Posts

, ,

The Response to HIV/AIDS in Croatia

CroatiaHuman immunodeficiency virus (HIV) and its advanced stage, Acquired immunodeficiency syndrome (AIDS), are significant global public health issues. According to the World Health Organization (WHO), by the end of 2023, HIV had infected 39.9 million people. The virus targets white blood cells in the body, resulting in a weaker immune system and various complications. A case study conducted in Croatia and four other countries aims to track the virus and those it affects and make care more accessible for the well-being of their citizens.

HIV/AIDS in Croatia

Croatia, a country nestled between Slovenia and Bosnia and Herzegovina, launched a national response to the ongoing HIV/AIDS crisis within its borders. Starting in 1985, the surveillance of the virus gradually improved as testing and programs were established to combat its spread. Between 1985 and 2015, there were approximately 77 to 116 new cases reported annually. The majority of transmissions occurring through sexual contact in male-homosexual relationships.

The government’s response to HIV/AIDS in Croatia included implementing certain educational and health care pillars to maintain and promote the declining spread of the virus. The pillars of the program include easy access to care for people living with HIV/AIDS. Additionally, youth education is targeted, as well as introducing more protective behaviors in order to stay safe. Making sure that blood or blood-related products are clean and safe are also a key priority.

EmERGE

Part of the easy access to care included investigating the cost-effectiveness of a program called EmERGE, which offers support to those who are in a stable condition with the virus. This program has three primary goals:

  1. To gather insights into living with HIV and providing care for individuals with HIV.
  2. To determine which mHealth features are viewed as valuable in HIV care.
  3. To explore potential advantages and address concerns related to mHealth.

One of five clinics was opened in Zagreb, Croatia, where a study soon ensued with 309 initial participants, which later fell to 293 participants. The clinics collected outpatient data one year before and one year after the EmERGE program was implemented. The results of the case study were very promising, as outpatient visits declined by 17%. They led to decreases in all other areas, such as annual costs and costs related to anti-retroviral drugs.

The Future

Croatia’s response to HIV/AIDS has made great progress in making care more accessible. Results from the patients showed that they appreciated the autonomy that it gave them as well as reducing travel and waiting times. The only downside is the safety of the participants’ phones; should privacy not be protected, the information could leak. However, further efforts are being implemented to study and expand mHealth and EmERGE to cover a more broad range of needs.

The effort that has been put in to monitor and reduce HIV will save lives in the future. Croatia’s national plan will further the health and safety of its citizens and create new educated generations who will be less likely to contract the virus. Furthermore, with the success of Emerge, other countries may adopt a similar institution to combat the HIV/AIDS crisis. While the case study focused on five countries, Croatia’s success may inspire others to follow.

– Isabella Chavez

Isabella is based in Swampscott, MA, USA and focuses on Global Health for The Borgen Project.

Photo: Pexels

, ,

Suniti Solomon: Pioneering HIV/AIDS Researcher and Activist

suniti solomonSuniti Solomon neatly laid out photographs of prospective brides and grooms on her small desk, carefully tucking them under a stainless-steel cup and saucer and away from the force of the wind. Over filter coffee, and with her colleagues’ help, she was going to play matchmaker.

But what was evolving in this unassuming house on a quiet street in Chennai’s otherwise bustling T. Nagar was far from an ordinary arranged marriage. It was a result of Dr. Solomon’s affection for everyone who knocked on the door of her NGO. Deeply involved with her patients’ lives, she understood how their suffering was compounded by social stigma. She was working hard to remedy their lack of matrimonial opportunities by matching them with each other.

Suniti Solomon’s Discovery of HIV in India

Dr. Solomon joined the Madras Medical College in 1971 for her postgraduate degree in microbiology, after having trained in London and Chicago. As a member of its faculty in the early 1980s, she read papers across international medical journals detailing the quick spread of what many considered a mysterious disease then: HIV, according to The Hindu.

Working against the government’s HIV-denying narrative at the time, Dr. Solomon, along with her student Selleppan Nirmala, collected blood samples from 100 members of the sex worker community in Chennai in 1986. As she had anticipated, six samples tested positive for HIV. This was possibly indicative of a much larger epidemic across the country, given the size of India’s population.

This shocking finding catapulted the government into action. It braced for a crisis like no other, given the prevalence of poverty and lack of access to quality health care in the country. However, remarkably enough, this disaster was averted: India’s incidence rate has remained below 0.3%. The annual number of people newly infected with HIV declined by close to half between 2010 and 2021 in India.

