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Self-Testing for HIV/AIDS In The Dominican Republic

HIV/AIDS in The Dominican Republic
HIV/AIDS in the Dominican Republic is on the agenda of the Pan American Health Organization (PAHO) and HIV/AIDS has been the focus of the Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections 2016-2021. The goal of the plan is to end HIV/AIDS in many regions of the Americas, including the Dominican Republic, by 2030.

From 2010 to 2019, HIV cases have reduced to 13 a year and the number of deaths has gone down by 4,000 over the years. Female sex workers are a portion of the population the epidemic affects; they accounted for 37% of new infections in 2019. Less than 30% of individuals do not know they have an infection and about one-third receive a late diagnosis. Over 200,000 were getting antiretroviral treatment in 2019.

HIV Diagnosis Decline

HIV/AIDS in the Dominican Republic has seen an advancement in health through more testing and the option of antiretroviral treatments. The options of PrEP, pre-exposure prophylaxis, and PEP, post-exposure prophylaxis, have contributed to the decline of infections. The COVID-19 pandemic has put a dent in the success of the decline of HIV/AIDS.

The pandemic is changing the social landscape and interaction of people through social distancing measures. Access to medical personnel has also experienced strain because of rising and new COVID-19 infections. When comparing 2019 to the current pandemic, the diagnosis of HIV has reduced by the thousands in the Dominican Republic. According to PAHO, “Self-testing is a key strategy for reaching the U.N. goal of having 90% of people with HIV know their status.”

PrEP and PEP

PrEP and PEP are two types of antiretroviral treatments that people can use to prevent HIV transmission. Individuals can take the antiretroviral treatment PrEP before HIV infection and it is available through two brands. Meanwhile, one can take PEP after an HIV infection and must take more than one medication. The CDC suggests that individuals consult with a doctor for more information. While both treatments are important, PEP offers more because sexual assault victims can use PEP or those who had a workplace accident. Advisories state that one should take PEP within three days of a dire situation and complete treatment within a month. Both treatments are highly effective with PrEP reducing HIV transmission from sex by 90% and PEP reducing risk by 80%.

HIV Self-Testing Market

The HIV self-testing market looks promising on a global scale especially with  HIV/AIDS in the Dominican Republic. Globally, there is a necessity and high demand for rapid diagnosis of HIV in many regions including Latin America. Self-testing is a better alternative because one can do it privately and it is less risky because it will prevent exposure to the COVID-19 pandemic. The self-testing market will grow more between 2020 and 2025. Self-testing will experience a great impact through government investments in healthcare worldwide. The HIV self-testing kit collects samples through blood, saliva and urine. In HIV testing, blood samples provide the most accurate read. According to MarketWatch, “The self-testing market in Latin America is anticipated to reach a value of 51.24 million USD in the year 2025.”

The COVID-19 pandemic has undoubtedly impacted the fight against HIV/AIDS in the Dominican Republic. However, despite HIV/AIDS’ prevalence, antiretroviral treatments and opportunities to self-test should result in improvements.

– Amanda Ortiz
Photo: Flickr

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Treating HIV in West and Central Africa

treating hiv in west and central africa
As of 2017, 1.8 million adolescents around the world are living with HIV. This accounts for five percent of total HIV cases. Approximately 1.5 million, or 85 percent, of these adolescents, live in Sub-Saharan Africa. Of this, 61 percent live in Eastern and Southern Africa and 24 percent live in West and Central Africa. The region with the second-highest HIV rates for adolescents in the world is West and Central Africa. Ending HIV in West and Central Africa requires strong national and international efforts to protect and treat children and adults.

One of the largest problems in the region is a lack of HIV testing. According to Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa, a majority of children living with HIV are not receiving the proper care because they have never been tested and do not know they have the disease.

One way to resolve this is to ensure testing is being done at primary health facilities in communities, with a family-centered approach. It is equally important to increase testing and treatment for pregnant women. Only 47 percent of pregnant women with HIV in West and Central Africa were able to use antiretroviral medicines, which prevent transmission to the unborn child.

