programmes. Protecting the human rights of everyone is vital for protecting the health of everyone.

Investments in both condom and voluntary medical male circumcision programmes, which are both effective in preventing HIV, have fallen in some of the countries with the largest HIV epidemics. In addition, breakthrough HIV prevention options such as pre-exposure prophylaxis (PrEP), medicine to prevent HIV, are still only available to a small fraction of the people who need them.

There are unprecedented opportunities for HIV prevention in 2024. There is a growing array of prevention options including existing tools and new long-acting prevention technologies, as well as country examples of how to implement prevention at scale and increase choices available to communities.

HIV Prevention programmes need to be at scale, efficient and equitable. The actions that are needed for success and sustainability are known, have been shown to work, and have been agreed: collaborate, follow science, tackle inequalities, protect everyone’s rights, let communities lead, and invest in what is needed. Sliding back on resourcing or inclusion would hurt everyone. Solidarity will benefit everyone. Communities, countries and international partners can prevent new infections – together.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Two years of war in Ukraine have resulted in significant humanitarian consequences. Forty percent of the current population of Ukraine,14.6 million people, are in need of humanitarian assistance, 6.4 million refugees have fled the country, and more than 3 million people are internally displaced. People living with and affected by HIV continue to be vulnerable to the effects of the war, even as HIV services have been restored and are functional in most parts of the country.

Russian strikes have continued to wreak havoc on Ukrainian cities, causing death and destruction, impacting access to water, electricity, heating, and health services for millions of civilians.

In addition, there have been 1,570 attacks on health facilities and 630 health facilities damaged.

According to the latest data from The Ukrainian Public Health Center, prior to the war, Ukraine had made significant progress in reducing HIV incidence (-47%) and AIDS-related mortality (-81%) since 2010. Despite the initial disruption to the national AIDS response at the onset of the war, the national AIDS program has gradually resumed routine operations.

As of the end of 2023, the number of patients on antiretroviral therapy (ART) was only slightly below the pre-war figure, standing at 118,348 (130,724 as of February 2022). Additionally, approximately seven thousand patients are known to receive ART abroad. In the last two years, the number of patients on opioid agonist therapy (OAT) increased by 38%, reaching 27,511 people. Pre-exposure prophylaxis (PrEP) more than doubled, reaching 12,354 people.

However, in eastern and southern occupied territories data is incomplete or not available. This is true of Donetsk, Luhansk, Zaporizhzhia, Kherson regions, AR Crimea, and the city of Sevastopol. The same occurred in 2023.  Despite these challenges, the surveillance system in the government-controlled areas remains operational, ensuring the completeness and quality of data on HIV prevention, testing and treatment services.

In addition, 9.6 million people in Ukraine are estimated to be at risk of or living with a mental health condition, and 3.9 million people are estimated to suffer from moderate to severe symptoms. And there has been an increase in gender-based violence.

Ukraine remains committed to the HIV response through a strong coalition of government, civil society, international organizations, and donors, first and foremost The United States President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. This collaboration has secured vital supplies of antiretroviral therapy (ARV), tuberculosis medicines, and opioid agonist therapy (OAT), ensuring uninterrupted HIV treatment and services.

UNAIDS Secretariat, Co-sponsors and UN agencies have joined forces to provide a unified response, ensuring that vulnerable populations, including those on the frontline and in the most severely affected areas, receive comprehensive support. This collaborative effort aims to bridge gaps and address the unique challenges faced by women, people living with HIV and key populations, including the delivery of crucial humanitarian aid and HIV services.

The past two years have been very challenging. Even though the country has managed to maintain HIV services, the unpredictability of what lies ahead has many fearing the worst. Support is needed to ensure sustainability of the AIDS response and to protect key populations affected by the enduring hardships of war.

For more information and more in-depth analysis, read the Situation Report (February 2024)

GENEVA/HARARE, 4 December 2023— The world can end AIDS as a public health threat if communities on the frontlines of the HIV response are fully engaged and supported to do their work. This was the important message UNAIDS brought today to the opening of the 22nd International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), which is being held in Harare, Zimbabwe from 4-9 December.

Under the theme AIDS IS NOT OVER – participants will be calling for inequalities to be addressed and innovation to be accelerated to end AIDS. They will be urging for more support to community-led responses to deliver essential HIV services to people on the margins of society who are often hard to reach.