This progress is thanks to the successful control of contagion in India. This has been achieved with free antiretroviral therapy, awareness initiatives and effective engagement with civil society. But it is also due, at least in part, to Dr. Solomon’s efforts.

Treating the Disease and Healing the Individual

Thoroughly attuned to patients’ stories of struggle – from the case of an infected 13-year-old to a family whose members died by suicide when news of their diagnosis spread, Dr. Solomon opened India’s very first voluntary HIV testing and counseling center at Madras Medical College. She transitioned to independently running her own NGO in 1993, the Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE).

With this, Dr. Solomon built a safe and nurturing space for every person living with HIV who had fallen through the cracks in public health care. YRG CARE started with just three employees. However, it now has a 1,000-member-strong workforce, spread throughout India’s 28 states, according to the American Society for Microbiology. It pioneered HIV awareness programs in schools and colleges. It has provided care to nearly 2 million people living with HIV, from easier access to specialized pharmaceutical drugs to recuperation facilities at in-patient centers.

Suniti Solomon: Legacy

Dr. Suniti Solomon received many accolades when she was alive, from an honorary Doctor of Medical Science degree from Brown University to a Lifetime Achievement Award by the Tamil Nadu AIDS Control Society. She passed away in 2015, at the age of 76. Many people, including The New Yorker’s Michael Specter, remember her as warm, empathetic and soft-spoken. Old interviews reflect her feistily unorthodox and good-humoured spirit. Colleagues recall that she inspired hope and courage in them. The government of India posthumously awarded her with the Padma Shri, India’s fourth-highest civilian honor, in 2017.

– Shiveka Bakshi

Shiveka is based in London, UK and focuses on Good News, Global Health for The Borgen Project.

Photo: Flickr

, ,

Leading The Way: Cabo Verde’s HIV Fight

cabo verde's HIVCabo Verde, a West African country consisting of islands in the central Atlantic Ocean, has become a leader in the fight against HIV and AIDS in Africa through its health care investments and social initiatives. Currently, Cabo Verde is estimated to have an HIV prevalence of around 0.6%. At the same time, AIDS-related deaths decreased from around 200 in 2004 to less than 100 in 2022. This progress has involved declining poverty, which dropped to 28.1% in 2022 from 56.8% in 2001. Cabo Verde’s HIV fight is now focused on projects directed at vulnerable groups, such as pregnant women, children and disabled people.

Investment in Communities

Combating HIV and AIDS requires involving both the general public and individuals living with HIV in decision-making processes. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has reported that the West Africa region is not on track to meet the goal of eradicating AIDS by 2030, a target set during the Africa Rising Forum in 2014.

The group’s Executive Director expressed the need for “policies and programs that focus on people not diseases.” This involves community-led HIV testing to reach more people. Furthermore, support groups for mothers living with HIV and individual visits by social assistants are also key. One assistant in Cabo Verde expressed how this work allows patients to “have a good quality of life and avoid stigma and social marginalization.”

Regional Asymmetry

A key challenge for Cabo Verde is the disparity in resources between islands, which affects HIV patients’ ability to access care. At independence in 1975, the country had only 13 doctors. However, the health system has since expanded in both size and sophistication, with 80% of the population now living within half an hour of a health facility. The decentralization of smaller health centers has improved access to care, enabling HIV patients to receive antiretroviral therapy to manage the disease. UNAIDS estimates that by 2023, 72% of individuals living with HIV in Cabo Verde were accessing antiretroviral therapy.

Free Health Care

Cabo Verde’s economy has grown significantly since the ’90s, driven by foreign investment and tourism. This growth has led to increased health care spending, rising from $65 per person in 2001 to $165 in 2013. Citizens are entitled to free basic health care, including preventive care and treatment for HIV and AIDS. The country’s social protection efforts are supported by widespread health education, facilitated by high literacy rates and good access to electricity, fostering greater public awareness and engagement.

Advocacy for the Disabled Community

Despite Cabo Verde’s broad progress, vulnerable communities, such as those with disabilities, continue to face challenges. Handicap International, active in Cabo Verde since 2006, has worked to include disabled individuals in the fight against HIV. The organization improved data on the biological vulnerability to HIV infection and promoted inclusive education on HIV and AIDS.

Research found that the HIV prevalence rate among people with disabilities in Cabo Verde is 2.3%. Additionally, about 79% of disabled participants unaware of available HIV care and support. However, the study itself led to 96% of participants gaining an improved understanding of HIV and AIDS.