Gender Matters

Among adolescents, there are often gender disparities in HIV infections. In many parts of the world—including South Asia, East Asia, the Pacific, Latin America, the Caribbean, the Middle East and North Africa—more boys than girls between the ages of 15 and 19 were newly infected in 2017. Whereas in West, Central, Eastern and Southern Africa significantly more girls than boys were infected. In West and Central Africa, 66 percent of the new were girls, while only 34 percent were boys.

Women and girls in this region are particularly at risk of HIV because of cultural, social and economic inequalities. They are less likely to attend school. Girls that are uneducated are twice as likely to become infected with HIV than girls who have attended school. Additionally, uneducated girls are at a greater risk for partner violence, increasing the risk for HIV.

Access to healthcare is also a significant issue. Women’s inability to see a healthcare provider prevents life-saving testing and treatments. Approximately 50 percent of girls and young women in Sub-Saharan Africa are not allowed to make personal health decisions.

International Efforts

Ending HIV has long been a focus of international humanitarian organizations. Recently, with the increased focus on preventing HIV infections among adolescents, UNAIDS created ALL IN! This collaboration improves knowledge about HIV, as well as how it can be prevented and treated. The goal is to reduce new HIV infections by 75 percent by 2020, aiming for ending the epidemic by 2030.

UNAIDS reports that HIV has already decreased in some of the most severely affected countries due to the adoption of safer sexual practices by adolescents. Often, school is crucial to providing the necessary sex education.

Efforts to reduce HIV in West and Central Africa is not only being done by international organizations such as UNAIDS; governments and their partners are taking initiatives to better prevent and treat HIV in youth and adults.

In Côte d’Ivoire, the government made the decision to stop charging people for HIV testing and treatment services. Fees have long been a barrier for those who live in poverty. Currently, only 46 percent of those in Côte d’Ivoire living with HIV were accessing treatment. Hopefully, this initiative will begin to increase this number, helping nearly half a million people.

Treatments and Strategies

Those who are at a high risk of HIV in West and Central Africa but have not yet contracted the disease can take the pre-exposure prophylaxis (PrEP) regimen. A pilot study is taking place in Burkina Faso, focusing on providing this preventative treatment to the most vulnerable. This includes homosexual men, who often avoid medical treatment due to the stigma surrounding their sexuality.

Once the study, which began at the end of 2018, is completed the plan is to expand PrEP across the nation and, eventually, the entire region. Benjamin Sana, a participant in this pilot study, is thankful for the treatment and believes that PrEP has the potential to save lives.

In response to a new survey, Muhammadu Buhari, Nigeria’s president led the development of a Revised National HIV and AIDS Strategic Framework for 2019 to 2021. Since 2010, Nigeria has tripled the number of people who receive HIV treatment and adopted an effected test and treat policy in 2016.

The new strategy aims to ensure services are being delivered to the people who need them the most, even in remote areas with less health care access. One of their primary goals is to ensure that no more children are born with HIV in Nigeria, according to the president.

These efforts in Côte d’Ivoire, Burkina Faso and Nigeria, as well as other countries in the region, will hopefully have a significant impact on the future of HIV in West and Central Africa, saving thousands of lives.

– Sara Olk
Photo: Flickr

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Free PrEP in Cuba Combats HIV

Free PrEP in Cuba

In April 2019, news broke that Cuba passed a bill making pre-exposure prophylaxis (PrEP) free. PrEP is a drug that significantly reduces the chances of contracting HIV/Aids. Free PrEP in Cuba could reduce the number of those infected and improve the lives of those most susceptible to the virus. Cuba’s history with HIV is extensive and controversial, with practices considered inhumane, yet Cuba’s desire to “better study” to eliminate the virus has always been prevalent.

Cuba’s History of HIV

In 1988, The Los Angeles Times published an article detailing the quarantine that occurred in Cuba. The article states that “one-third of the nation’s 10.2 million people” were tested for HIV, and 270 Cubans had the virus. Cuban officials supported the quarantine, though many found this tactic controversial.

In 2015, Cuba became the first country in the world to be certified by the World Health Organization for the elimination of mother-to-child transmission of HIV and syphilis — elimination defined as only 50 babies per 100,000 live births having HIV. This milestone is a precursor to eradicating the virus for generations to come.

There are currently 234 cases of HIV in Cuba and 30 cases being presented each year. Sixty percent of all HIV cases are derived from Cardenas and the capital city, Matanzas.

