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HIV/AIDS Prevention in Zambia

Antiretroviral therapy in Zambia has been one of the most effective HIV/AIDS prevention strategies in recent years. Thanks to the efforts of the CDC and the Zambian government, the spread of HIV/AIDS has decreased steadily by 13 percent since 2010.

HIV/AIDS Prevention in Zambia – Strategies

  • Education and Awareness: The effective response and resource allocation from the Zambian government through early HIV testing had a profound effect on the stigma surrounding the virus, encouraging more people to get tested. To that end, the government implemented the GIPA policy, emphasizing equality in medicine free from discrimination. In addition, the National Health Services Act is a government policy aimed at strengthening the structural power of Zambia’s medical field to increase its influence on rural communities. Aside from spearheading research, the act more clearly defines Zambia’s medical infrastructure with a power structure to allocate resources as effectively as possible. Integrating these government programs into the heart of Zambia’s most impoverished communities decreases the chances of an outbreak.
  • Antiretroviral Therapy: As mentioned above, the CDC is also active in Zambia, focusing on early antiretroviral therapy in highly affected areas like the Copperbelt and the western provinces. Within these parameters, 89 percent of those who began treatment immediately are less likely to spread the virus. Outreach programs to reach the more impoverished and marginalized groups have also been successful, with antiretroviral therapy increasing among children from 23 percent in 2009 to 79 percent as of 2019. The government has also promoted the use of Pre-Exposure Prophylaxis (PrEP), a daily course of antiretroviral drugs (ARVs) taken by HIV-negative people which reduces the risk of contracting the virus.
  • Preventing Mother-to-Child Transmission: Through the PMTCT (Prevention of Mother To Child Transmission) plan, Zambia has made great strides aimed at preventing the spread of the virus from mother to offspring by providing lifelong antiretroviral therapy in Zambia. According to the CDC, through early education and effective policy implementation, the health protection agency has prevented 98 percent of HIV-exposed babies from contracting the virus.

Final Thoughts

The lack of access to basic health care and a comprehensive understanding of how HIV spreads, especially in rural communities, produces a hostile environment where exposure risk increases. Furthermore, high poverty and unemployment levels create a shaky foundation where socio-economic growth is key to eliminating the HIV/AIDS epidemic in Zambia. However, increased government spending has sprouted new testing facilities in rural areas, providing quality service where “…the Government is scaling up social protection by increasing allocations to the Social Cash Transfer (SCT) and Food Security Pack (FSP) program[s] and other poverty mitigation measures.”

The key to a structural change in Zambia’s HIV epidemic lies partially in assisting Zambia’s fairly large impoverished community. In addition, antiretroviral therapy in Zambia continues to be a focal point of the government’s long-term plan to eliminate the virus with increased spending on antiretroviral therapy and sex education in a bid to secure more prosperous futures for its citizens.

Adam Townsend
Photo: Pixabay

HIV and AIDS in South Africa

South Africa has the largest number of people living with HIV of any country in the world. South Africa comprises of approximately one-fifth of the 37 million people in the world living with HIV, with an estimated 7.2 million people living with HIV in 2017. This translates to a general population in which an estimated 18.8 percent of South Africans are HIV positive.

And yet, the country is making progress in reducing HIV and AIDS. In recent years, efforts to combat HIV and AIDS in South Africa have been ramped up. According to a study by the Human Sciences Research Council (HSRC), the statutory research agency of South Africa, there were 231,000 new HIV infections in 2017, representing a 44 percent decrease since the last major study in 2012.

Largest Antiretroviral Drug Campaign in the World

South Africa has the largest antiretroviral drug campaign in the world, which its own domestic resources largely fund. In 2015, South Africa was investing more than 1.34 billion (US dollars) towards its efforts to combat HIV and AIDS. And yet, it was not always like this; the South African government regarding and treating HIV and AIDS as a major and important public health issue and one to which it allocates resources to is a fairly recent phenomenon.

The government spearheaded this change, at least in part, by the exit of former South African President, Thabo Mbeki, who headed the government between June 14, 1999, and September 24, 2008. He had a track record of aversion to the combating of HIV as a public health issue and largely turned a blind eye to the issue. ‘“Many people do not remember that in 2000 there were only 90 people in South Africa on treatment,” said Michel Sidibé, executive director of UNAIDS.” When Mbeki left office in 2008, a tide turned and HIV and AIDS became to be regarded in the milieu and in public policy as a major and important public health issue, and now approximately four million people are receiving antiretroviral drug treatment in South Africa.

