adminCatherine Murombedzi
In Zimbabwe no family has not been touched by the AIDS scourge. For some it has been heavy as breadwinners were wiped out in the 90s and 2000.
The pandemic spread with so much weeping as families buried loved ones yearly. In some cases it was a monthly occasion that locally people had to heed the call to behaviour change.
The then Minister of Health and Child Welfare, Dr Timothy Stamps, was on record around 1998 that he could stand seeing a used condom on the road rather than a fag from a cigarette stub.
He took the condom message to every event he attended. Since the main vector of HIV was heterosexual, behaviour change was called for and the message urged sticking to one faithful uninfected partner. Condom use was promoted as it was seen to be an effective method in halting transmission.
Three decades after the pandemic first reared its ugly head globally and 28 years locally, the world has moved in leaps and bound in trying to find a cure.
Today anti-retroviral medicines are available in brand and generic form. The coming in of the generic medicine has seen the price fall a hundred fold. Indian pharmaceutical firms, dubbed the Third World pharmacies, have made most medication available at a cost reachable to many.
Brand ARVs which cost an arm and leg (US$300) as the millennium began now cost US$10 for a month’s supply.
Much of the progress to date is due to widespread use of anti-retrovirals for both treatment and prevention. ARVs prevent the virus from replicating, staving off illness and making people less infectious and less likely to spread the disease.
This has seen AIDS-related deaths go down globally to 1,5 million from 2,4 million a decade ago. There were 2,1 new HIV infections, down from a peak of 3,4 million.
The number of people living with HIV has been stable at 35 million.
On the home arena AIDS-related deaths have come down to 59 000 annually from 80 000. New HIV infections have come down to 14,2 percent, up from 26 percent a decade ago. UNAids reported that it is estimated that 1,3 to 1,4 million people are living with HIV in Zimbabwe.
The Minister of Health and Child Care, Dr David Parirenyatwa, has emphasised the importance of prevention and has weighted in with the three-prong approach.
Speaking in Harare recently he said that prevention remained the cornerstone of halting new HIV infections.
“The first most important aspect is to prevent the spread of HIV. The second most important aspect becomes prevention and the last but not least still remains prevention,” said Dr Parirenyatwa.
The use of condoms increased by 22 percent in the past two decades owing largely to behaviour change, says Population Services International.
Dr Parirenyatwa appealed to retailers to assist Government’s efforts to end HIV by displaying condoms at till points where they are easily noticeable. Dr Parirenyatwa said married couples were shunning condoms hence the low usage in marriage.
“There are cultural norms that create barriers to communication on sex and negotiating safe sex, in particular within marriage and long-term relationships,” he said.
There is a recognition too that drugs alone, for prevention and treatment, will not be enough.
With condoms playing their part science is accelerating research as they battle to find a vaccine which will write the final chapter of the AIDS pandemic.
The 90-90-90 plan, unveiled by UNAIDS, aims to end the spread of HIV by 2020, and eliminate the disease altogether by 2030.
This practically means 90 percent of the infected are tested and diagnosed. Presently testing stands at 55 percent.
After testing at least 90 percent of those diagnosed with HIV must access ARVs.
Today that number stands at 37 percent.
The gold standard of testing those on ARVs is viral load testing.
The third 90 prong aims to have 90 percent of people on ART attain undetectable level of the HIV virus in their bodies. In Zimbabwe less that 20 percent of people living with HIV have had viral loads done.
Michel Sidibé, the director of UNAIDS, said the 90-90-90 goal is obviously ambitious but history shows that clear targets are the best way to progress.
“90-90-90 is not just a numeric target, it’s a moral and economic imperative. It will drive the HIV-AIDS epidemic into history,” he said.
Globally about US$19 billion a year is being spent on tackling the HIV-AIDS pandemic, with much of the money coming from Western donor countries. To implement the 90-90-90 plan, that would have to jump to US$24 billion next year, and then upwards as millions more get on treatment and have their viral loads monitored. But supporters argue that spending more money upfront will actually lead to lower costs in the long run.
“Without a vaccine we will not be able to end the epidemic,” said Dr Wayne Koff, chief scientific officer of the International AIDS Vaccine Initiative speaking in Melbourne at the Aids Conference.
“Despite all our efforts, we still have a couple of million new infections a year, so we need an effective vaccine. Developing a vaccine is proving more difficult than scientists ever imagined, but there is steady progress.”
Globally we have walked 34 years into the epidemic, AIDS is far from over. We can’t talk about elimination or eradication, not with 35 million people living with HIV and no vaccine.
Stigma discourages people from being tested and treated, and dysfunctional health. Access to medication as in the case of remote areas in Zimbabwe is not medical but geographical.
“The impediments that exist are not medical; they’re social and political,” said Mr Stanley Takaona, a member of the community monitoring team that visits all health centres nationally to assess needs and medication stocks.
Special attention also needs to be paid to the few countries that are still driving the epidemic. Fifteen countries, chief among them South Africa, Nigeria, Uganda and India, account for 75 percent of new cases.
The road to 90-90-90 in 2020, and to eventual elimination of AIDS, in either 2030 or beyond, starts with getting to a point where there are fewer new cases than deaths, meaning the overall threat is dropping.
That milestone is close but calls for less or even no new HIV infections. Vaccine finding is needed like yesterday but for now it’s behaviour change, condom use and being faithful.
Online Reporter