Governments must invest in pre-exposure prophylaxis to end HIV/Aids

By Lahja Nashuuta

NAMIBIA is among countries in Southern Africa that made momentous progress towards achieving the United Nations 90.90.90, the fast track universal targets to end HIV by 2030.

However, based on the US President’s Emergency Plan for AIDS Relief (PEPFAR), Aids remains the number one killer, accountable for 3,900 deaths per year,

The 90.90.90 is a concept introduced by United Nations Programme on HIV/Aids in 2013 as a set target for UN member states to unsure that by 2020, people who are HIV infected will be diagnosed, 90 percent of who are diagnosed will be on anti-retroviral treatment  and 90 percent who receive  ARV treatment will be virally suppressed.

According to this approach, if one can identify the infection early and start treatment on time their will become virally suppressed, then onward transmission of HIV will be prevented and this will have an impact on HIV incidence at a population level. Viral suppression is when a person’s viral load or the amount of virus in an HIV positive person’s blood is reduced to an undetectable level.

PEPFAR reveals that Namibia is close to achieve 90.90.90 targets.

The country has managed to test 300,849 during 2015/2016 fiscal year while 14,961 new HIV positive people were identified and placed on ARV treatment.

According to the Ministry of Health’s Prevention of Mother to Child Transmission (PMTCT) programme, the country has recorded 86 percent reduction of new HIV/Aids infections countrywide during the 2015/2016 fiscal year.

The remarkable expansion in availability of antiretroviral therapy (ART) in Namibia over the past two decades has transformed HIV infection into a manageable chronic condition. People living with HIV virus now live long and healthy lives on treatment that is simpler, safer and cheaper. The WHO also ranked Namibia among the top African countries in ARV delivery.

By 2015, about 104 531 HIV positive Namibians were on ARV treatment while the number increased slightly over 130 000 in 2016.

There has also been a marked reduction in mother-to-child HIV transmissions over the years from 33% in 2002 to 4,1% in 2015 in Namibia, according to a 2016 Unicef study.

Although progress has been made on the battle against HIV/Aids, at both regional and local levels, a lot still needs to be done for the country to end HIV/Aids by 2030. One of the best strategies that will work for African countries to end HIV is to invest in pre-exposure prophylaxis (PrEP). As of September 2015, WHO recommends that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.

PrEP is the use of an anti-retroviral medication to prevent the acquisition of HIV infection by uninfected persons especially those that are at substantial risk of getting it to prevent HIV infection.

Among the people at risk of getting it to prevent HIV infection are women and young girls , gay and bisexual men, commercial sex workers, those that are in violent relationships and street kids.

According to WHO, PrEP may either be taken orally, using an anti-retroviral drug available for treatment of HIV infection, for instance Truvada which contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.

PrEP can be used topically as a vaginal gel containing tenofovir.

When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent.

The American government’s iPrEx trial conducted in South Africa, indicates that Truvada reduces the infection risk among gay and bisexual men by 44 percent on average, if taken once a day.

Of course PrEP is already available in most of SADC countries but available only to the privileged few due to affordability.  Truvada is expensive and it is only found in private health sector.  In South Africa, it costs about R475 while in Namibia without insurance, PrEP costs about R1 300, a price that millions of poor people in Africa cannot afford.

Therefore government, together with assistance from private sector international development agencies such as PEPFAR,  can afford to deliver Truvada where it is needed the most.

May 2017
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