“AIDS is not over, and it continues to disproportionally affect the most marginalized in poor countries in Africa where some of the highest HIV burdens are found,” said Winnie Byanyima, Executive Director of UNAIDS. “We have an amazing opportunity to end the AIDS epidemic by 2030 by supporting community led organizations to lead the way, and by tackling the drivers of HIV, such as inequalities and harmful laws,” added Ms Byanyima.

Around 66% of the 39 million people living with HIV live in Africa and some 51% of new HIV infections occurred on the continent, as did 61% of AIDS-related deaths.

Communities on the frontlines

Communities from South Africa to Thailand to Brazil waged the battles in the 1990’s and in the 2000’s to break pharmaceutical monopolies on access to HIV treatment. Their campaigning brought the price of these life-saving medicines down from US$ 25 000 per person per year in 1995 to as low as US$ 70 per person per year in many of the countries most affected by HIV.

Communities have been fighting to overturn laws that criminalize people most at risk of HIV. Several countries in Africa including Botswana, Angola, Gabon and just this year, Mauritius have overturned these harmful laws.

“Giving LGBTQI people the freedom to come forward and access the services they need to save their lives – this is community action,” said Ms Byanyima. “Communities have taken services right to the last person in the corners of the villages – they know who needs to be reached and they reach them.”

AIDS still claiming lives unnecessarily

While there is a clear path that ends AIDS, including through collaboration between governments and communities, AIDS claimed a life every minute in 2022. Globally 9.2 million people living with HIV do not have access to HIV treatment, just over half are in Africa where AIDS remains the fourth-leading cause of death. 

Women and girls are still disproportionally affected. In sub-Saharan Africa, 3100 young women and girls became infected with HIV every week in 2022. Across Africa 85% of new infections among adolescents (aged 10-19) are among adolescent girls and 15% among adolescent boys. For young people (aged 15-24) some 77% of new infections are among young women and 23% among young men. 

However, there is hope. There has been a decline in the number of people who were infected with HIV in 2022, showing that the end of AIDS is possible. The number of new infections represented the fewest people who acquired HIV in 2022 than at any point since the late 1980s. The biggest declines in annual new HIV infections in that period have been in eastern and southern Africa (57% reduction) and western and central Africa (49% reduction) since 2010 for both regions. 

In sub-Saharan Africa, Botswana, Eswatini, Rwanda and Zimbabwe, are on the path that ends AIDS. In these countries, 95% of the people who are living with HIV know their HIV status, 95% of the people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed. When a person’s viral load is suppressed, HIV cannot be transmitted. A further 16 other countries are close to meeting these targets. 

Embrace science and innovation 

Communities drive innovation in the response to HIV. The innovation, passion and insight of communities are crucial to end AIDS. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. 

Botswana’s success in reducing vertical transmission of HIV stems from its high coverage of HIV testing and treatment among women overall. Women living with HIV start antiretroviral therapy well before becoming pregnant, resulting in achieving and sustaining viral load suppression. That’s following the science.  

Ensure political support, sufficient sustainable funding for communities and innovation to end AIDS 

Despite existing and clear evidence that community-led responses have a positive impact, communities are not yet getting the recognition and the political and financial support they need, instead, communities are under-recognized and under-resourced and, in some places, even under attack.  

Underfunding of community-led initiatives is holding them back from operating and expansion. If these obstacles are removed, community-led organizations can add even greater impetus to the global HIV response, advancing progress towards the end of AIDS.  

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to key populations. However, whereas in 2012, over 31% of all HIV resources were channelled through civil society organizations, in 2021, only 20% of funding for HIV was allocated for civil society—an unprecedented backsliding in commitments which is costing lives.   

“When community-led organizations are supported politically and financially to accelerate their life-saving work, the end result can be an end to AIDS as a public health threat,” said Ms Byanyima. “An AIDS-free world is possible, but only if communities lead.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Since the beginning of the war in Ukraine, communities of people living with and affected by HIV have been at the forefront of ensuring the continuity of life-saving HIV services, both for those who remained in Ukraine and for those arriving in Germany as refugees.

At a special World AIDS Day event in Berlin co-hosted by UNAIDS and 100% Life Ukraine, community representatives and civil society activists thanked the German government and UNAIDS for their support and spoke about the continued challenges they face.

“Our journey exemplifies how the strength of perceived minorities and real community leadership can drive life-saving programmes and innovations that can impact the lives of millions of people,” said Valeriia Rachinska, Director of Human Rights, Gender and Communities at 100% LIFE Ukraine. “None of this would be possible without the support of international partners and donors. Global solidarity and support from our partners are the chance for a fair and thriving tomorrow for all, especially those living with HIV.”

