HIV/AIDS fight takes a knock

MASERU – LESOTHO is one of the countries that has recorded commendable progress in the fight against HIV/AIDS, eight years ahead of the 2030 target which seeks to end the HIV/AIDS epidemic as a public health threat.

Compared to other developing countries, Lesotho achieved the 90-90-90 target in 2020, which requires that 90 percent of all people living with HIV will know their HIV status, 90 percent of those diagnosed will receive sustained treatment, and 90 percent will have viral load suppression.

But, many warn that such success is no reason for complacency.

According to official figures, the country recorded 7,700 new HIV infections in 2020, while 280 000 Basotho are living with the virus.

Be in the Know, an online HIV magazine, says at least 4,700 Basotho died of AIDS-related illnesses in 2020, the latest available statistics.

With 1.5 million new HIV infections recorded across the world in 2021, UNAIDS Country Director, Pepukai Chikukwa, says the virus remains a crisis globally. The figure is one million above the global 2020 target set at 500 000 per year.

“We are failing in terms of the target that we set ourselves,” Chikukwa said.

Despite effective HIV treatment and tools to prevent, detect and treat opportunistic infections, she said 650 000 people died of AIDS-related illnesses globally as the HIV pandemic took a life every minute on average.

“During the last two years of Covid-19 and other global crises, progress against the HIV pandemic has faltered,” she said.

Chikukwa said globally, new infections dropped by 3.6 percent only between 2020 and 2021, “the lowest annual decline in new HIV infections since 2016”.

“From 2016, our declines have been averaging 10 percent or more.”

“Resources have been shrinking, with many major bilateral donors reducing international assistance for AIDS, some by over 57 percent,” she added.

Chikukwa said low and middle income countries, including Lesotho, are struggling under the greater fiscal burdens caused by the Covid-19 pandemic.

Four decades into the HIV response, she said, inequalities persist for the most basic services like testing, treatment, condoms and even more so for new technologies.

“These inequalities have been further exacerbated in the last two years.”

She said young women in Africa remain disproportionately affected by HIV, while coverage of dedicated programmes for them “remain too low”.

In 19 high burden countries in Africa, dedicated combination prevention programmes for adolescent girls and young women are operating in only 40 percent of the high incidence locations, she said.

“Only a third of people in key populations, including gay men and other men who have sex with men, transgender people, people who use drugs, sex workers and prisoners have regular access,” she said.

“Key populations face major legal barriers including criminalisation, discrimination and stigma.”

In the East and Southern African countries, including Lesotho, adolescent girls and young women are three times likely to acquire HIV as adolescent boys and young men, she said.

Chikukwa said 4 200 adolescent girls and young women aged between 15 and 24 years become infected with HIV every week.

Chikukwa said the gendered HIV impact, particularly for young African women and girls, occurred amidst a disruption of key HIV treatment and prevention services, millions of girls and boys are out of school due to the Covid-19 pandemic and spikes in teenage pregnancies and Gender-Based Violence (GBV).

“We have only eight years left before the 2030 goal of ending AIDS as a global health threat,” Chikukwa said.

“Therefore, economic, social, cultural and legal inequalities must be addressed as a matter of urgency,” she said.

“In a pandemic, inequalities exacerbate the dangers for everyone.”

She said the end of HIV/AIDS can only be achieved if we tackle the inequalities.

Leaders, she said, need to act with bold and accountable leadership and “all of us must do all we can to help them”.

Chikukwa said this as Lesotho joins the world in the commemoration of World AIDS Day today under the theme “Let’s equalise: HIV & AIDS services for all. Leave no one behind”.

“The ‘equalise’ slogan is a call for action,” she said.

The National Aids Commission (NAC) Chief Executive Officer (CEO), Lebohang Mothae, said Lesotho has made remarkable progress in its HIV/AIDS response as reflected in LePHIA 2020 and the medium term review of the national HIV & AIDS strategic plan.

“We are on the right track but we are also in a fragile state because if we don’t, in any way, attend to these inequalities we will regress,” Mothae said.

She said although Lesotho has achieved beyond the 90-90-90 targets, “we realised that the progress is slow”.

“Because of the risks that are persisting from time to time, we are actually going to be in danger if we don’t act at a faster pace than the inequalities and the risks that we are confronting.”

She said gender inequality needs to be dealt with decisively.

“We see it culminating into GBV, which include sexual offences and intimate partner violence, the inequality that leads to having a high number of early and unintended pregnancies, early marriages and the type of inequalities that put a huge risk adolescent girls and young women,” she said.

She said some parts of the society still have low access to and uptake of services.

“In some services for young people, we are still performing lower prevention services and now we have to accelerate all the efforts geared towards closing that gap that we see between our young people.”

Mothae said key populations are another group of concern.

She said they are also disproportionately affected as ease of access of services is still a challenge and yet HIV prevalence amongst them is high.

“If we don’t attend to this inequality of denial to access services, there is going to be a high risk to the general public.”

She said geographical location is another inequality experienced in Lesotho.

“These inequalities and barriers that affect different populations drive new infections…we need to work hard and accelerate all the efforts to bring everybody to make them central to the response.”

Mothae said: “As long as we leave anyone behind, we are at risk. We need to start reprioritising HIV and put it back on a national development agenda.”

According to LePHIA 2020 statistics, there is high prevalence among women aged 15-44 at 29.4 percent, 71.9 percent among female sex workers while 32.9 percent among male sex workers.

The report shows that 80 percent of new infections are among young women aged 15-34 and the largest number of new infections occur among women who have never married (29 percent) and 26 percent among uncircumcised men who never married and 13.5 percent among couples with male partners of positive status.

’Mapule Motsopa