We can win the war on AIDS
Correspondent | Tuesday December 1, 2015 17:14
Such a future is now possible. Botswana could be among the first countries to control the epidemic. We must collectively seize the opportunity to do so.
December 1 is a chance for people to unite in the fight against HIV, show support for people living with HIV and commemorate people who have died from this terrible disease. While there are far too many AIDS-related deaths and new HIV infections in the world to claim victory, we have much to celebrate during this year’s World AIDS Day.
The latest report from UNAIDS shows tremendous progress against this disease. Though 1.2 million people died from AIDS in 2014, that number was down from 1.3 million the previous year and from a peak of 2 million in 2005. The actual number of new infections has also decreased – to 2 million in 2014 compared with 2.1 million in 2013 and 3.1 million at their peak in 2000. Much of the credit for this goes to anti-retroviral therapy – and countries like Botswana which have provided this life-saving treatment to people who need it. The numbers of people on HIV treatment worldwide have doubled in five years from 7.5 million in 2010 to 15.8 million.
What’s important now is not only maintaining these successes, but also aggressively seeking new prevention and treatment targets that will reduce new infections and bring us closer to the UNAIDS’ 90-90-90 goals. That means 90% of those infected will be aware of their status; 90% of those aware of their status will have sought and received treatment; and, for 90% of those being treated, the drugs will have had the intended effect of suppressing the patient’s viral load. The good news is we know exactly what it’s going to take to meet these lofty goals: We need to focus on the right things, in the right places, and do them right now.
The US President’s Emergency Plan for AIDS Relief (PEPFAR) is my country’s global health initiative to assist countries in responding to the HIV epidemic. Over the last decade, the US government has committed more than $700 million to Botswana in the response to HIV. Together, with the Government of Botswana, civil society and people most affected by the epidemic, we have come a long way. But our work is far from done.
Earlier this year, PEPFAR Botswana launched a new era of evidence-based programming. Investments have shifted and become more focused on the hardest-hit geographic areas and most impactful activities. We are actively working with partners to help Botswana achieve epidemic control by 2018.
So what are the right things? Offering HIV treatment to anyone living with HIV is one of the right things. Moving towards earlier initiation of treatment is strongly supported by a recent international randomised clinical trial, called the START trial, which found HIV-infected individuals on early treatment have considerably lower risk of developing AIDS or other serious illnesses than those who delay initiation.
Treatment also acts as prevention by lowering the risk of transmission to uninfected sexual partners. The World Health Organisation and PEPFAR are encouraging all countries to consider this “Test and Treat” option for all people living with HIV.
Reaching more people with HIV prevention, care and treatment services requires strengthened linkages between health facilities and community service providers.
Communities have an important role to play in the response to HIV, helping to reduce stigma and encouraging community members to get tested and adhere to treatment. PEPFAR is now focused on strengthening this continuum of care model by ensuring that people living with HIV are linked to treatment programmes and other services, such as gender-based violence (GBV) support and social services. To promote adherence to medication and retention in care, individuals should be provided with appropriate and ongoing care and support services at the community levels.
Other right things include ensuring life-long treatment for HIV-positive pregnant women, regardless of their CD-4 count – a programme that helps prevent new infections among children, saves mothers’ lives, reduces the number of orphans and is cost-effective. Scaling-up Safe Male Circumcision, especially in 15-29 year olds, is key to reaching our goals. Finally, addressing TB/HIV co-infections, averting GBV and ensuring quality and accredited laboratories are also necessary.
Where are the right places? PEPFAR has shifted from working in all 24 health districts to focusing on just 11 districts. About 80% of people living with HIV in Botswana reside in those districts, and focusing efforts in those places offers an opportunity to make the biggest impact in the shortest amount of time. The right places also means targeting the right groups of people who stand to benefit the most.
Overcoming the barriers that prevent key populations – including female sex workers and men who have sex with men – from receiving treatment and care is critical to reaching epidemic control in Botswana. Other focus populations for PEPFAR include adolescent girls and young women, and orphans and vulnerable children.
Finally, what do we mean by right now? The theme for this year’s World AIDS Day is “The Time to Act is Now.” This theme conveys the urgency of implementing the UNAIDS fast-track strategy to achieve its 90-90-90 targets and end the AIDS epidemic by 2030. The longer we wait, the harder it is going to be to reach epidemic control. For its part, PEPFAR is laser-focused on data-driven decision-making, mutual accountability, transparency, and ensuring our programmes have impact. We know what we need to do to control and, ultimately, end the epidemic, but the work is far from done. The Time to Act Is Now.
Ambassador Earl R. Miller*