Preventing Vertical Transmission

Preventing vertical transmission of HIV from mother to fetus is a key priority for Cabo Verde in reducing new infections. Minister of Health Arlindo Nascimento do Rosário emphasized, “Every child has a right to be born healthy and to live a healthy life.” As part of the free health care system, pregnant women are offered HIV testing. If they test positive, they receive antiretroviral drugs and antenatal support to minimize the risk of transmission.

In 2019, the World Health Organization (WHO) shared the story of Leila Rodrigues, a mother who discovered she had HIV just weeks before giving birth. Thanks to the care her son received, transmission was prevented. Rodrigues later joined the National Network of People with HIV of Cabo Verde.

Final Note

Cabo Verde’s progress in HIV health care has not come without challenges. However, the country has become a model for investing in change and empowering communities. The WHO Africa Health Forum has highlighted Cabo Verde as an exemplar, with participants visiting to observe how innovations have built a strong health care system. Emulating Cabo Verde’s commitment to social inclusion, universal health coverage and decentralized HIV testing could enable the West African region to more effectively combat the disease.

– Daisy Outram

Daisy is based in Kent, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Wikimedia Commons

, ,

USAID Programs in Eswatini

USAID Programs in EswatiniEswatini, due to its geographical location, relies on South Africa for the majority of its trade, with 65% of its exports and 75% of its imports going to South Africa, meaning that this is a large contributor to Eswatini’s economy. Despite the GDP per capita in Eswatini remaining relatively high, standing at $3,823 in 2023, nearly 70% of the population lives in poverty, with diseases such as HIV and AIDS having a devastating impact on citizens. With education quality being insufficient, alongside access to education, many do not receive an education that will prepare them for the workplace.

USAID Programs in Eswatini

Whilst there are several USAID programs in Eswatini, most of its work in Eswatini, and Southern Africa as a whole has been a part of the President’s Emergency Plan for HIV/AIDs Relief (PEPFAR), which works to control the HIV/AIDS pandemic in at least 50 countries across the world. The project has four main priorities within its operation: making progress towards HIV/AIDS control in more than 50 countries across the world, helping partner countries in spending every dollar they receive on creating data-driven policies, giving access to support to the populations that the by HIV/AIDs impacts the most and providing them with innovative solutions that are appropriate to their situations while utilizing partnerships in several different sectors to increase their impact.

After partnering with USAID and PEPFAR in 2007, Eswatini’s first Swaziland HIV Incidence Measurement Survey (SHIMS) in 2011 proved HIV rates in Eswatini were relatively high. Only less than 62% of the infected population aged between 18 and 49 knew their status, and out of those, only 73.1% were undergoing treatment and were virally suppressed. However, after SHIMS3 in 2021, these figures had improved significantly, with 93.7% of the population living with HIV knowing their status, and of this, 96.2% were undergoing treatment

DREAMS

USAID introduced the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program in Eswatini with help from PEPFAR in 2015, to help teenage girls and young women by addressing factors that make them susceptible to HIV/AIDS. The program offers services such as access to pre-exposure prophylaxis (a drug that can prevent the acquisition of HIV), education subsidies and wider access to HIV screening, testing and counselling. In Eswatini, young girls also have access to business mentorship with Cabrini Ministries, as youth unemployment currently stands at 58%, and this mentorship provides young girls with employment opportunities in a social climate where job opportunities for women are sparse.

In 2024, PEPFAR announced that it is looking to roll out DREAMS NextGen, in partnership with USAID, which will aim to take a specific approach for the situation in each country, by expanding the services already in place and specific services for women in each partner country. This USAID program in Eswatini is the next step within the DREAMS program, which aims to create “supportive environments” for teenage girls and young women, with aims including strengthening families with social protection with subsidized education costs and parent and caregiver programs and mobilizing local communities to promote change through a roll-out of school and community HIV and violence awareness and prevention.

The Future

It is clear that with the help of USAID programs in Eswatini and schemes such as the PEPFAR, the country will be able to sustainably develop beyond USAID programs and control the HIV/AIDs pandemic. With further support from both of these organizations, the people of Eswatini will be able to prosper, with access to things like better and subsidized education that will better prepare young people for the workplace and better healthcare to improve their quality of life.

– Freyja Stone

Freyja is based in Manchester, UK and focuses on Global Health and Politics for The Borgen Project.

