By Gift Briton
Experts have cautioned that despite significant progress in combating HIV, especially in Africa where the disease burden is high, the absence of strong political commitment poses a threat to sustaining advancements in the HIV response.
Addressing journalists at a forum during the International Workshop on Adolescence, Sexual Reproductive Health Rights, and HIV 2024 in Nairobi, Kenya, Chip Lyons, the President of Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) highlighted the potential reversal of progress if countries fail to take ownership of their HIV response without relying solely on external donors.
“We have the best tools, treatment, prevention and testing for HIV. What we do not have right now is the political seriousness to end the epidemic. PEPFAR has played a huge role in the HIV response but that is not going to last forever. What happens when PEPFAR goes away?” Lyons posed.
He warns that the looming withdrawal of funding from donors underscores the need for African governments to mobilize domestic resources for sustainable HIV response programs to maintain the level of progress that has been made over the years.
“HIV neither has a cure nor vaccine which means, if we stop paying attention to it, if we no longer make it a priority because we have control of it, what we thought was contained is coming back,” Lyons warned.
In addition to mobilizing domestic funding, Dr. Agnes Mahomva, Public Health Advisor to the President and Cabinet of Zimbabwe, called on African governments to forge a way to collaborate, talk to each other and share best practices.
“Donors are starting to withdraw the funding they give to Africa. We need to start mobilizing funds domestically for HIV response programs so that we do not depend on donors. If our partners and donors withdraw, we will be in serious trouble. The African Union had already outlined that countries must set aside 15% of their budget to go to health,” she advised.
Disparities in HIV Response
While some African countries have met the World Health Organization (WHO)’s 95-95-95 for ensuring that 95% of people living with HIV know their HIV status, 95% of people who know their status are receiving HIV treatment, and 95% of people on treatment are virally suppressed, the disparity in progress for children and adolescents remains a significant concern.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) report highlighting disparities between children and adults in terms of treatment and progress in the HIV response, underscores the need to prioritize children in the HIV response to ensure they are not left behind.
Sonia Ndimbiri, Lead of Africa Reach, emphasized the importance of focusing on children to achieve the goal of ending AIDS by 2030.
“Although there has been progress made over the years, much of the success has been in the adult population and children are being left behind. Ending AIDS in children is one of the low-hanging fruits within the bigger HIV response. So, as we work towards 2030 goals, we have to ensure that children are not being left behind,” Ndimbiri told journalists. Africa Reach is an Africa-led initiative, formed in 20222, that focuses on ending AIDS in children through advocacy.
She outlined Africa Reach’s four key pillars that can be explored to end AIDS in children. First, domestic financing: Countries are urged to make sure that they not only meet the commitments made in the Abuja declaration of 2001 but go over and above and ensure that they sustain the financing for HIV response programs.
The second pillar is access to information prevention and sexual education. Ndimbiri notes that there is a lot of important information on HIV prevention that is not being shared with the right population at the right time.
“Access to information on prevention is one of the key prevention tools that are not being shared,” Ndimbiri noted.
Thirdly, there is a need to put more emphasis on community health workers. According to Ndimbiri, community health workers are at the heart of sharing this information and ensuring communities’ access to treatment, and information. Therefore, they too need to be funded better if HIV elimination goals are to be achieved.
The fourth pillar is access to optimal paediatric and child-friendly treatment. According to the United Nations International Children’s Emergency Fund (UNICEF) estimates, one in five pregnant women living with HIV was not receiving antiretrovirals to prevent the vertical transmission of HIV to their newborns.
Africa Reach recommends the need to introduce paediatric fixed-dose combination dispersible(paDL) and paediatric dolutegravir(pDTG) to support simplifying treatment and improve outcomes for children living with HIV.
