Morenike Oluwatoyin Folayan
New HIV Vaccine and Microbicide Advocacy Society
25th August 2019
A new study published by the Global Burden of Disease 2017 HIV Collaborators on the 19th of August 2019 in the Lancet HIV journal (https://www.ncbi.nlm.nih.gov/pubmed/31439534) reported that despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality.
The study used a modelling strategy for each country to assess the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories.
The study authors found that global HIV mortality peaked in 2006 with 1·95 million deaths and decreased to 0·95 million deaths in 2017.
Also, new cases of HIV globally peaked in 1999 (3·16 million) and since then have gradually decreased to 1·94 million in 2017. Between 2007 and 2017, the global age standardised annualised rate of change in HIV incidence decreased by 3·0%.
The confluence of these trends produces a steady increase in the total number of people living with HIV. Prevalence has increased from 8·74 million (7·90–9·68) people living with HIV in 1990 to 36·8 million (34·8–39·2) in 2017, of whom 40·5% (37·8–43·7) were not on ART.
The decrease in HIV related mortality, new HIV infections and ART scale-up globally, resulted in a steady increased in the HIV prevalence, from 8·74 million people living with HIV in 1990 to 36·8 million people living with HIV in 2017. Of the total number of people living with HIV in 2017, 40·5% were not on ART.
The estimates highlight differences in HIV burden between males and females and between different age groups. Females aged 30–34 years had the highest percentage of HIV deaths of all female age groups while males aged 35–39 years had the highest percentage of HIV deaths of all male age groups.
New infections among women were mostly among younger adults, with 20·8% of new infections occurring among females aged 20–24 years in 2017, relatively unchanged from the incidence in 2007 (20·9%, 19·8–22·1). In 2017, males aged 25–29 years had the highest incidence of all male age groups, accounting for 18·6% of new infections that year, which is a substantial change from 2007.
Although HIV infections in children have decreased substantially with the scale-up interventions for prevention of mother-to-child transmission, in 2017, 139 555 new infections were in children younger than 1 year, and 122 254 HIV deaths were in children younger than 15 years.
Most HIV deaths in people younger than 15 years are in children younger than 5 years, but this proportion has decreased from 82·1% in 2007 to 63·4% in 2017, showing the increase in lifespan for children who are HIV positive.
Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini.
In Nigeria 128 000 females and 88 800 males were newly infected with HIV in 2017. Also, 87 500 females and 81 600 males died of HIV related deaths in Nigeria. The age standardised annualized rate of change in HIV new infections between 2000 and 2017 was –5·1% while that age standardized annualized rate of change in HIV related deaths was –5·2%.
The study concluded that although great progress has been made in reducing HIV related incidence and mortality since their peaks earlier in the epidemic, only 54 countries are on track to meet the 2020 target of 81% ART coverage (90% started, 90% retained), only 12 countries are expected to meet the 2030 target of 90% ART coverage (95% started, 95% retained). Also, fewer than ten countries will meet the mortality or incidence targets in 2020 and 2030.
The authors noted that although treatment access and prevention mechanisms exist and can be widely implemented, inadequate ART coverage and adherence could perpetuate the AIDS epidemic.
They also note that that decreases in mortality have out-paced decreases in incidence, therefore much needs to be done to prevent new cases of HIV. To truly end the HIV epidemic, the pace of progress needs to increase. Strides in this direction can be made by continuing to expand universal access to ART and increasing investments in proven HIV prevention initiatives that can scale to have population-level effects.
A prior study conducted by the Global Burden of Disease Health Financing Collaborative Network published on May 5 2018 in the Lancet (https://www.ncbi.nlm.nih.gov/pubmed/29678342), had identified that though the total health spending per country had increased worldwide from 1995 to 2015, there had been a decline in development assistance for health continue, including for HIV/AIDS. The authors also warned that additional cuts to development assistance could risk slowing progress towards global and national health goals including those related to HIV control.
1. Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995-2015.Lancet. 2018 May 5;391(10132):1799-1829
2. GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV. 2019 Aug 19. pii: S2352-3018(19)30196-1.
David Ekpenyong Ita
21 August 2019
Youths are the leaders of today and not of tomorrow. The youth of any country need to think and see themselves as essential for country growth and development in the present and not the future. This will enable them contribute their quota for national development. This change in thinking paradigm can change through investment in the education of the youths.
For 2019, the Youth International Day tagged “transforming education” re-echoes this. Youths need education to facilitate their access to essential integrated sexual reproductive health education. This is accessible through integration of such education into the formal school curriculum.
As an advocate for sexual reproductive health (SRH) and HIV prevention, I strongly push for transformation in the educational sector to improve youth education on their sexual health and rights.
I strongly advocate for the reduction in the age of access to SRH-HIV services.
Youth are urged to take advantage of the “NOT TOO YOUNG TO RUN BILL” and the Disability Bill to ensure they are involved and equally represented in political matters that are related to their population.
Youth should advocate for policies that have direct positive impact on their health and wellbeing without religious sentiments, ethnicity, HIV status and gender bias.
Finally, a youth without education is like weapons without bullets. Education for the youth is critical to enable them unleash their potentials. They should access education and make the case for education to be accessible to all young persons
Long live youth! God bless our youths.
NHVMAS join other allies to call for a reduction in the age of access to sexual and reproductive health services to 14 years. The continued mix in the age of maturity as declared by the Nigeria constitution, and the age of access to sexual and reproductive health services is a big gap in addressing sexual and reproductive health concerns in Nigeria. The demographic health surveys consistently show adolescents become sexually active by age 13 years. Adolescents do not become sexually active with parental consent. Yet, access of adolescents to sexual and reproductive health services, including those that can prevent them to unwanted outcomes like contraception, have to be with parental consent in most of the public and private clinics in Nigeria. Though health care workers recognise this concerns, they are unable to work outside the ambit of the law. A policy directive is required. The age of 14 is appropriate based on research evidence – at this age, adolescents make as much judgemental errors as adults. At the joint meeting of concerned allies on the need to reduce the age of access to services in Nigeria hosted by EVA in collaboration with APYIN and NHVMAS, there was a consensus to develop a roadmap for actions on this issues.
New HIV Vaccine and Microbicide Advocacy Society
25th July 2019
Members of Civil Society Organisations working in the 36 +1 States in Nigeria recently made a loud call for the State governments in the country to support public access and use of HIV self-testing kits.
In a communiqué released at the end of a one day training on the policy, guidelines and use of HIV-self testing services, participants welcomed the availability of guidelines and kits for HIV-self testing. They identified the need for extensive public education on the use of the test-kits to address possible concerns, myths and misconceptions about the tool. One of this had to do with the use of the test-kits of HIV positive individuals who are virally suppressed – the test-kits shows a HIV seronegative result for these individuals. There were concerns raised about misconceptions for such results in a clime where there charlatans who proclaim miracle cures for HIV infection. Public education needs to explicitly address the appropriate use of the kit for HIV self-testing, diagnosis and treatment access.
Speaking about the communique released after the meeting, Walter Ugwuocha noted that the constituency he represented which is CISHAN, was extremely enthused by the prospect wide public access to the HIV self-testing kit holds. He stated: wide public access will enhance the opportunity for the country to close the huge HIV testing gap in the country. As we raise towards the global 90-90-90 target by 2020, we can promote the diagnosis of HIV in persons skeptical about testing in public spaces. They can now test in the privacy of their homes and access services when they identify they need treatment.
Participants at the training were concerned about cost of the test kits as this was not to be a deterrent for access by the populations most vulnerable to HIV infection in Nigeria including adolescents.
Florita Durueke, the Program Manager for the New HIV Vaccine and Microbicide Advocacy Society also shared her concerns. She notes: my organization have been pushing hard for adolescents access to pre-exposure prophylaxis (PrEP). This implies that with public awareness about and access to HIV self-testing kits, adolescents will likely buy and self-test for HIV without parental consent. This has implications for adolescents: how do we then facilitate access of adolescents who identify they need HIV treatment or PrEP? Also, how do we start to provide active counselling for persons who self-test and are HIV negative but are eligible to PrEP? We have continued to ask the government to develop a PrEP roadmap for the country. Now, access to HIV self-testing is throwing up more dusts and concerns for me and my organization about the implications for adolescents. We need to concretely address the issue of universal health access and the poor coverage of the national health insurance scheme, age of access for sexual and reproductive health services, and the barriers created with the institution of user fees for HIV treatment access.