Photo: Unsplash

,

HIV in India: Working Towards Improving the Health Care

hiv in indiaMore than two decades ago, Bill and Melinda Gates learned about the contagious Rotavirus, present in several countries. The more they learned, the more devoted they became to helping. Higher-income countries could treat rotavirus with ease, but lower-income countries struggled with it, leading to many casualties. Hearing this, the Bill and Melinda Gates Foundation started working in India in 2003. The foundation launched the Avahan Program, which targeted HIV prevention. Avahan was incredibly successful in its endeavors, eliminating nearly 600,000 infections.

The Bill and Melinda Gates Foundation also partnered with others to help the Indian government in defacing polio. These efforts were not easy; nearly 2.3 million volunteers helped with vaccination efforts, and their labors were fruitful. The efforts helped provide vaccines to 170 million children finally eradicating polio in India in 2014, according to the foundation’s website.

CDC in India

In 2001, the Centers for Disease Control and Prevention (CDC) established its first Indian office in New Delhi. Establishing this office was one of the first steps to their end goal: eliminating any presence of HIV in India by 2030.

The CDC, partnering with National AIDS Control Organization (NACO) began advancing HIV treatment in India. They improved accessibility to antiretroviral therapy (ART) and viral load (VL) testing. With CDC, NACO created 740 ART centers in India, all providing specialized care, disease management and ART, according to a 2024 CDC report.

Regarding their laboratories, the CDC has worked on reaching remote areas through community-led testing, and access to PLHIV. Additionally, the CDC is collaborating with the Indian Government to create systems within their laboratories, dedicated to the early detection and management of HIV, along with continued care regarding cervical cancer, according to the same report.

The CDC and the Indian Government have partnered together regarding testing, targeting districts with a high HIV prevalence, including Mumbai, Mizoram, Manipur, Nagaland, and Andhra Pradesh, according to the CDC. This partnership has led to an increased awareness and understanding regarding HIV.

USAID Project

Additionally, USAID and the Johns Hopkins University School of Medicine started a project to make HIV treatment available in socially remote areas. This program has opened several centers that help with treatment. There are centers dedicated to teenagers, where they have access to “sports, music, and life-skills programs, while also accessing counselling, social services and peer support on their HIV journey.”

This mix of services allows them to navigate life and challenges as they live with HIV. There are also centers for transgender people, that provide specialized treatment for HIV along with general healthcare services as well. In these specific centers, they provide stigma-free care, allowing for a more accepting, safe atmosphere for patients. There are also online platforms such as SafeZindagi.in, which can often be a faster or easier option for patients. It provides confidential care and counselling for those living with HIV.

HIV in India: The Future

Having centers like these available to the general public is a game-changer. Factors that may inhibit people from seeking care include stigma, transportation accessibility, cost, lack of awareness, and more. Programs like these, along with the work from the CDC and Indian government, are slowly tackling these issues and working towards a healthier India.

Now, around 2.5 million people are living with HIV in India, compared to the 39.9 million people living globally with HIV. Thanks to the efforts from the CDC, the Indian Government and USAID, HIV prevention in India is advancing in an upward trajectory.

– Lakshya Anand

Lakshya is based in Bellevue, WA, USA and focuses on Global Health for The Borgen Project.

Photo: Unsplash

, ,

Prevention Strategy: HIV/AIDS in Cambodia

CambodiaCambodia, a Southeast Asian nation with a population of approximately 16.8 million people, has achieved significant progress in controlling HIV infection rates since the peak of the epidemic in 1996. In 2022, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that public health interventions had achieved a 91% reduction in HIV infection rates across the population. Specifically, the estimated number of infections dropped to 1,400 from 15,000 in the past three decades.

Correlation Between HDI and the Rate of HIV Incidence

According to a study into the correlation between the Human Development Index (HDI) and the rate of HIV incidence, populations with a higher average socioeconomic strength are more likely to avoid outbreaks of HIV infections. For Cambodia, the country’s HDI has doubled since the ’90s, currently at 0.600 (148th worldwide), supporting the conclusions found in the study.

Ultimately, to satisfy the conditions of the UNAIDS 95-95-95 HIV prevention scheme by the end of the decade, support for the most vulnerable has to be further reassured. These key populations include pregnant mothers, sex workers, people injecting and children living with HIV in impoverished communities. Integrated in 2023, the National Social Assistance Fund (NSAF) envelops efforts to support impoverished individuals living with HIV/AIDS in Cambodia.

