EDITORIAL COMMENT: War on HIV can be won, we just have to keep going
HIV and Aids have tended to drift away from the headlines as some remarkable work is done by medical professionals, community leaders and others leading the fight, but despite the immense progress we are some way off from zero new infections, zero new deaths and defeating the virus.
This week the issue once again moves under a brighter light in Africa as the two-yearly International Conference on Aids and Sexually Transmitted Diseases in Africa, ICASA, meets in Zimbabwe to take stock of what has happened over the last two years, look at the latest research and outline the major programmes that will need to be continued, modified or introduced to cope with the next two years.
Zimbabwe’s offer to host the conference was accepted because we have made a lot of progress since those dreadful days at the height of the pandemic, because we have been serious about the infection and because we have been effective in the fight and appear to remain committed to the long battle ahead. It is useful when your host is serious.
We were in that first group of countries that reached the 90-90-90 target, that is 90 percent of people infected with HIV knew their status because they had the courage to be tested, 90 percent of those who were positive were on antiretroviral drugs because these were available for both the poor and the rich, a Government decision, and 90 percent of those on the medication now had their virus load sufficiently suppressed that they were no longer infectious, a sign that most of those taking their medication were doing so consistently and correctly.
We are now hovering around the 95-95-95 target, which sounds rather good until you do the three multiplications and find out that only about 81,5 percent of the HIV positive have a suppressed viral load.
The other 18,5 percent are still infectious, at least to some degree. This shows the both the progress, the 81,5 percent, and the heavy haul still ahead, that 18,5 percent and the need to maintain all the pressure to reduce infection rates.
The research is not on a single axis. UNAIDS, the global agency set up to fight the pandemic with the goal of an Aids-free world, keeps tabs on a wide range of factors that can speed up and retard the progress.
UNAIDS executive director Winnie Byanyima spelt out some of the most critical, and these go beyond just statistics and start looking at societies and cultures and human attitudes.
She scored the victories, HIV infections are 60 percent down on the 1995 peak and deaths are 70 percent down on the 2004 peak, the difference in the two figures being a result of antiretroviral treatment.
But we still have 9 million of the 39 million people living with HIV still to start treatment, and just because Zimbabwe is up there with the most committed does not mean we are in the clear, only that we have made significant progress, but still have more to make.
Among Dr Byanyima’s more worrying statistics is that young people are still the most vulnerable to new infection, despite having grown up in a world where AIDS is an everyday topic and where they know of relatives who died.
Even more horrific is that young women of 15 to 24 are three times as likely to be infected as young men of the same age group, and there were have a whole range of society attitudes that still need changing and more support to be available for young women.
But at least we know where to concentrate a lot of our efforts, and these go beyond protecting young women. Persuading older men to behave a lot more responsibly would appear to be a very useful approach, and getting them out of the lives of younger women.
For Zimbabwe we need to keep on with our policies, and be looking for ways we can improve them.
The target is the elimination of AIDS and of new HIV infection, and then maintaining the treatment regimes we have in place until the last person infected finally dies of extreme old age, next century if it is a teenager or young adult infected today.
To be blunt, we now need to go for 100-100-100, which would mean that no one is infectious and so there are no new infections. Then we just carry on the care of an ever diminishing group living normal life spans.
That 100-100-100 is not going to be easy. It starts with everyone who is positive knowing that status, and there are always some who resist a test, or even think they do not need one.
The middle 100 is probably easier, getting all those who do test positive to start treatment. Here we push self-interest, the earlier you start the better. And then once they are on treatment it is the same method as needed by all taking medication every day of the rest of their life for a chronic illness, from blood pressure onwards, just self-discipline.
We have some things right. It is easy and cheap to be tested. Once a positive test result is confirmed, the treatment medication is readily available and no one goes without because they are poor.
All this costs money, but we all pay a surcharge on our income tax, so there is quite a lot of Zimbabwean money, and that serious and effective approach means that we can tap international funding since we use it properly and efficiently.
But that still means that the funders care enough, so we need to maintain our own funding and build our own funding.
As UNAIDS continues to point out, it is cheaper to treat existing infection and eradicate new infections that let new generations fall ill and die in their most productive years, if you want to look aside from humanity reasons and just at the pure economics.
In a Zimbabwean context this means that more people in their 30s and 40s earning more money will pay more tax and so more Aids levy, and at the same time they will be staying healthy for a rather small monthly sum instead of needing a lot of expensive medical care for a whole range of opportunist diseases as their immune system becomes ever more damaged.
They will also look after their own children.
This is one of those cases where humanity and economics sing on the same hymn sheet.
When we look back on the 1990s and 2000s as HIV and AIDS become obvious, and the numbers grew and the death toll grew and then the first signs of hope arrived with the antiretrovirals, we can see how the major effort, which included major cultural changes, worked.
That included a lot of positive personal choices and taking of personal responsibility.
But we cannot be smug and we cannot relax, not now when something closer to victory is in sight and at least is possible.
We have done so much together, and won so many battles together and individually, that we need to carry on, fill the gaps, make the changes and so win the war.