HIV self-testing kits will soon be accessible in public spaces including pharmacies and NGO created outlets.
Radical Patient Self Management will address current health challenges in Africa.
The need for differential care to address health challenges including the low ratio of medical doctors to patients in developing countries across Africa necessitated a debate during the just concluded INTEREST 2019 conference which took place in Accra, Ghana. Divers views exist as to whether radical patient self-management will address the current health challenges in Africa.
Scientists argue that while radical patient self-management could be seen as differential care especially for patients who have shown adherence to drugs over an extended period of time. However, there is a need to have a clear model for which patients would be placed on radical self-management.
Radical self-medication is convenient for patients. It is as well economical for both the healthcare system and the patients. This would reduce frequent facility visits for patients who have demonstrated satisfactory adherence to drug regimen over time thus create more time for doctors to see patients who need more frequent visits to the facility for urgent medical care. However, patients on radical self management could be followed up through targeted facility visits. One of the conference attendees, a woman who has been living with HIV over 17 years and adhering to ARV said ‘’I still feel worrisome that after 17 years of living with HIV, I still have to visit the hospital regularly to get ARV and see the doctor… such time should be rather focused on others who need regular facility visits than myself’. According to her, it best work for her to be on radical patient self management as this saves time and resources for her and the healthcare provider.
In other to sample the audience views on the topic of debate, voting was done before and after the debate on whether Radical Patient Self Management will address current health challenges in Africa. Out of the 106 delegates that voted prior to the debate, 60 (56%), 35 (33%) and 11 (10%) voted Agree, Disagree and Undecided respectively. Similarly, voting result after the debate showed that more conference delegates (60%) agreed that Radical Patient Self Management will address current health challenges in Africa as seen in the post-debate voting of 60%, 30% and 5% for agree, disagree and undecided respectively.
Apart from adherence to the drug regimen, there is a need to consider other issues including patients knowledge and access to necessary health information, effectiveness of the M&E system for relevant data collection. There is also a question of who qualifies for radical self-management? Other socioeconomic considerations including security, poverty and other related factors that may affect patient’s mental health are also critical as these issues would necessitate for occasional visits to the facility for proper patient management.
2017 LeNNiB Champion
The Nigerian population is disproportionately young with over 50 million Nigerians being between the ages of 10 and 24 years and vulnerable to sexually transmitted infections including HIV and AIDS, unwanted pregnancy, unsafe abortion, and gender-based violence. Factors such as judgmental attitudes of healthcare service providers, socio-cultural norms, adolescents own fear and shame, disapproval from parents and community gatekeepers still contribute to adolescents’ inaccessibility of sexual reproductive health information and services.
Hence, study has shown that the integration of adolescent youth-friendly health services into primary health care centers have facilitated access of young people to sexual reproductive health information and services. Although this is only made possible when certain global standards are met in ensuring that the services provided are “youth-friendly”.
What makes these services provided youth-friendly, find out below:
Stigma-Free: service providers should be trained to provide youth-friendly services. They are not to discriminate, judge or stigmatize young people that want to access these services.
Convenient location and opening hours: The facilities should be easily accessible to young people and the opening hours should be convenient for them.
Privacy and Confidentiality: Young people should be given utmost privacy and assured of topmost confidentiality. They should feel safe and free to discuss any and all issues bothering them as regards their health and wellbeing.
Low/No cost: Young people should be provided with services for little/no cost at all.
Active youth engagement: Young people should be engaged at all levels of the intervention, from the designing to implementing. Their views and opinion should be sought. They can also be engaged as adolescent and youth-friendly health services promoters and peer educators as well as volunteers at the centers.
It is our collective effort as Government, CSOs, NGOs, and young people to ensure that young people have access to adolescent youth-friendly health services.