The 90 90 90 Plan

The 90 90 90 Plan summarizes some of the efforts to combat HIV and AIDS in South Africa. This plan aimed to test 90 percent of people so they would know their HIV status, followed by 90 percent of those diagnosed receiving sustained antiretroviral therapy and 90 percent of those receiving antiretroviral therapy to have viral suppression.

South Africa reached the first of the 90-90-90 targets, with 90 percent of people aware of their status, jumping up from only 66.2 percent in 2014. Of the affected, presently 61 percent of adults (people between ages 15-49) and 58 percent of children are on antiretroviral treatment, and so these current numbers are not at target though they are continuing to trend upwards. Life expectancy has seen a significant increase over the past several years, largely due to the efforts launched with antiretroviral therapy. There has been an improvement in life expectancy from 61.2 years in 2010 to 67.7 years in 2015.  With an increase of nearly 10 percent in just five years, one cannot overstate South Africa’s success in reducing HIV and AIDS within the country.

– Lacy Rab
Photo: Flickr

Five solutions for reducing HIV in South Africa
South Africa has the largest HIV epidemic in the world with a prevalence of 18.8 percent of the country’s population aged from 15 to 49. Consequently, South Africa has some of the most comprehensive treatment and support systems for this issue. In addition to dedicated civil society organizations, the government has a guiding framework for reducing HIV in South Africa. One of such initiatives is the National Strategic Plan (NSP) for HIV, TB (tuberculosis) and STIs (sexually transmitted infections) 2017-2022 that aims to overcome barriers and set goals that could ultimately help influence global HIV infection management. In this article, five solutions for reducing HIV in South Africa that this country is implementing are presented.

Five Solutions for Reducing HIV in South Africa

  1. Address inclusivity. Reducing the HIV epidemic in South Africa requires caring for the most vulnerable populations in society: sex workers, men who have sex with men, transgender women and people who inject drugs. Discrimination, intolerance and neglect culminate in intense stigma consequently keeping these cohorts out of the research and clinics where valuable testing and treatment are available. In addition, up until recently, nationally available programs like the National Sex Worker HIV Plan and the South African National AIDS Council’s LGBTQ HIV Framework were unavailable. The creation of specialized programs to address the unique needs of a chronically abused population is a valuable first step towards reducing HIV in South Africa.
  2. Support women. Women and girls comprise more than half of the 36.7 million people living with HIV around the world. This statistic is even worse in South Africa where HIV prevalence is nearly four times greater for women and girls than that of men of the same age. These staggering high numbers are the result of poverty, systemic gender-based violence and intergenerational marriage. In addition to the programs identified above, nationally deployed resources like the She Conquers campaign provide multiple societal interventions like reducing teenage pregnancy and gender-based violence as well as providing educational support and business opportunities.
  3. Prioritize prophylactics. A little over three years ago, South Africa became the first country in Africa south of the Sahara to completely approve pre-exposure prophylaxis (PrEP), which stands for the use of antiretroviral drugs to protect HIV-negative people from infection. This initiative is a primary tenet in the NSP‘s first goal to acceleration HIV prevention, especially for the most vulnerable population. The goal is to increase PrEP treatments to nearly 100,000 participants in the coming years. In addition, campaigns to distribute condoms, educate the population and even encourage male circumcision are operating to reduce initial transmission by providing means to encourage safe sex thus keeping the entire population safer from infection.
  4. Deliver ART. South Africa has the largest antiretroviral treatment (ART) program in the world and UNAIDS estimates that 61 percent of South Africans living with HIV are receiving treatment in 2017. This figure has more than doubled since 2010. This success is largely due to the latest “test and treat” strategy that makes anyone who has tested HIV positive immediately eligible for ART treatment. Moreover, this strategy incentivizes the population to get tested which is a major barrier to reducing HIV in South Africa. Additional work is needed to encourage South Africans, specifically men, to get tested, as men tend to get tested and start treatment much later and at a more progressed stage of infection thus reducing effectiveness and placing the population, especially women, at risk. It is important to note that South Africa has made tremendous strides in reducing mother-to-child transmission (MTCT) largely because of the ubiquity and delivery of ART therapies. As a result, MTCT rates have been reduced by more than half between 2011 and 2016, achieving the national target for 2015 of a transmission rate below 2 percent.
  5. Treat Tuberculosis (TB). Tuberculosis is the leading cause of death in South Africa. HIV severely suppresses the immune system leaving victims vulnerable to all infections, however, TB is particularly difficult and without treatment, fatal. It is estimated that two-thirds of HIV-positive South Africans have TB. In response, South Africa’s NSP incorporated TB reduction strategies and sets forth priorities for reducing TB mortality.

