By Catherine Murombedzi
The 2022 World Aids Day commemorations, themed ‘Equalise’, got me thinking, in a way. I was saddened by the unequal access to HIV and AIDS services. Could it be the inequalities, and constrained access, coupled with the Covid-19-induced lockdown of 2020 and 2021?
Never before, have we noted such massive new HIV infections. Globally, a total of 3 million new HIV cases were recorded within the two years. A whopping 1.5m new HIV infections in 2020 and 1.5m in 2021, this drawback takes the gains of ending Aids by 2030 off track.
In December 2020, UNAIDS released a new set of ambitious targets calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral load suppression by 2025.
With 1.2 million people living with HIV in Zimbabwe, the 95-95-95 targets give a scope of where the nation stands and where it intends to go.
Aids Healthcare Foundation (AHF), a not-for-profit organisation in the health sector, strives to offer access, thereby bringing equality to people living with HIV. It offers friendly specialised services to people living with HIV and has a friendly environment for key populations, (KP) being prisoners, sex workers, lesbians, gays, bisexuals, transgender, intersex, or questioning (LGBTIQ). Stigma and discrimination can result in KPs not seeking services due to negative attitudes from a few healthcare providers and a not-friendly clinic setup.
During a recent visit to Parirenyatwa Group of Hospitals, where AHF runs a Centre of Excellence, the comprehensive service became a Health one-stop centre offering Covid-19 testing, HIV counselling and testing, with treatment, care and support extended to those who test HIV positive, VIAC cancer screening, diagnostic and laboratory services, TB screaming, family planning services supported by an efficient pharmacy. The pharmacy is digitally connected to the service rooms, with no long waiting periods for clients. One briefly sits in the waiting area and collects when the name has been called out.
Among the people who were seeking services were two young women, Vengai Hadji and her friend Mirinda Phiri.
The two live in Hatcliffe, Harare, with Hadji, a peer educator for young mothers living with HIV in her community. Asked about the purpose of their visit, Hadji spelt out.
“We are young women living with HIV. I was born like that and I am an orphan who grew up taken care of by my mother’s loving sister. Luckily, now with treatment as prevention, I am assured that my children are HIV-free. We collect our medication from the satellite clinic in our community, but we come here for specialised services. Today, we are waiting to have the Visual inspection with acetic acid and cervicography (VIAC). It is annual because we are at risk of cervical cancer, more than our HIV-negative sisters who take the inspection once in three years,” said Hadji.
Hadji is a mother of two healthy HIV-negative minors aged five and two years.
“I also get my Viral Load Testing (VLT) here annually. When we planned to have our second baby, VLT was done after every 6 months and we were advised that it was safe to have a baby. Up to today, I have a virally suppressed immunity with the HIV virus not detected,” said Hadji.
Hadji said she once collected her resupply from the centre.
“I used to collect my anti-retroviral therapy (ART) refill here. However, as a stable client, I have been referred to a centre near home ” explained Hadji.
When one is virally suppressed, the chances of passing the HIV virus are very minimal, science has proved that Undetectable = Untransmittable, U=U.
However, people on ART must adhere to treatment to be virally suppressed. Missing doses can see the virus mutating. In simple terms, the mutation is the multiplying of the virus getting out of control. With mutation, comes virus resistance to the treatment used.
One then fails treatment requiring tests to be run and have the patient moved to the second line. Second-line treatment is expensive and needs strict monitoring.
If one fails on the second line, the final treatment regimen is the third line, which costs an arm and a limb. There is no 4th line, one books an early bed in the cemetery after failing the third line.
Of the 1,211,030 people living with HIV in Zimbabwe, the Ministry of Health and Child Care, (MoHCC) as of June 2022 reported the following on their website:
First line = 1,160,597
Second line = 49,944
Third line = 499
The escalating cost as each line fails is staggering.
Average cost per patient per year:
Adults and Adolescents.
1st line US$63.09
2nd line US$378.64
3rd line US$1088.06.
1st and 2nd line US$251.59.
Viral suppression is a result of treatment adherence and has healthy outcomes.
Zimbabwe recorded 25,000 new HIV infections with 22,000 Aids-related deaths in the last year according to the Ministry of Health and Child Care. The number contributes to the 1.5 million global infections in 2021.
That death rate is unacceptably high, considering that ART ushers a new lease of life. An insight into the causes of defaulting will shine a light on this risk.
Dr Pascal Shambira, heading the AHF Centre of Excellence at Parirenyatwa Group of Hospitals said the Opportunistic Infection clinic (OI) had 5 620 clients as of June 2022.
All the clients are doing well on ART. Someone may ask why clients and not patients. The people living with HIV sector is particular about stigmatising language. They prefer to be clients when they face no health challenges. Like a person taking hypertension medication, one is able to do all required of a healthy person. Anyone with high blood pressure and taking medication accordingly would not like to be addressed as a patient. Only when ill can they be referred to as patients.
Dr Shambira was pleased to note that 95% of their clients were virally suppressed and they hoped to surpass that target by year-end.
“We are proud to announce that we reached 95 percent HIV viral load suppression, and we are set to surpass it by year-end,” said Dr Shambira.
Reaching the third 95 means the first and second 95 have been attained.
The visit to Sally Mugabe Centre of Excellence and Glen View Poly Clinic, which is AHF supported, was an eye-opener as the media got to appreciate the HIV response from a facility and client perspective.
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