Tuesday, July 22, 2014 - 16:42
It is actually the end of Day 4 and the first time I am back in my hotel room before 9pm – it has been quite hectic!
I realized this afternoon that the world has nothing new on prevention. Last conference we were talking about VMMC – voluntary medical male circumcision – I felt then that we were kind of grasping at straws. Now it is more of the same, and an acknowledgement that we have to go back to communities. We need to know where and why there are higher rates of HIV incidence (new cases of HIV) and start tackling the social issues that drive it. In Uganda this may be fishing communities and truck drivers. Migrancy in general is highlighted in the UNAIDS Gap Report. Adolescents too. As deaths due to AIDS are declining in other age groups they are still increasing in adolescents.
There is a new initiative on adolescents – All In. The goal is to halve the rate of new infections in adolescents. And yet adolescents everywhere still struggle to access SRH information or services. Maternal mortality (death associated with pregnancy and child birth) is 8 times higher in women living with HIV who are not on treatment than it is in women who are not living with HIV. Adolescents are much less likely to be tested, to be on treatment.
We are all excited about more and more people on treatment but as you go around the posters you pick out here and there stories about poor adherence to treatment. Psychosocial support is needed HUGELY now to promote and support adherence. The possibility of a multidrug resistant HIV or many multidrug resistant HIV strains appearing is too awful to consider. Someone pointed out that without a vaccine or a cure we can only manage HIV – we may end AIDS, but only as long as HIV is under control. PSS is an area we can be raising with our NACs in all countries. I think along with UNAIDS three 90%s we need to lobby for a fourth – 90% adherence. In a way it is implicit in 90% viral suppression but so often when people feel better they think they don’t need the treatment any more and stop.
In the build up to post 2015 and the MDGs the world is developing the Sustainable Development Goals (SDGs). To date there are 17 areas of focus and HIV is one of them. ECD is also for the first time. There will be ongoing discussions on these next year. We still need strong lobbying to keep HIV on the list. The battle is not yet over.
There is MUCH more emphasis on disability at this conference than I have been aware of before. One billion people in the world are living with disability – 15% of the population. As the REPSSI paper on PSS & Disability shows – the rate is much higher in countries with higher HIV prevalence – 36% in Swaziland, 20 – 24% in Namibia and South Africa, 14 – 17% in Zimbabwe, Kenya, Zambia and Malawi. People with disability are at greater risk of abuse, more likely not to be in school and therefore more excluded from the job market and suffer greater poverty. Adolescent girls living with disability have poor access to reproductive health services, suffer much greater stigma and are more left out than other adolescents. There is no sign in sign language for many of the terms – HIV, condom etc. The sign for sex and love are the same. Funding for materials in Braille or sign language is not easy to get.
There is quite a lot of discussion on stigma as well. Other plagues have not been discriminatory, but HIV feeds on discrimination. Until we tackle stigma (PSS again) we cannot win this fight. The REPSSI presentation on stigma was made by Marija Pantelic this afternoon. She was presenting on data from the SAD study in Zambia that has been reanalyzed. That showed that the cause of orphaning (by AIDS or other) was not a major factor in stigma and bullying. However, poor health and poverty were. The conclusion is that our programming needs to target poor health and poverty. Whole school programmes are one way to do this.
This evening SAfAIDS was celebrating SAfAIDS@20 at a hotel very close to the convention centre. We joined the celebrations!
Lynette Mudekunye is Adviser at REPSSI