These five solutions for reducing HIV in South Africa have been a successful start for the country as they tackle the world’s largest HIV epidemic. The government has developed a comprehensive, multi-dimensional plan that shows a lot of promise, however, following through remains questionable. National organizations like the Treatment Action Campaign question the government’s ability to remain engaged and accountable.

Addressing HIV requires relentless attention and civil society participation, especially since UNAIDS’ ambitious 90-90-90 (90 percent of all people know their HIV status, 90 percent HIV-positive patients will receive ART therapy and 90 percent of ART therapy patients will have viral suppression) goal to suppress and eliminate HIV and AIDS, all by 2020, is right around the corner.

– Sarah Fodero

Photo: Flickr

AIDS_Crisis

Surrounded on all sides by its neighbor South Africa, the little country of Lesotho is the largest enclave in the world; larger than its only rivals Monaco, San Marino and Vatican City.

Essentially a landlocked island amidst African highlands, Lesotho also features the lowest point of any country in the world, measured at 1400 meters or 4,953 feet. However, it has another, less fortunate distinction; it places third on the list of countries with the highest HIV/AIDs prevalence.

In total, nearly one quarter of the population lives with HIV, which accounts for 360,000 people. Close to 26,000 new HIV infections and 14,000 AIDS deaths were recorded in 2011. Of these infections, 40,000 are in children while around 60 percent of adults with HIV are women. On top of these harrowing figures, 42 percent who need treatment cannot access it.

Lesotho’s first reported incidence of HIV occurred in 1986, and accelerated rapidly into a national epidemic. While the government made attempts to monitor and treat the illness, the proved insufficient due to poor finances and infrastructure. Just six years later, in 1992, 3.2 percent of pregnant women between the ages of 20 and 24 had HIV. By 1996, the figures had exploded; in just four years, a quarter of the same demographic was living with HIV.

The sheer extent of this illness has had a detrimental impact on the development of Lesotho. The most productive age group in the country is also the most infected. This has compromised their ability to work and sustain themselves and their families.

For the Basotho people, family is vital. For centuries, extended relatives have supported one another through any hardship. However, AIDS/HIV has eroded this support system by orphaning 220,000 children. This has left children as the head of families in which the working generations are debilitated or have died.

One can notice the extent of the AIDS epidemic by looking at the data. It has significantly shortened the life span of the average Basotho to just 48.3 years from nearly 60 years in 1990.

Moreover, the two main statistics most indicative of development, GDP and the Under Five Mortality Rate have worsened. Since 1990, the Under Five Mortality rate has risen from 85 in 1000 to 100 in 1000. While from 1970 to 1990 the average annual growth rate of Lesotho stood at 3 percent, it fallen to 2.6 from 1990 to 2012.

With such a widespread influence throughout the Lesotho, the nation’s government, along with international aid groups has made efforts to tackle the AIDs crisis. The first step was to provide universal testing for the entire country. Beginning in 2004, the program called “Know Your Status” involved training thousands of health care workers to perform swift HIV testing. However, the government has only trained one quarter of the required workers, failing to meet its objective of universal coverage.

Besides testing, the government has implemented a variety of campaigns to confront the epidemic, but with mixed results. It introduced HIV/AIDS awareness to the curriculums of both primary and secondary schools. A ‘road show’ was also planned to inform communities about AIDS/HIV while providing both entertainment and HIV testing. Despite the efforts, only 29 percent of 15 to 24 year old males and 29 percent of females from the same demographic had an understanding of HIV prevention.

Unlike awareness efforts, distribution of cheap condoms has also served as an effective mainstay of HIV intervention in Lesotho. In 2001 affordable condoms began selling throughout communities. The sales spiked, with the number of distributors tripling and the number of condoms bought doubling.

In order to help those already infected with AIDS, the government has worked to provide better access to antiretroviral treatments. Since 2004 the government of Lesotho has sought to make antiretroviral treatment free to those in need. With only 89 trained medical professionals in the whole country, the program lagged behind at first. But since expansion in 2008 coverage has expanded to around 86,000 people, or close to 60 percent of those needing treatment. Still, only a quarter of children in need receive antiretroviral treatment.

While Lesotho has become closer to controlling its AIDS epidemic it has come at the cost of the nation’s development. Despite its aspirations, the country’s inadequate infrastructure, health care and budget have hindered its efforts. With more foreign assistance, Lesotho has the capacity to get back on its feet.

– Andrew Logan

Sources: Avert, CIA, PEPFAR, UNDP, UNICEF 1, UNICEF 2
Photo: NY Times