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Slowing the global toll of HIV and Aids

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By Alick Ponje:

LUBA — Communities are often left on the receiving end

She made what she calls the most important and life-changing choice just at the right time. Now, she and her son are living lives in fine fettle.

Emma Dzonzi of Kalengamadzi Village on the outskirts of Lilongwe City was diagnosed HIV-positive when she had already fallen pregnant.

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It was a time when Malawi was still stuck in the past and HIV talk was mostly thrust into the periphery of ideas and associations. The scourge, left to rage by pervasive indifference, was like a cruel monster that should be left to rove out of necessity.

“I decided to defy the trends at that time, 10 years ago, and when I was found HIV-positive, I was immediately put on medication,” Dzonzi recalls.

Her decision—like many others made by those with similar courage—came at a cost. It meant she was put on medication ‘earlier’ than was previously the case when one had to wait for their CD4 count to drop before beginning treatment.

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Although antiretroviral (ARV) medications are said to be cheaper than ever, the overall cost of HIV and Aids care and treatment is reportedly still high.

But decisions, like those made by women who get tested when they fall pregnant, ultimately result in the slowing down of the global toll of the epidemic that has already claimed more than 35 million lives.

“My son was born HIV-negative because I was put on medication and suppressed the virus. I also prevented many other opportunistic infections which are common in people who start medication late. But to me, the most important thing is that I bore a child who is without the virus,” Dzonzi says gratefully.

Her husband died a few years after her son’s birth and she suspects it is because he did not start the medication early enough.

Now, she is fully equipped with the knowledge and skills to take HIV prevention messages to households in her village, a small community acutely hit by the epidemic.

“Apart from talking about mother-to-chid prevention, I also encourage couples to test so that they are put on medication immediately if found positive. They protect their own lives and those of others,” she brags.

The biological argument of treatment as prevention is that ARV therapy (ART) reduces viral load and lower concentration of HIV-1 virus in an individual’s blood and genital secretions such that it decreases the likelihood of sexual transmission of the virus.

In 2011, the HIV Prevention Trials Network (HPTN) published results from one of its studies which showed that early initiation of ART reduced sexual transmission of HIV among serodiscordant heterosexual couples by up to 96 percent.

And now, scientists are coming up with more HIV prevention tools which seek to further slow the global toll of HIV and Aids.

The latest research in every form of biomedical HIV prevention, including vaccines, rings, microbicides and other female-controlled forms of prevention, pre-exposure prophylaxis (PrEP) and long-acting delivery systems were explored at the HIV Research for Prevention 2018 Conference that ended in Madrid, Spain, on Thursday.

Conference Co-chair Georgia Tomaras, who is a tenured professor of surgery, immunology and molecular genetics and microbiology at Duke University, US, said extraordinary progress in prevention research has expanded opportunities to control and ultimately stop the epidemic.

“As prevention science advances, however, the challenges of maintaining the political will and funding to support a global movement to end Aids come into even sharper focus,” Tomaras said.

With more than 1,400 researchers, policy makers and advocates gathering for the global scientific meeting dedicated exclusively to biomedical HIV prevention, it is envisaged that an ultimate solution to the epidemic is on its way.

Scientists believe that one discovery of a progressive intervention informs further research.

Anthony Fauci, a physician who directs the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Maryland, US, says the “inspirational goal” of ending the global epidemic is highly dependent on the effective prevention of new infections.

He is, however, worried that despite the availability of prevention modalities such as treatment as prevention and PrEP, the global incidence of HIV infections had declined only minimally in recent years.

“Although the HIV prevention toolkit has expanded with interventions such as voluntary medical male circumcision and increased emphasis on PrEP, their adoption has been suboptimal…

“Therefore, despite significant progress, it is clear that a durable end to the HIV and Aids pandemic will require the development and vigorous implementation of new and improved prevention modalities. In this regard, novel non-vaccine and vaccine-based prevention tools will be needed,” Fauci states.

In Malawi, PrEP is not yet initiated. However, other prevention tools like Prevention of Mother to Child Transmission (PMTCT) and test and treat policies have significantly reduced HIV incidences in the country.

But these prevention interventions still remain suboptimal and lifelong treatment of infected people has significant clinical and socioeconomic challenges, scientists observe.

For a country that relies extensively on donors for HIV interventions, an effective cure strategy would be ideal in reducing the incidences of HIV and eventually eradicate the virus.

Aids Vaccine Advocacy Coalition (Avac) African Region Advocacy Adviser Maureen Luba, who is also Project Coordinator of a joint advocacy project between Centre for the Development of People and Malawi Network of People Living with HIV, is of the view that engaging community members in HIV interventions should also be a priority.

“Communities are often left on the receiving end of interventions. They are rarely involved in the design, planning and implementation of the majority of programmes and this affects community ownership and uptake of these interventions.

“However, ending the HIV epidemic will require a robust pulling together of strategies and efforts from different stakeholders, including communities,” she says.

Luba also wants the early adoption of polices on evidence-based interventions, addressing both social and cultural barriers that have a negative impact on the epidemic and addressing legal and structural barriers to services to be prominent in the HIV battle.

And as she takes up the challenge of fighting for an HIV-free generation, Dzonzi does not allow her small stature to dampen her resolve.

Her own story, told over and over again in her locality, is a perfect testament that while scientists spend sleepless nights to find a solution to the epidemic, lay people must also play their part to ensure current interventions are effective.

Dzonzi goes from household to household, delivering a simple message that is resulting into giant leaps.

“Many men and women have gone for testing after I tell them about the advantages. Many children in my area are being born HIV-negative. That is what is most important. If an HIV cure is ultimately found, all good. It will be an additional advantage,” she says.

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