Covering Medical Costs for Vulnerable Families

In 2023, Hun Manet’s newly elected government launched the NSAF to centralize health care planning, targeting protection toward the more economically vulnerable across all provinces of Cambodia. Broadly, the fund provides crucial health care benefits for older adults, retired civil servants and those living in impoverished communities.

The social safety nets this fund provides include insurance or cash transfers to cover existing medical costs. While health care is not guaranteed as a dedicated right, it is subsidized based on the approval of a government grant through an application process. This safety net is HIV-sensitive, meaning that individuals living with HIV receive prioritized access. Statistics dating back from 2019 show that beneficiaries of the insurance support amounted to nearly 350,000 pregnant women and children aged less than 2. Recipients of the cash bank transfer scheme were approximately 17,000 impoverished or disabled people.

Tia Phalla, Deputy Director of the National AIDS Authority in Cambodia, argues that people living with HIV can benefit more from financial coverage. She states that nutritional and wage support are as integral as medicinal support and both are offered effectively with economic aid.

Seeking Treatment Anonymously

The new government has nevertheless outlined a new priority to provide upward of 450,000 vulnerable families with health care cards to offer them complete health services coverage. As of December 2023, 13,600 people living with HIV have registered for health care coverage schemes using IDPoor, a smartphone application that alerts HIV treatment centers when a family member is living with the virus. By notifying health care professionals of their status, registrants become eligible for an Equity Card.

This card provides a straightforward and universal way to share their HIV status with treatment centers and other officials. A significant obstacle during the HIV crisis has been the stigmatization of the virus by some uninformed members of the public. The IDPoor registration addresses this issue by offering anonymity to people living with HIV seeking treatment, as their status is revealed through the platform without disclosing their identity publicly.

Final Thoughts

UNAIDS and nonprofit organizations combating HIV/AIDS in Cambodia highlight that an effective health care strategy to counteract increasing HIV infection rates needs to include the following:

  • Fair and inexpensive access to antiretroviral medication.
  • Anonymous services to access treatment and information.
  • A viable social safety net to financially support those unable to work due to illness.

Continued efforts in these areas will be essential for maintaining the progress made and ensuring Cambodia’s HIV/AIDS protection strategy is effective. By prioritizing vulnerable populations and strengthening health care infrastructures, Cambodia can move closer to achieving the UNAIDS 95-95-95 targets and eventually eradicating HIV/AIDS in Cambodia.

– Ramiro Ruiz Martinez

Ramiro is based in Edinburgh, Scotland and focuses on Technology and Global Health for The Borgen Project.

Photo: Flickr

, ,

South African Women: The Young Women for Life Movement

South African WomenThe socioeconomic system set in place during South Africa’s apartheid era continues to pervade the country today. HIV’s disproportionate impacts Black South Africans, particularly women, is but one example. South African girls and women are disproportionately impacted by HIV due in part to gender- and race-based inequality. South Africa’s 2023 strategic plan for HIV, Tuberculosis (TB) and sexually transmitted diseases (STDs) reports that nearly two-thirds of all new HIV infections occur in women.

According to the International Journal for Equity in Health, the low socioeconomic status of women, especially Black women, in the country places them at greater risk of contracting HIV. Poverty — which in South Africa is the result of historical inequalities — is a “significant factor” in the way HIV/AIDS spreads — the majority of people living with HIV/AIDS are experiencing poverty. In response, the Young Women for Life Movement works with girls and women who are affected by poverty, marginalization, gender-based violence and HIV/AIDs, helping them to “break free of the cycle of poverty and violence.”

Cape Town’s Young Women for Life Movement

The Young Women for Life Movement was founded in 2019 when 80 adolescent girls and young women came together in a backyard in Cape Town. The program receives support from the United Nations (U.N.) Women, the Joint United Nations Program on HIV/AIDS (UNAIDS) and the Southern Africa Catholics Bishops Conference and Peace Commission. With their support, the program has grown and, as of June 2024, has impacted 8,000 women and girls in South Africa.

Women can grow within the program as it provides financial literacy training, skills-building training in business and entrepreneurship, leadership dialogues and peer support through a network of women and girls who face similar circumstances. The Young Women for Life Movement “models a unique approach to building resilience against gender-based violence and HIV among young women,” stated U.N. Women HIV/AIDS Specialist Jacqueline Utamuriza-Nsizabira. The movement also helps women influence policy through advocacy. It has grown into a “powerful network for influencing policies,” Utamuriza-Nsizabira said.