What is PrEP?

Pre-exposure prophylaxis (PrEP) is medication for people who are at very high risk for HIV. If taken daily, the medication could reduce the risk of contracting HIV by 90 percent; for those injecting drugs, the treatment could reduce their risk by 70 percent. Although PrEP reduces the risk of acquiring HIV, it does not erase the need to practice safe sex.

The pill has been 99-percent effective against the virus. In the U.S., there have only been two cases in which people contracted the virus while taking the pill, and the strain of HIV that they had was resistant to treatment.

Present Day Cuba

Free PrEP in Cuba became possible through the Pan-American Health Organization (PAHO), an agency of the United Nation, partnered with Niura Pérez Castro, who is head of the municipal program for preventions of STDs, HIV, AIDS and hepatitis.

The prevention medication has already been supplied to 28 people in Cardenas and is available to whoever needs it. For those who are HIV negative and wish to partake in the program, the Center for Prevention and Control of STIs, HIV and AIDS in Cárdenas evaluates people’s HIV status to make sure they could take the prevention medication.

Cuba’s battle with HIV has been extensive and controversial, but with strong determination, they have made strides. Free PrEP in Cuba and the end of mother-to-child transmissions promise a brighter future for generations to come.

– Andrew Valdovinos
Photo: Flickr

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Five Solutions for Reducing HIV in South Africa

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

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How Doctors Without Borders is Fighting HIV in Mozambique

HIV in MozambiqueDoctors Without Borders (DWB) is an international organization that works to improve global health conditions. One of their current missions is fighting HIV in the sub-Saharan African nation of Mozambique. In Mozambique, one in ten adults is estimated to be HIV positive. DWB is focusing its efforts on increasing treatment and reducing the spread of the disease for sex workers and truck drivers — two demographics that are particularly at risk for infection. Their highway corridor project is estimated to reach and positively impact 3,800 sex workers and 4,500 truck drivers.

In the port city of Beira, cargo trucks are continuously moving through docks, loading and unloading cargo. The cargo is then transported to many areas of central and southern Africa. This highway corridor used for cargo transportation is also at risk for spreading HIV. DWB offers weekly HIV testing and counseling for truck drivers along the highway as far as the border of Malawi. Additionally, the organization is responsible for distributing free condoms at truck stops.

The organization has also implemented several strategies for sex workers, who are ten times more likely to be HIV positive than the general population.

Most strategies fighting HIV in Mozambique focus on educating these workers and increasing access to HIV prevention and treatment. Another important tactic includes distributing free condoms to women who engage in sex work. DWB also encourages sex workers to get tested for HIV and even provides on the spot testing in Beira.

If a woman’s test result is negative, she is offered the option to join a program called PrEp, which stands for pre-exposure prophylaxis. In this program, patients receive an anti-AIDS drug that aims to block the virus in women who face a high risk of infection. Although PrEP is relatively new for fighting HIV in Mozambique, it has been shown to significantly reduce one’s chance of infection.

If tests results come back positive, women are referred to a clinic for further treatment. They also have a chance to talk with DWB’s “peer educators,” who are current or former sex workers employed by DWB to speak publicly about HIV prevention and treatment. Women feel comfortable talking to them because they do not make them feel ashamed of their work and all information discussed is kept confidential.

Hearing HIV discussed in public settings greatly reduces the shame and discrimination that is often associated with the disease. In 2010, Mozambique experienced a 58 percent increase in the number of people receiving antiretroviral treatment for HIV. This does not reflect an increase in the number of people infected, but rather an increase in willingness to be tested and receive treatment.

To increase access to treatment, DWB employs people to speak publicly about their own experiences in order to reduce shame surrounding the issue, which is a key step in fighting HIV in Mozambique. The organization also offers a training program for nurses that will allow them to be able to prescribe antiretroviral treatments for patients. Not only does this increase access to treatment, but it also creates jobs and more self-sufficient communities.

Both sex works and truckers in Mozambique often engage in unsafe sex practices that make them vulnerable to HIV infection and transmission during their travels. Through the numerous initiatives mentioned above, DWB is working to improve the quality of life for these two groups as well as for all HIV patients.

– Nathaniel Siegel

Photo: Flickr