By Lillian Mworeko

Ending AIDS by 2030 may seem to be achievable and indeed it should be! 

Why not? 

We have come from far!  History sometimes is good to help paint the picture of where we have come from, where we are and what the future holds. 

As a country, Uganda has come from far. From being a successful story and leading the world in programming for HIV using the multi-sectoral approach. There was a time when community education and sensitization was high on the agenda including the AIDS drum on major radio and national television station – even though it was really stigmatizing!

Treatment and care

We have come from a point of despair by people living with HIV, where they only waited to die, to a point where Antiretroviral (ARVs) drugs were only accessible to the few individuals like Major Rubaramira and positive living was the next remedy. Then came the time when ARVs became available free of charge and most Ugandans could then be started on treatment. 

The first regime of ARVs saved lives but also crippled many.  Some people became crippled; some had and still are disfigured!  It did not matter as long as one was alive, that was the most important.

Today we are talking about options and choices of ARVs and because of this, we can boast of high level of adherence by People Living with HIV. With the newest on the Uganda shelves being Dolutegravir (DTG), evidence suggest that young people who were challenged with adherence ad retention are doing well – this is because they were given a choice that works for them, where a tablet is taken once a day!

Imagine when the injectable hits the shelves of Uganda, this could be another game changer!

We have enough evidence of what works.  We have enough tools for prevention, care, treatment and supporting those infected and affected.

Globally most countries are no longer registering any new HIV infections vertically (parent to child transmission).

We know what works, what programmes can lead to ending AIDS by 2030; we have the technical people.  What is remaining however is addressing the areas where there are gaps, targeting those critical populations that need to be targeted with services that are appealing to their needs, challenges and options.

Sub Saharan Africa continues to register the highest numbers of infections among adolescent girls and women. In Uganda, 506 Adolescent Girls and Young Women (AGYW) newly contract HIV Weekly.  This is unacceptable!  Something is not right.  Talking about statistics has been normalized.   We mut invest in prevention.  Prevention is key.  Prevention options and choices must be provided so that the unique needs of individuals are addressed.

Adolescent girls and young women face many challenges that make them susceptible to contracting HIV and such challenges include gender-based violence, stigma, discrimination, social cultural challenges and these are compounded by limited space for their participation in decision making processes.

The prevention tools that are on market, do not work for them for example, the male condom is affordable and easily accessible, but it is male controlled and thus an AGYW cannot negotiate for its use even if she wanted.  The female condom, is inaccessible and more expensive and it has been painted bad that even young women would not bother look for it.

Most adolescent girls and young women don’t have capacity to negotiate for safer sex, are economically poor, are socially marginalized and the surrounding environment is unfavorable.

Prevention

Scientists and Researchers have progressed faster than policy/decision makers and programmers.  We thus need the same speed and we will end AIDS by 2030. 

Pre-Exposure Prophylaxis (PrEP) is now available (oral PrEP) and Cabotegravir (CAB-LA) [an injection] has hit the market. The Dapivirine Vaginal Ring (DVR) has been approved for use by World Health Organisation and some countries like Zimbabwe have approved for use both of these products.  Countries like Uganda, need to approve and roll out such prevention tools to reach all people in need, in that way, we are able to provide choices to people as a way of prevention. Any HIV prevention, like any other intervention should take into consideration issues of privacy, confidentiality and convenience.

The DVR is a female-initiated option to reduce the risk of HIV infection. The Dapivirine Vaginal Ring is worn inside the vagina for a period of 28 days, after which it should be replaced by a new ring. The ring is made of silicone and is easy to bend and insert. 

Cabotegravir is an injectable form of pre-exposure prophylaxis that has shown to be highly effective at reducing the risk of HIV acquisition.  The two-month injection is a highly effective method of preventing new HIV infections.

Imagine if such prevention options were fast-tracked by the Country and implementation scaled up, would dramatically reduce infections among young women, key and vulnerable populations who due to several reasons like stigma and discrimination, religious and cultural factors, fear of bill burden would have access to another option of prevention.

So embracing these new prevention tools and methods could lead us to ending AIDS by 3030; this will probably possible if there is remarked domestic financing for health and the HIV response.  At the moment the response is highly shouldered by donors.

The writer is Executive Director, International Community of Women Living with HIV Eastern Africa (ICWEA)