Overcoming Stigma

According to a 2023 study published in the National Library of Medicine, stigma and discriminatory attitudes against individuals with HIV are “persistent” throughout communities in South Africa, both urban and rural. HIV stigma in South Africa is correlated with HIV-affected individuals undergoing less medical treatment in terms of voluntary HIV antibody testing, palliative care and counseling — subsequently increasing HIV transmission. According to AVAC, HIV stigma is “deleterious to health-care use and delivery behaviors in South Africa.”

AVAC also stated that Black women living with HIV in South Africa experience significant trauma, with their positive HIV status adding further stress to their lives. Extreme cases of HIV stigma can manifest as violent behavior. The Madridge Journal of AIDS reports that stigma affects South African adolescent girls and women “socially, economically and mentally,” undermining their chances of seeking health care and improving their quality of life.

The Young Women for Life Movement helps girls and women “break through” this stigma and fear of discrimination, providing a sense of community where women and girls feel safe to disclose their HIV status and are encouraged to seek proper care. Program coordinator Phindile Maseko informed U.N. Women that some young women and girls in the Cape Town movement are living with HIV. “They were so discouraged when we met them that they had even stopped taking antiretroviral medication,” she said. But now, they have hope and are fighting for a better future.”

Overcoming the Cycle of Poverty

Maseko met Gugulethu Mdoba, who had gotten pregnant when she was 18 and struggled to raise her child, encouraging her to join the program. When Mdoba joined the Young Women for Life Movement, she sold baked goods to raise money to support her child. After gaining support and learning business skills through the program, she now has a bakery and recently began to teach other girls and young women how to bake.

“My business has grown a lot,” said Mdoba. “I have many customers now. I deliver my products to salons and shops. Sometimes I just walk a short distance and my muffins are sold out because people pre-order them and I deliver them the next day.” By providing girls and women with financial literacy, the initiative empowers them to access better health care and support services, which can improve their health outcomes and overall well-being. With increased economic stability, they are better equipped to confront and challenge stigma, reducing their social isolation and improving their ability to live openly and confidently.

Closing Thought

By empowering South African girls and women living with HIV/AIDS to break through stigma and the cycle of poverty, the Young Women for Life Movement promotes resilience, promotes better health outcomes and enhances their overall quality of life.

– Ahna Fleming

Ahna is based in Minneapolis, MN, USA and focuses on Business and Good News for The Borgen Project.

Photo: Flickr

, ,

Prevention and Development: HIV in Eswatini

HIV in EswatiniThe priority of health and well-being is a privilege not all nations can embrace. Eswatini, located in the Southwest of the African continent, has faced significant setbacks in its quest for a healthier nation due to the devastating effects of an HIV epidemic in recent years. With a population of roughly 1.2 million, Eswatini has one of the highest HIV rates globally, leading to widespread suffering, death and low life expectancy. However, development and aid efforts, both governmental and global, are advancing steadily, bringing the prospect of a healthier nation within reach.

HIV in Eswatini

Eswatini has been at the top of the charts in regard to HIV prevalence in the past years. During the peak of the HIV epidemic in 2015, almost one out of every three people in the nation were living with HIV. Although treatment for HIV existed during the mid-’90s, not many citizens in Eswatini had access to the treatment. In 1995, no treatment was made available for the Swazis, leading to 73,000 people contracting the disease and 2,400 people dying that very same year.

The fight for controlling the epidemic has been difficult in the following years, with the implementation of various programs and treatments failing on a widespread level. Currently, the life expectancy for the Swazi people is 54.6 years. Although low in regards to the global comparison, this is actually progress for the nation. In Eswatini, the life expectancy in 2000 was 47 years, which means that it has improved by 7.55 years in the past 24 years.

Relief and Aid

A primary factor in the improvement of controlling the HIV epidemic, as well as increasing the life expectancy of the Swazis, has to do with the partnership between the Government of Eswatini and the United States (U.S.) Presidential Emergency Plan for AIDS Relief, more commonly known as PEPFAR. PEPFAR is the largest commitment by any nation addressing HIV in history, enabled by the support of the U.S. Congress, presidential administrations and many other powerful figures in the U.S. political sphere.

PEPFAR-funded programs such as the REACH and REACH II programs have focused on developing local organizations in the community. These organizations, such as Umliba Loya Embili and Insika ya Kusasa, have aided in the fight against HIV, addressing risks such as miseducation, poverty, child protection and more.

