Breaking the HIV/Aids silence

Thirty-two years ago, Prof William Kwabena Ampofo, then a young scientist, performed the laboratory detection of the first case of HIV in Ghana at the Noguchi Memorial Institute for Medical Research.

The discovery which set the stage for the national HIV response was sadly greeted with fear and misconceptions due to the limited information and access to treatment options associated with the discovery.

For years, there was a subtle silence surrounding the HIV epidemic, particularly testing and treatment.

Families who had relatives with the disease disowned them while HIV positive patients lost their jobs because of their status. People who tested HIV positive also went into hiding without treatment because of the stigma attached to the deadly disease.

However, subsequent researches, increased information on preventive measures and protection, and the discovery of HIV treatment drug, gave a sense of relief to patients and began the paradigm shift from a health-oriented response to a multi-sectoral response.

The adoption of the multi-sectoral response was borne out of a global call and a national consensus to align Ghana’s HIV response with the UNAIDS ‘Three One Principles’, that is one national AIDS coordinating authority, with a broad based multi-sector mandate, one agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners; and one agreed country-level monitoring and evaluation system.

Consequently, the Ghana AIDS Commission was established in the year 2000 and later backed by Ghana AIDS Commission Act, 2002, Act 613 to implement the country’s HIV response which has been by four medium term strategic plans.

Through innovative approaches driven by subsequent leadership of the Ghana AIDS Commission and the collective efforts by the health and non-health implementing partners, more and more stakeholders began talking about the HIV prevention testing and treatment.

This resulted in reduced stigma which then translated in increased treatment rates and low prevalence of HIV, currently below two percent in Ghana.

Between 2010 and 2016, a number of adults and children on anti-retroviral treatment increased by 148 percent, a number of pregnant women receiving treatment for prevention of mother-to-child transmission(PMTCT) increased by 81 percent, resulting in a 50 percent reduction in new HIV infections in children aged zero to four years, a number of people receiving HIV testing services increased by 48 percent, new infections in children aged 14 years and below reduced by 46 percent; and AIDS deaths in both adults and children reduced by 40 percent,” UNAIDS data shows.

The country has also achieved TB/HIV integration.

However, within the same period, new HIV infections increased by 21 percent across all ages in the country.

Latest UNAIDS data shows a growth of new infections – 45 percent– in young people aged 15-24 years, yet over the same period globally, new infections reduced by 16 percent with the steepest decline (26 percent) occurring in Eastern and Central Africa.

The report indicates that men are not using HIV prevention services and are not going for the HIV test as much as women are doing; they are accessing treatment late.

“Having a rising trend in new infections at a time when many African countries are seeing significant reductions in new infections calls for renewed national commitment to HIV prevention especially targeting the general population in order to stem the tide,” President Akufo-Addo, Chairman of the Ghana AIDS Commission and Co-Chair of Eminent Advocates of the Sustainable Development Goals, said in a statement at the opening of the National HIV/AIDS and Research Conference in Accra this week.

90-90-90

The UNAIDS set an ambitious treatment target to help end the AIDS epidemic by 2020.

The target, which Ghana is a signatory to, commits the country to ensure that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained anti-retroviral therapy and 90 percent of all people receiving anti-retroviral therapy will have viral suppression.

The UNAIDS Country Director, Angela Trenton-Mbonde, stated that scaling up HIV testing and treatment to reach the 90-90-90 targets is the first game changer in the fight to end HIV epidemic.

“This would be a game changer because Ghana has achieved above 50 percent of the first 90 and just over 40 percent of the second 90, so catching up including with the active involvement of the government paid community health workers in this process is an imperative,” she added.

President Akufo-Addo was certain stakeholders have a shared optimism that ending AIDS is a possibility using the ‘90-90-90’ treatment policy.

“Today, the ‘Treat-all Policy’ adopted in 2016 in line with the WHO guidelines makes every Ghanaian who is diagnosed HIV positive qualified for treatment without reference to his/her CD4 count,” he said.

“Our success at achieving the second and third 90s is largely dependent on identifying at least, 90 percent of all persons living with HIV in the country through testing.

I wish to take this opportunity to encourage everyone resident in Ghana to know their HIV status by having HIV test. Effective HIV prevention at the individual level begins with knowing your HIV status through testing.1

Knowing your HIV status is empowering as it allows you to live an informed life driven by healthy lifestyles. The good news is that whatever the outcome of your test, there are interventions in place to safeguard longevity of your life,” the president urged.

Sustaining domestic funding

UNAIDS reports that declines in new infections are particularly evident in countries with sustained and more strategic domestic investments, which take into account the specifics of local epidemics, increased political leadership and community engagement and scaling up of HIV prevention and treatment programmes.

Ms Trenton-Mbonde hinted that the country’s biggest enemy to the successful fight against HIV is complacency.

She observed that it is easy to be complacent as AIDS in Ghana is not as visible as it is in East and Central Africa, where the burden of the epidemic has been greatest.

The UNAIDS country representative, therefore, pointed out that counterpart funding to donor funding for testing and treatment scale up will have to be maintained, adding that a gradual weaning off donor funding will help to sustain the good results and impact being gained.

“If we do not front-load investments and spend on HIV prevention and treatment, we will pay much more later with higher costs for avoidable illness, deaths and loss to the economy,” she asserted.

Meanwhile, President Akufo-Addo has assured that his government will provide the political leadership and ensure sustained funding for the country to reduce new infections to the barest minimum.

“I am fully awakened to the reality of dwindling donor support to the country for HIV and AIDS programmes. My government has accepted the challenge and is working assiduously to operationalise the National HIV and AIDS Fund this year.

This fund will not only ensure adequate domestic resources for the HIV and AIDS response, but will also front-load the resources needed to make the national response financially self-reliant on a sustainable basis,” he said in the statement.

Game changing actions

To give prominence to HIV prevention, UNAIDS and UNFPA have established a global prevention coalition with a combination of preventive strategies.

The government of Ghana will soon launch the Ghana national prevention coalition and inaugurate champions for the prevention with the support of the UN system.

This campaign will leverage the gravitas and clout of prominent Ghanaians to advance the prevention agenda.

These prominent people, as national prevention ambassadors, will champion the HIV prevention campaign with a strong national coalition made up of government, civil society, private sector, the media, traditional authorities and development partners working in concert.

This campaign coalition is expected to accelerate the comprehensive prevention agenda towards zero new infections.

The Director-General of the Ghana AIDS Commission, Dr Mokowa Blay Adu-Gyamfi, said HIV prevention among women and girls is a priority for the country, “this includes prevention of mother to child transmission of HIV and keeping mothers alive by ensuring they are on treatment.”

“We must not forget key populations which include female sex workers and men who have sex with men and prisoners- the right to health and zero tolerance for stigma and discrimination require that no one is left behind,” she said.