Online Reporter
THE approval and planned rollout next year of Lenacapavir, an injectable prophylactic that can prevent transmission of HIV to the protected person, fills an important gap in Zimbabwe’s programme to eliminate all HIV transmission, but should not replace the already effective prolonged use of antiretroviral medication.
The gap in the eradication programme is significant.
Zimbabwe has now reached the 95-95-95 targets, with this use of ARVs, in some cases bettering them noticeably.
This means that at least 95 percent of those who are infected with HIV know their status, more than 95 percent of these are on ARVs so can live a normal life for many years; of this group 95 percent have been on ARVs long enough to have suppressed the virus and are no longer infectious, although must continue taking the medication for the rest of their life to maintain that position.
This takes care of the large majority of those living with HIV.
The double benefit of continued use of ARVS is not only that the person lives a normal life but that they become non-infectious so that those they no longer pass on the virus, thus protecting their partners.
A lot of effort has been made to push these percentages even higher, on the basis when every infected person has a suppressed viral load, there simply will be no further transmission of the virus, and we can just wait out the rest of the century until those still on medication die of old age.
However, those magnificent percentages hide a degree of human suffering and human arrogance. The 95-95-95 means that around 14 percent of those with HIV do not have a suppressed viral load. Because we are doing better than 95 percent in some categories, especially people living with HIV taking medication, we are probably doing better than having 14 percent of those infected still infectious. But even 10 percent would be a danger.
Some of these infectious people are those who have not had a test, or do want a test. Some are people who do not want to take medication, or for various reasons cannot access medication despite the major effort by the Second Republic to bring everyone into the programme. And we have people who simply do not care if they are infectious and have little regard for their partners.
So there are a number of people who are partners of people who are potentially infectious and not desperately responsible about how they behave. We all know about such potential sources of infection. For example, there is the continued prevalence of young women pushed into marriage with dubious older men, even if we are making inroads in stopping this for under 18s, puts significant numbers at risk. There will be many others who go through life without taking adequate precautions or acting responsibly, along with those who simply find it difficult to enter the standard programmes.
This is the gap the injectable prophylactic can fill, protecting people who for a host of reasons have an infectious partner who either does not care that they have yet to reach the viral suppression stage, or who are generally unwilling to take tests and start medication.
The injection is not lifelong. The person needs to have repeats every six months, so in some ways it is more of a medium term programme that can fill the gap while we continue to bring in the modest minority of those infected but not yet non-infectious into the main programme.
More importantly it stops a continued source of infection. Those on the injections are likely to be responsible people, since they have taken the trouble to seek medical treatment and care and are, therefore, likely to undergo testing when advised. But if they are not infected within their own personal experience, then eventually those whom they partner will either go through the testing and medication route or eventually die off. Either way they will cease being the problem of continuing infection.
We stress, and it will be necessary for the medical authorities to stress, that going the ARV route has that essential double benefit, keeping the person living with HIV alive until other illnesses of old age chip in, while also keeping them non-infectious.
This allows them to have a double normal life for very little more trouble than taking a tablet every day and making sure they renew supplies as needed.
So we must continue that ARV-centred approach that has served us so well and will continue to bear the brunt of our successful battle against HIV until it is eliminated.
HIV infection is defined as a chronic illness, the same as hypertension or diabetes or heart complaints. Everyone with such an illness in the 21st century is no longer condemned to an early death since there are simple, cheap and effective treatments that will keep them alive, and not just alive, but able to live a normal life rather than being bedridden. Many, like HIV, require a daily tablet but this hardly messes up anyone’s life.
The Lenacapavir injection by its very nature is there to protect those who have little or no other protection against HIV infection, and it will play an important part in helping us eliminate at least the effects of that 14 percent who are infected but are not with suppressed viral loads from a daily dose of ARVs. This is the gap we need to fill.