The increase in Swazis taking preventative medication for HIV has also been a major success in the decrease in HIV rates in recent years. The dissemination of drugs, in particular, pre-exposure prophylaxis, more commonly known as PrEP, has been a milestone in aiding the risk and containment of HIV. In 2016, the World Health Organization (WHO) globally recommended the introduction of PrEP among people at high risk of contracting HIV, including adolescent girls, young women and sex workers.

Eswatini was one of these countries and now the number of PrEP users is increasing yearly, going from 2,200 in 2018 to 32,750 in 2022. The increase in protection being available for citizens at their local clinic is a positive step in the right direction, which is openly decreasing the potential for Swazis to contract HIV.

The Future of Eswatini

Addressing the HIV epidemic in Eswatini will be a slow and incremental process, given that large-scale relief and aid have only recently been introduced. The transition from a lack of relief, education and medication to a growing support system marks progress in the fight against high HIV rates. Continued funding for education and medical care is essential for building a healthier future for the people of Eswatini.

– Oliver Martin

Oliver is based in Honolulu, HI, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

, ,

Diseases Impacting Tanzania

Diseases Impacting TanzaniaTanzania has, in the last 10 years, seen a consistent reduction in its poverty rates after it decreased from 34.4% to 26.4% between 2007 and 2018, this mostly being in more rural areas of the country. Disease in Tanzania is becoming a lesser problem for citizens: the combined efforts between the World Health Organization (WHO) and the Ministry of Health in monitoring outbreaks and surveillance of diseases have resulted in improved responses to disease and treating the infected.

The decrease in poverty has also meant that increased funding can go into health care facilities, for example, the 2.22 trillion Tanzanian Shillings (Tsh) allocated to health care in Tanzania in 2017-2018, an increase of 34% from that in 2016-2017.  However, communicable diseases in Tanzania remain a threat to public well-being, and without a fast diagnosis and access to correct treatment, they can often be fatal. Here is information about three diseases impacting Tanzania.

Malaria

Malaria, a disease carried by mosquitoes, is one of the most common communicable diseases in Tanzania. In 2022, there were an estimated 7,960,000 confirmed cases of malaria in the United Republic of Tanzania, making Tanzania the country with the sixth highest number of cases. In response to this, the World Health Organization (WHO) began offering training for district vector surveillance (and control) officers (DVSOs), who collect samples of vectors from around Tanzania that can be analyzed.

This training then saw the certification of 56 new DVSOs, who now play a vital role in malaria prevention and elimination as mosquitos and other disease vectors often tend to behave based on human interaction, and the study of how they behave would help in creating new strategies that align with recent changes in vector behavior. With access to the correct resources, malaria is incredibly preventable. For example, the use of mosquito nets in sleeping areas helps to keep mosquitoes from biting citizens, and even just wearing protective clothing can minimize the spread of malaria in Tanzania.

HIV and AIDs

In 2021, the United Nations states began to work towards the 95-95-95 targets for HIV/AIDS, which aim to ensure at least 95% with HIV know their status, 95% of those with HIV are undergoing treatment and 95% of those undergoing treatment are virally suppressed. In Tanzania, as of 2019, there were 1.7 million people who had confirmed cases of HIV, and in line with the 95-95-95 goals, 83% of those suffering from HIV knew that they had it, and of these, 92% were virally suppressed and receiving treatment.

The National AIDS Control Programme in Tanzania has worked to ensure that condoms are readily available to the Tanzanian population, to prevent the spread of HIV and age-appropriate messages to educate about HIV prevention and myths young people may encounter surrounding it are distributed, in hopes of minimizing the disease and its impact in Tanzania.

Tuberculosis (TB)

Estimates currently indicate that there are around 208 cases of TB for every 100,000 people in Tanzania, and the country is currently on a watchlist for its high TB burden rates, according to the WHO’s Country Outlook. Because of the high rates of HIV and AIDs in Tanzania, this immediately puts anyone impacted at higher risk of contracting TB, due to the compromise in their immune system. In 2021, The Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), Directorate of Preventive Services through the National TB and Leprosy Programme (NTLP) launched a StopTB Partnership that works to end TB in Tanzania by 2030.

So far, it has been working on raising awareness about TB, by holding workshops to educate local journalists about TB and calling for increased funding towards TB diagnosis and treatment in Tanzania. It has also enforced a framework which ensures that treatment in the form of antibiotics is free to all TB patients through public and private health care systems and that TB notifications are mandatory, according to its 2023 report. This increased access to treatment for Tanzanian citizens could hopefully lower infection rates and decrease its impact in Tanzania.

