Dr Ade Fakoya
Senior Disease Coordinator HIV, The Global Fund to Fight AIDS, Tuberculosis and Malaria
Pictured above: Kigamboni, Dar es Salaam, Tanzania – Skolastica Alphonce, a client, receiving a refill of ARV’s, at a care and treatment clinic in Vijibweni Hospital.
Despite considerable advancements, we must address the areas where we are making less progress in the battle to control HIV as a public health threat. These include young women and adolescent girls in east and southern Africa, key populations including men who have sex with men, sex workers and transgender persons, and high-risk men and boys in HIV prevalent settings.
With over 20 million people on life-saving, anti-retroviral therapy, we have made incredible progress in the fight against one of the world’s biggest health threats: HIV.
However, by the time you have finished reading this article, there will be ten new HIV infections in young women and girls aged 15-24. By the end of the week, this number will have soared to 6,400.
Despite the success of programmes such as the President’s Emergency Plan for AIDS Relief (PEPFAR) DREAMS programme, or the Global Fund’s HER) HIV epidemiological response, there is still a long way to go.
We are not on track to meet our ambitious – but achievable – global goals of reducing the number of new infections to 500,000 by 2020. Currently, they stand at 1.7 million. Nor are we on track to reduce the number of people who die of HIV to 500,000 per year; we’re currently at 1.2 million.
Three areas particularly need attention: the inexorable persistence of new infections in adolescent girls and young women (AGYW), the high prevalence of HIV in key populations (over 50% of all new infections worldwide were in key populations and their partners in 2018) and the late access to services for many heterosexual men in East and Southern Africa.
Getting local: better data = better programmes
What do we need to do differently? Firstly, we need to have much more specific, locally-generated/locally-owned data to drive high quality programming. Understanding the specific needs of the local population, who they are, who is getting infected and the coverage of services, is vital to mounting an effective response. Local community and local facility data should drive programmes. We call this ‘geographical targeting’.
An easy mantra to remember this is ‘population, location and saturation’ – then using this data to understand on whom you need to focus.
People-centred care – “involve us, we’ll tell you what we need”
Providing biomedical interventions alone will not end HIV. Good programmes require a whole range of layered services and being bold in tackling underlying gender inequalities. These inequalities include vulnerability to HIV infection, gender-based violence, educational and economic disadvantage and a lack of involvement in programme development and delivery.
There are now many good examples of community involvement and participation, which are improving the quality and reach of services. Two critical areas for success are the meaningful involvement of AGYW themselves, in the design and monitoring of services, and the tailoring of services according to the varying needs of those accessing treatment and prevention services.