The global war against the HIV/AIDS scourge seems to be gaining momentum, all thanks to the United Nations’ agency saddled with the responsibility to champion the fight- the Joint United Nations Programme on HIV and AIDS, UNAIDS. In this interview conducted by Akinola Akingbala with the Executive Director of the agency in Switzerland, Mr. Michel Sidibe, he gave a vivid and blunt account of the situation on things concerning the disease with particular reference to the situation in Nigeria.
Treatment 2015, what is it all about?
UNAIDS launched Treatment 2015 in July this year. Treatment 2015 is a framework designed to ensure that the global target of 15 million people on HIV treatment is reached by 2015 as an important milestone towards the ultimate goal of universal access to treatment. Treatment 2015 emphasizes speed in scaling up, innovation in service delivery, and focusing treatment services on the areas and populations where need is greatest.
It has three main pillars: Demand – creating demand for HIV treatment, led by people living with HIV, as well as by key populations most affected by HIV; Invest – mobilizing sustained investment, giving priority to innovation and using the available resources as strategically as possible; and Deliver – ensuring that health and community systems, infrastructure, enabling laws and policies as well as community systems are in place to deliver treatment to all people living with HIV who are eligible. We are confident that this approach will help countries to reach their goal of achieving universal access to treatment much more rapidly.
How does antiretroviral therapy help?
Antiretroviral therapy saves lives. By preventing the virus from replicating, antiretroviral therapy stops the progression of the disease and prevents the deterioration of the immune system. As a result, access to antiretroviral therapy reduces AIDS-related deaths.
Furthermore, antiretroviral therapy reduces HIV transmission, it can prevent sexual transmission and prevent children being born with HIV, which are yet more reasons why access is so important.
What is the state of funding for global HIV treatment?
In 2012, we estimate that of the global total of US$ 18.9 billion, US$ 9.9 billion was available for HIV treatment and care in low- and middle-income countries from both domestic and international sources.
This funding is enabling around 10 million people to access treatment, however new guidelines from the World Health Organization, released this year, give clear recommendations that people living with HIV should start antiretroviral therapy earlier, and immediately in some instances. Under the new guidance some 28.6 million people in low- and middle-income countries are eligible for treatment. This is why using existing funds more strategically and looking at new and innovative sources of financing are essential.
What is the latest concerning the quest for cure for the disease?
Research is pushing forward to find a cure for HIV. Although there have been a few isolated cases where a cure seems to have been achieved, we need a much better understanding of how to eliminate HIV. New approaches are already in research trials, but it will be a few years before we know whether any of these approaches could be scaled up to make a real difference to the epidemic.
Similarly, there is ongoing research to develop long-acting medicine that could be used as part of HIV treatment, but today the best treatment remains daily combinations of antiretroviral medicines.
From the month of June to October, people living with HIV in Nigeria complained vehemently about the quality of drugs they are been given- it dissolves in the mouth moment it touches the tongue, breaks into powdery particles in the bottle, the bottle not closing after it was opened, etc. What is UNAIDS doing to ensure the standardization of the drugs across all suppliers be it branded or generic?
UNAIDS is working with the World Health Organization and the Ministry of Health to understand the source and extent of this issue. UNAIDS strongly advocates for access to quality medicines and is part of a regional effort to strengthen and harmonize the regulatory capacity of African health authorities. The World Health Organization prequalifies medicines to assess the quality, safety and efficacy. This programme is critically important as it helps to ensure that medicines supplied by procurement agencies meet acceptable standards of quality, safety and efficacy. We will continue to work with the Nigerian Ministry of Health and the World Health Organization to ensure access to quality antiretroviral therapy in Nigeria.
Stigmatization and ill treatment of people living with HIV by medical practitioners is a common practice in Nigeria going by my investigations. What are you doing to ensure best practice and decorum by medical practitioners in HIV treatment?
Stigma and discrimination continue to block access to lifesaving HIV services. Every person counts. No-one should be denied access to health services because of their HIV status. This is why this World AIDS Day UNAIDS has launched a new campaign around achieving zero discrimination. UNAIDS is working closely with the World Health Organization to support countries, including Nigeria, to deliver health services in an equitable, rights based manner. We are supporting sensitization work in health settings as well as working on specific guidance for antiretroviral therapy service delivery, highlighting the importance of integrating health and community systems.
Nelson Mandela was one of the strongest AIDS campaigners, what will be the implication of his death on the quest to find a cure for the disease?
Nelson Mandela was a statesman, an activist and a visionary and one of the greatest advocates for ending the AIDS epidemic. He spoke out against stigma and demanded dignity for people living with HIV. He also championed science over superstition.
Until we have a cure or a vaccine, HIV may be with us into the future. But the disease that HIV causes need not sicken, kill or orphan anyone anymore. It is our duty to continue Nelson Mandela’s legacy by ensuring that everyone in need has access to lifesaving HIV prevention and treatment services and by continuing vital research into finding a vaccine and cure.
The programme to stop new HIV infections among children has been quite a success, what are you doing not just to sustain it but to improve on it?
Major progress has been made in stopping new HIV infections among children. Since 2001 new HIV infections among children have been reduced by 53% and countries have committed to eliminating new infections among children by 2015. To support country’s efforts, in 2011, UNAIDS and partners launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Through the Global Plan UNAIDS is providing particular support to the 22 countries where 90% of new HIV infections among children occur (21 of which are in sub-Saharan Africa). Nigeria accounts for one third of all new HIV infections among children, the largest number of any country, and is facing significant hurdles in responding. However, UNAIDS is working with the government on a new, intensive, state-focused and data-driven initiative to be able to meet the 2015 targets.
To improve on efforts, UNAIDS is supporting governments to adopt the new guidelines on antiretroviral therapy issued by the World Health Organization earlier this year which recommend more effective and simpler antiretroviral regimens as well as increased access to treatment.
UNAIDS is encouraging countries to strengthen efforts in helping women avoid HIV infection and unintended pregnancies. UNAIDS is working with governments to improve the coverage and quality of programmes to prevent new HIV infections among children which means providing services in more clinics to reduce the distance women must travel; to offer follow up services at home; and to increase the capacity of staff who can undertake some of these tasks. UNAIDS is working to strengthen the quality of services and ensure that women can get the most effective services in one stop.
Improving on efforts also means rapidly scaling up paediatric HIV diagnosis and treatment, as children are only half as likely as adults to receive these services.
UNAIDS is urging governments to invest more strategically and to contribute a larger share of their budgets to HIV funding. In many countries, as much as 90% of the AIDS response is funded by external donors. This is not sustainable––and while many countries are assuming greater responsibility, many are still overly reliant on donors.
Lastly, what are you doing to ensure strict compliance by governments to the 2011 political declaration of ‘target and elimination commitments’?
All countries are accountable for achieving their targets. Through our work at the global, regional and country level UNAIDS supports countries in their efforts to overcome challenges to achieve their targets. Countries also report annually on their progress. UNAIDS publishes this information through a transparent process of reports which are posted on the public UNAIDS website. Only by working together will be able to achieve these goals.