Looking Ahead

While these diseases impacting Tanzania still have a large impact on the population of the country, the work of these organizations has significantly decreased its impact and improved the lives of many. With continued funding and work from these organizations, Tanzania will likely be able to meet health targets, such as those set by the Global Technical Strategy for Malaria, and move towards eliminating these diseases impacting Tanzania in the future.

– Freyja Stone

Freyja is based in Manchester, UK and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

, ,

HIV and Syphilis: Mother-to-Child Transmission in Belize

Belize Eliminates Mother-to-Child HIV and Syphilis TransmissionIn May 2024, Belize achieved certification from the World Health Organization (WHO) for eliminating mother-to-child transmission of HIV and syphilis. Over the past 20 years, in collaboration with the Pan American Health Association (PAHO), health care workers in Belize have dedicated themselves to enhancing medical services, ensuring a generation free from these diseases.

Improving Medical Services in Belize

Since the early 2000s, Belize’s health care services, in collaboration with the Pan American Health Organization (PAHO), have been following the organization’s Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections. This initiative has improved and promoted access to prenatal HIV and syphilis testing. Health care providers now screen every pregnant woman for these viruses two to three times during pregnancy, at delivery and at 18 months postpartum.

The vastly improved testing services have reduced mother-to-child transmission in Belize, of HIV and syphilis by 81% from 2007 to 2023, achieving eradication by 2024. This success depended on effective treatments administered to pregnant women who tested positive for these diseases. For syphilis, health professionals administer three consecutive weeks of penicillin injections; HIV-positive mothers receive daily antiretrovirals along with prenatal vitamins. These treatments effectively prevent the transmission of HIV and syphilis to their children. To further ensure children are born virus-free, nurses follow up with mothers a week after treatment completion to verify the full course was administered and to identify any potential complications.

Encouraging Mothers to Seek Testing and Treatment

Throughout Belize’s collaboration with PAHO under its Plan of Action, the country has enhanced the research capabilities and capacity of its health care services, enabling more pregnant women to be tested earlier and more accurately for both HIV and syphilis. The percentage of women attending health clinics in their first trimester has risen to 90%, allowing for earlier and more effective administration of preventative treatments. When mothers test positive for these diseases, health care providers also encourage their partners to get tested, fostering community awareness and enabling more individuals to know their statuses and receive necessary treatment. As of 2022, 81% of people living with HIV in Belize are aware of their status.

Screenings and treatments in these clinics are free, ensuring that all women in Belize can access life-saving treatments for themselves and their unborn children. This accessibility has been crucial in eradicating the viruses and underscores the relentless efforts of Belizean health care workers. Additionally, if a mother misses an appointment, a nurse visits her home to conduct a follow-up check.

Nurses Maintaining the Transmission Rates

The critical roles of nurses in eliminating mother-to-child transmission of HIV and syphilis in Belize, particularly in remote areas like San Lazaro, are pivotal. The Belize Ministry of Health facilitates mobile health services that allow nurses to travel between villages to conduct screenings and treatments. This commitment underscores the dedication of health care workers to achieving the certification for eradicating HIV and syphilis transmission from mothers to their children.

Health care services in Belize actively educate and promote awareness of HIV and syphilis, encouraging mothers to seek regular testing. During prenatal checkups at clinics, health care workers emphasize the importance of screenings for both the women and their unborn children. This approach normalizes early testing upon pregnancy, increasing awareness and helping more women know their health status.

Testimonies from Belizean health care workers emphasize that their diligence, research and efforts are crucial for sustaining the elimination of mother-to-child transmission of HIV and syphilis. The Minister of Health and Wellness of Belize, Hon. Kevin Bernard, notes that cooperation and teamwork between health care workers and the communities they serve are essential for delivering optimal services and effectively preventing the spread of the disease.

Looking Ahead

The WHO certification confirming the elimination of mother-to-child transmission of HIV and syphilis in Belize highlights the success of the country’s health care workers and medical services. According to Dr. Natalia Largaespada Beer, this achievement not only ensures a new generation free of these diseases but also represents an opportunity to strengthen the health care system. The enhancement of services and nationwide access to life-saving treatments promise a bright future for Belize in sustaining this elimination, ensuring every child has the right to be born free from these diseases.

– Ben Kane

Ben is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr