Although notable progress has been made globally in fighting HIV and Aids, the world still has a long way to go in combating the epidemic, a United Nations Programme on HIV and Aids (UNAids) senior official has said.
Dr Catherine Sozi, regional director for UNAids in East and Southern Africa (ESA), told delegates at a meeting convened by Champions of a HIV-Free Generation on Sustainable Innovative HIV Financing here, that a lot still needs to be done in response to HIV and Aids.
“Just ahead of the recent July 2018 International Youth Conference, we at the UNAids launched the Miles to Go Report as a mid-term appraisal of progress towards the 2020 fast track targets. The report is very clear in its message, at the half-way point to the target, the pace of progress is just not matching the global ambition,” she said.
Warning that the global Aids response was at a precarious point, Dr Sozi said partial success in saving lives and stopping new HIV infections is giving way to new complacency.
Yet all is not lost.
Dr Sozi said the report also states that accelerated, strategic, resourced action can still put the world back on course to reach the 2020 targets whose objective is to ensure that the year 2020, 90 percent of all people living with HIV will know their HIV status. 90 percent of those diagnosed with HIV should receive sustained anti-retroviral therapy while 90 percent of those on ART must be virally suppressed.
She said the timing of the dialogue, which brought together the Champions and other stakeholders, who included Cabinet Ministers, Members of Parliament, staff of the SADC Parliamentary Forum and heads of national Aids authorities, was opportune.
The dialogue allowed delegates to assess what they could do better in terms of closing gaps, breaking barriers and righting injustices to achieve the critical 2020 targets as well as end Aids as a public health threat.
It is crucial to protect the gains realised so far in the global Aids response; and to ensure sustainability.
Dr Sozi said the East and Southern Africa is home to nearly 19,4 million people living with HIV, of which 60 percent are women.
She acknowledged that domestic and international investments have led to significant increases of people on anti-retroviral treatment (ART,) something that was not thought to be possible at the turn of the millennium.
“This scale-up on ART has actually led to a reduction in Aids-related deaths, with more women on treatment than men in the ESA region. However, even with these huge investments, significant gaps still remain.”
She said there is still need to identify the approximately 1,7 million people living with HIV. Additionally, about four million people living with HIV are not yet on treatment. Of the ones on treatment, only 48 percent have achieved viral suppression.
“As we strive to ensure that people living with HIV have good quality lives, we have failed to significantly turn off the tap of new infections. There is a very slow decline in new HIV infections in this region and this is uneven among countries and population groups.”
Adolescent girls and young women, key populations including sex workers, men who have sex with other men, trans-gender persons and people who use drugs, continue to have disproportionally high rates of infection and access to existing services does not meet their demands, according to Dr Sozi.
She said it is evident that many people, including young people who move from rural areas to peri-urban areas, are still marginalised.
Dr Sozi said drivers of HIV such as gender inequality and violence increase the risk of HIV and undermine the progress in enabling access to prevention, treatment and care services.
The UNAids official said many people are still struggling to access food and nutrition, education, housing and clean water.
“We are simply not moving fast enough. Bio-medical interventions by themselves will not protect the people left behind. Are our current resources being invested in programmes that will enable the very well-known bio-medical interventions to work? Can we commit any national resources to ensure that what we have done so far is sustained and that it goes beyond?”
Speaking at the same occasion, Dr Mbulawa Mugabe, the UNAids country director for South Africa warned that the region would not be able to meet the interim target of half-a-million new infections by 2020 at the pace at which infections are increasing.
“We cannot talk about sustaining this response if we do not deal with this prevention crisis. If we cannot deal with the vulnerability of women and girls in this region, then we are fighting a losing battle.”
“We are saving lives, but we are not sufficiently reducing new infections. We need to reinvigorate our HIV response, particularly on prevention. That will only happen if we take a more integrated and strategic approach towards HIV.”
However, he acknowledged the progress made so far.
“There has been a lot of progress in terms of saving lives, putting people on treatment and in terms of the targets that were set under the 90-90-90. We have been making significant progress,” Dr Mugabe said.
He said in terms of global 90-90-90 targets, at least 80 percent of people living with HIV are aware of their status. Of those, 81 percent are on treatment. However, there are approximately 15 million people unable to access treatment.
“These are the people that we need to ensure gets on treatment. We need to fast-track our services to reach them.
“In other words, primary prevention has not delivered the dividend we want. The Champions of an HIV-Free Generation have also made prevention their key strategic objective.”
Dr Mugabe noted that several countries have made commitments in responding to HIV.
Sustainable Development Goal 3, which seeks to ensure healthy lives and promote well-being for all at all ages, fast tracks the international community’s efforts to end Aids by 2030.
Several governments have developed their own national strategic plans to attain this goal.
“The African Union also took this goal as part of its catalytic framework for ending Aids, TB and Malaria, which sets out very specific targets for the African continent to end Aids by 2030,” he said.
Dr Mugabe said current statistics indicate that globally, at 30 years into the HIV pandemic, almost 40 million people are living with HIV.
“In terms of new infections, we have almost two million new infections per year. In terms of Aids-related deaths, there has been some progress at less than a million, but these are our fellow human beings.”
He said the epicentre of the global HIV pandemic remains in sub-Saharan Africa.
“This is where the focus need to be if we are to turn this epidemic around.”
Turning to HIV financing, Dr Mugabe said contrary to widespread beliefs, the HIV response in low-income countries has been largely driven by domestic funding.
“Today, 56 percent of the expenditure on HIV in low and middle income countries is from domestic funding. The question is, do we continue to push our Treasuries to put in more than they have already done? What needs to change? International funding has been the mainstay of the response in terms of international solidarity.”
Dr Mugabe said there are about 44 countries classified as low and middle income economies.
“Member States can not constantly look up to their national treasuries for resources. What happens if there are no commitments from the international community?
“Countries need to look at efficient and effective ways of using the resources currently on the table. While we continue calling for additional new funds, let’s look at what we have on the table.”
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