Annually, the world commemorates World AIDS day on December 1st. It is a day to remember those who have lost their lives, but it also serves the purpose of showing support to people living with HIV and those affected by it. This year the call was to “Equalize”. Unfortunately, inequalities are still present four decades into the HIV/AIDS response for the most basic services such as testing, treatment, condoms and for new technologies.
The COVID-19 pandemic and other global crises during the last two years have further exacerbated the existing inequalities resulting in shrinking resources and millions of lives being at risk. Young women, particularly in Africa, are disproportionately affected by HIV and coverage of programmes dedicated to them continues to be low. For instance, in 19 African countries, dedicated combination programmes for adolescent girls and young women are operational in only 40% of the locations known to have a high incidence of HIV. In sub-Saharan Africa, women accounted for 63% of new HIV infections last year. Additionally, adolescent girls and young women in sub-Saharan Africa are three times more likely to acquire HIV than boys and men of the same age.
Key populations, which include gay men, transgender people, people who use drugs, sex workers and prisoners are also disproportionately affected by HIV and only about 33% of people in this group have regular prevention access. For instance, sex workers who live in countries where criminalisation of sex work occurs have a seven times greater chance to be living with HIV than in countries where sex work is either partially legalised or fully legal. Evidently, as long as these populations continue to be criminalised, discriminated against and stigmatised, the agreed global AIDS targets are not going to be achieved. The AIDS response needs a multi-pronged approach and prevention remains paramount.
This year, I am very excited about one of the new tools at our disposal that can potentially assist in the fight against HIV/AIDS. I am talking about the use of long-acting injectable Cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV prevention. CAB-LA has been recommended by the World Health Organization (WHO) to be administered to people at substantial risk of HIV infection as part of comprehensive HIV prevention approaches. The drug, which is safe, well tolerated and highly effective in reducing the risk of acquiring HIV, is injected every two months. This is a considerable advantage over existing PrEP pills that are taken daily, increasing the chances of forgetting to take one on a hectic day. WHO recommended the use of tenofovir-based oral PrEP in 2015 and dapivirine vaginal ring in 2021 which makes CAB-LA the third PrEP product to be recommended by the organisation.
CAB-LA has received marketing authorisation in two high-income countries, the United States of America and Australia. The United States Food and Drug Administration approved the use of CAB-LA in December 2021 and Australia’s Therapeutic Goods Administration approved it in August 2022. In October 2021, the Medicines Control Authority of Zimbabwe approved CAB-LA for the prevention of HIV, making Zimbabwe the first country in Africa and also the first low- and middle-income country to approve the new drug for the purpose of prevention. Other African countries should follow suit and design and develop programmes that allow CAB-LA to be safely and effectively implemented for the benefit of the continent’s population.
In addition to approving CAB-LA, African governments must draw up national budgets that prioritise the health and well-being of all people, particularly the vulnerable and those affected by HIV-related inequalities. In low- and middle-income countries, the fiscal space for investments in health must be expanded, including through the cancellation of debt and progressive taxation.
Moreover, new investments must be sought that address HIV-related inequalities, especially now that many high-income countries are reducing aid for global health. Funding available for HIV programmes in low- and middle-income countries in 2021 was short by US$8 million and this highlights the urgent need for increased public and private support to get the AIDS response to the level it needs to be at.
Commendable progress has been made in the fight against HIV/AIDS and now is the time that we as Africans equalize and leave no one behind.