Kester Kenn Klomegah* Talks to UNAIDS Expert

MOSCOW (IDN) – For over three decades, Africa has fought HIV/AIDS and is now battling another pandemic, COVID-19, that has shattered the continent’s economies. While adequate measures have been taken to halt the spread of the pandemic, Coronavirus has increased the financial burden. But HIV/AIDS experts say strengthening health institutions and commitment by political leaders (African governments) as well as development and international institutions could help to achieve adequate solutions especially in developing countries such as those in Africa.

In an emailed interview, Dr Medhin Tsehaiu, who has worked with UNAIDS since 2011, and is UNAIDS Country Director based in Nairobi, Kenya, offers an insight into the current stage of combating the spread of HIV/AIDS, valuable resources that are available and the impact on the economies in Africa. Here are excerpts from the interview:

Q: Let me begin by comparing HIV/AIDS with Coronavirus. Which of the two would you describe as posing greater challenges to Africa, and the world?

A: UNAIDS data indicates that in 2019 there are about 38 million people living with HIV globally and 690, 000 AIDS-related deaths. Whereas about 16 million people are infected by the coronavirus and about 650,000 deaths, though in a short period of time. 

Thus, it should not be a matter of comparison between the HIV and COVID-19 pandemics as both have serious effect on people’s lives, exacerbate inequalities, and socio-economic development among other things. 

We have learnt from the AIDS response that a human-rights based, multisectoral approach can effectively prevent and contain the spread of HIV and Coronavirus, while addressing stigma and discrimination that is common in both cases. 

The COVID-19 pandemic also poses a challenge to the HIV response, in that it affects the achievements gained thus far as a result of service disruption, constrained supply chain systems and diversion in financing of the response.

For instance, major donor countries might prioritize their domestic economic challenges that have been brought about by COVID-19 pandemic. The health system is getting overwhelmed due to the pandemic, thereby affecting service continuity for HIV and other essential services.  In summary, it is not “either or”, rather we must put all efforts to end both pandemics. 

A pandemic refers to an outbreak that is prevalent in a country or across the world. In this case, we can refer to the Coronavirus as a pandemic since it is prevalent in countries across the world and has affected a huge population. A deadly disease is a lethal infection that can end one’s life. When HIV is not managed through intake of ARVs, it can eventually turn to AIDS which is lethal hence leading to death. 

Q: It appears that global leaders and people have forgotten about the presence of HIV and AIDS. What is your objective assessment of the current situation specifically in Africa? 

A: According to the recent 2020 UNAIDS Global AIDS update report, Seizing the Moment – Tackling entrenched inequalities to end epidemics, the 2020 targets will not be met because of uneven success in different countries across the world which have derailed achievement of global Fast-Track targets. The report also highlights that COVID-19 risks blowing progress way off course. 

Africa is the most affected continent globally. Out of the approximately 38 million people living with HIV globally, Africa has approximately 25.8 million people living with HIV. The region also accounts for two thirds of the global total in new HIV infections. 

The AIDS financing in Africa has greatly been dependent on external sources. Global Fund and PEPFAR are the major funding mechanisms for HIV, saving millions of lives. There is a trend of a decline in financing the HIV response globally, which means that countries must increase domestic resource allocation to sustain the response. Countries such as South Africa and others have made a lot of progress in domestic funding. Africa and the rest of the world has to prioritize, resource HIV as a development agenda and strengthen country ownership and leadership to sustain the response.  

Q: The African continent is vast: How comparative are the trends, for example, in the five distinctive regions: West Africa (ECOWAS), Central Africa, Southern Africa (SADC), East Africa and the Maghreb region (Arab North)? 

A: East and Southern Africa carry the highest HIV burden in Africa with approximately 20.7 million people living with HIV. Having said this, ESA region has made tremendous progress in the response. For instance, according to the 2019 Global AIDS update, new HIV infections have declined by 38% and AIDS related deaths have also declined by 49% since 2010. Adolescents and young girls account for 26% of new infections in the region. 72% of people living with HIV are on treatment and 65% of PLHIV on treatment have achieved viral load suppression.

So far, seven countries in the region have reached the 90-90-90 targets. These are: Botswana, Eswatini, Namibia, Rwanda, Uganda, Zambia, and Zimbabwe. Others are also very close to reaching the targets. These are Kenya, Malawi, and the United Republic of Tanzania.  

West and Central African region has got the second highest HIV burden with approximately 4.9 million people living with HIV. The infections in the region have reduced by 25% and AIDS related deaths have also decreased by 37% since 2010. Adolescent and young girls account for 27% of the new HIV infections in the region and 45% of people living with HIV in the region are virally suppressed.

Lastly, Northern Africa and Middle East Region have the lowest HIV burden. It has approximately 240,000 people living with HIV. New infections have increased by 22% from 2010 to 2019 whereas AIDS related deaths have remained stable over the years. 52% of people living with HIV knew their status in 2019, 38% were accessing antiretroviral therapy and less than one third were virally suppressed. 

Q: Do you think the measures to reduce the infections in Africa are being strictly enforced by the authorities in many African countries? 

A: Africa has taken significant measures to reduce infections based on population. The use of evidence is key to identify which locations and population group are affected by the epidemic so that tailored interventions are designed and implemented. However, the measures taken, may not be equal across different population groups in different countries.

For instance, key populations (Adolescent and young people, PLHIV, pregnant women, men who have sex with men, sex workers, people who inject drugs, intersex, refugees, migrants, People with disabilities et cetera) are vulnerable and at higher risk of being infected with HIV. 

Key populations account for 62% of the global new infections. They also account for 69% and 28% of new infections in western and central Africa and East and Southern Africa Region respectively. There is need to remove barriers such as stigma and discrimination, address gender inequalities, punitive laws that limit access to services. We still have to do more to reduce new infections in Africa. 

Q: Do you think that, in order to fight HIV/AIDS, the media disseminate adequate information in Africa? How would you argue that African governments and non-government organizations have to step up support for this information campaign? 

A: Media plays a critical role in terms of dissemination of correct and timely information. Current technologies like social media, have made information dissemination easier. However, there is inequality among various groups in accessing technology hence limiting awareness on HIV prevention, especially by marginalized and vulnerable people. 

Radio broadcast is a good option for information dissemination since quite a large population in Africa are radio listeners. Another option is through religious institutions—churches, mosques and temples. Therefore, a multisectoral approach is key and could play a critical role in ensuring that information on HIV reaches people who need it the most.

Q: At least the UNAIDS offices are still monitoring and coordinating the disease situation in Africa. Is Africa still collaborating with foreign countries, for example the United States, Europe and Asia (China and India) on HIV/AIDS drugs and vaccines?  

A: Global solidarity is key to achieve the Sustainable Development Goals (SDGs) through strategic partnerships. In regard to the HIV response, the United States of America, through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund (GF) to fight AIDS, TB and Malaria are major partners playing a critical role in supporting HIV programmes in Africa. There are other diverse partnerships with African countries in education, health, job creation, climate and governance.

* Kester Kenn Klomegah is a frequent and passionate contributor to IDN. During his professional career as a researcher specializing in Russia-Africa policy, which spans nearly two decades, he has been detained and questioned several times by federal security services for reporting facts. Most of his well-resourced articles are reprinted elsewhere in a number of reputable foreign media. [IDN-InDepthNews – 29 July 2020].

Photo: Dr Medhin Tsehaiu, who has worked with UNAIDS since 2011, and is UNAIDS Country Director based in Nairobi, Kenya. Credit: UNAIDS.

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