100% LIFE is the largest patient-led organization in Ukraine which has as its mission to fight for life. The Network works with patients and for patients, including the representation of the interests of people living with HIV in 25 regions of Ukraine.

Since the beginning of the war in Ukraine, Germany has donated €1,050,000 in emergency funding to UNAIDS, empowering the provision of critical support to people living with and affected by HIV in Ukraine, Poland and Moldova. This includes providing temporary accommodation, humanitarian assistance, social protection, primary health care and testing for HIV, hepatitis C, STIs and tuberculosis. The emergency fund also covered the enrollment of people in HIV prevention and treatment programmes, offering comprehensive care and support.

Among the speakers at the World AIDS Day event was Silke Klumb, CEO of the German AIDS Federation, who underlined the importance of the partnership between government and civil society in ensuring continued access to HIV prevention, treatment and care services for people affected by the war in Ukraine.

"Community-led responses have been and continue to be critical in the HIV response, both in Germany and globally. Thanks to public funding Deutsche Aidshilfe has been able to engage in community-led prevention, counselling, testing, care, and support for 40 years now. Upon this foundation and through the broad network in Ukraine, Eastern Europe and Central Asia, Germany’s community-led organizations under the umbrella of Deutsche Aidshilfe were able to act immediately to Russia’s full-scale invasion of Ukraine,” said Ms Klumb. ”Over the last 18 months, we provided support, information, translations to people fleeing the war and linked them to care. Platforms such as self-help conferences and other meetings helped to strengthen the communities of people living with and affected by HIV. Deutsche Aidshilfe is committed to continue putting the communities at the centre of our work.” 

During the event, UNAIDS Deputy Executive Director of Policy, Advocacy and Knowledge, Christine Stegling, presented the new UNAIDS World AIDS Day report Let Communities Lead. The report shows how communities have been the driving force for progress in the global fight against HIV.  It shows that investing in community-led HIV programmes can have transformational benefits.

“Since the earliest days of the AIDS pandemic, community leadership has driven life-saving access to HIV treatment and prevention. Continued progress against HIV/AIDS in Ukraine - despite the war and its resulting refugee crisis - is the direct result of Ukrainian and German community leadership. A community-led response is well-positioned to maintain continuity of HIV prevention and treatment services, especially in times of crisis,” said Ms Stegling. “Continuity of HIV care is essential for achieving our ultimate goal of ending AIDS as a public health threat by 2030. UNAIDS thanks all community leaders who stepped up in these challenging times and we thank nations like Germany who understand the value of investing in a community-led response to HIV/AIDS - especially in times of war and other crises.”

The event was moderated by Peter Wiessner of Action against AIDS Germany.

HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK

LONDON/GENEVA, 29 November 2023—Ahead of World AIDS Day (1 December) UNAIDS welcomes a new research project to potentially expand ‘opt-out’ HIV testing programmes across England. According to NHS figures, a pilot ‘opt-out’ HIV testing scheme, pioneered by the Elton John Foundation in England has identified more than 3,500 cases of three bloodborne infections since April 2022—HIV, Hepatitis B and Hepatitis C—including identifying more than 580 HIV cases of HIV.

Under pilot scheme in England, anyone having a blood test in selected hospital accident and emergency units has also been offered a test for HIV, Hepatitis B and Hepatitis C, and has been given the option to opt out should they not wish to have the test. The trials have been taking place in 33 hospitals in London, Greater Manchester, Sussex and Blackpool.

"HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK," said Winnie Byanyima, Executive Director of UNAIDS. "Normalization of HIV testing will not only enable timely access to HIV treatment, allowing people with HIV to live healthy lives—it will also stop new HIV infections and reduce the stigma around getting an HIV test. It will save and change lives and help ensure that no one is left behind."

People living with HIV who are on effective HIV treatment cannot transmit the virus. In the UNAIDS Global AIDS Strategy, UNAIDS has set “95-95-95” targets. Aiming for 95% of people who are living with HIV to know their HIV status, 95% of people who know that they are living with HIV to be on lifesaving antiretroviral treatment, and 95% of people who are on treatment to be virally suppressed.

At least five countries, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

On 28 November, UNAIDS released its World AIDS Day report in London, UK urging governments to Let Communities Lead across the world to in ending AIDS. The report shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors. The Elton John Foundation is one of the many organizations supporting community action.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.