New HIV infections: We are in Trouble

New HIV infections: We are in Trouble

Staff Reporter

MASERU

HEALTH Minister Dr Molotsi Monyamane says he is not really startled by the increase in the HIV prevalence rate from 23 to 25 percent.

To him that indicates infected people are living longer because they are on medication. But what keeps him awake is the number of new infections which he says has remained high despite millions of maloti used in campaigns.

In the following interview Dr Monyamane explains how the government is reacting to the scourge.

 

The HIV prevalence has started climbing up again, according to a District Health Survey conducted in 2014 and 2015. Where are we getting it wrong?

 

I think we should look at what is happening to the youth first. There is comprehensive research that shows that 70 percent of youths in the SADC region don’t have a clue about HIV. Clearly we are not closing the gap. We have not managed to close that gap. If the youths know very little about the biggest threat to their lives then we are in trouble. We need to focus on reproductive education in the schools. Matters of sexuality should be in the school curriculum. We need to urgently establish adolescent friendly health centres. We have to address the availability and use of condoms. Our focus should also be on keeping children in schools to protect them against early marriages. Our girls are being married too young when they don’t have either the knowhow or the means to protect themselves against HIV once they are in the marriages.

 

Such interventions target the youths but they are not the only ones affected?

 

That is true. We are working hard on the prevention of the mother-to-child infections. There are pregnant women who are not getting tested. Those that are being tested are not getting treatment. There is also the problem of couples where one partner is positive and the other is negative. The positive partner must be on treatment so they reduce the chances if infecting the other. There are also some groups of people that are being left behind. Statistics have shown that the HIV prevalence rate is highest among sex workers and men who have sex with men. We are talking about a prevalence rate of 70 percent. Now, that means we need to improve access to pre-exposure prophylaxis and post exposure prophylaxis.

 

Could there be an element of some people not having access to health centres?

 

Indeed that is one of the major problems we face. There are people who are being left behind because they don’t have access to health services. We need to urgently improve our delivery of health services to people. Our outreach programmes have also been weak. Most of the HIV advocacy is targeting urban areas. There is not much for miners, herd boys and the general rural populace. There are hard-to-reach areas where the message is not reaching. These people have limited or no access to health services. We are pushing on workshops in Maseru and other towns while neglecting the people who really need the message and the services.

 

Why do you think people are no longer panicking when they hear that the HIV prevalence has increased from 23 to 25 percent?

 

It’s a historical issue. There was a time when people were visibly sick. Now people are living longer and remaining healthy because of antiretroviral drugs. The issue we should be worried about now is whether those that are on medication are taking precautions to protect their partners from infection or protecting themselves from being re-infected. In the past such numbers would make people panic because people were dying. The number that should really scare us is that of new infections which are currently at 100 per week.  That means we are having 5 200 new infections every year. The real crisis is on the 13 to 24-age group where the prevalence and new infections are highest.

 

How do we reverse that trend?

 

The solution lies in testing and treating. We need to test and treat people before it’s too late. Those who know their status will then take precautions to protect their partners. The earlier they get on treatments the more effective the medication becomes. The problem now is that people are coming for treatment when already too sick and by that time it will be too late.  We are guided by the 90-90-90 vision. By 2020, 90 percent of all people living with HIV will know their HIV status. By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression. We have seen the number of children on medication increase from 30 percent to 57 percent. The number of pregnant infected women on medication is 70 percent. Our major concern is that on the broader scale the number of adults on medication had been growing slowly. It has just grown from 40 percent to 45 percent, which is not enough. That to me says we should go on an aggressive campaign to test and treat.

 

How do you keep people on medication? 

 

That is the hard part. The medication is free but people don’t consistently follow the treatment plan. The reason could be that people are discouraged because they have to travel long distances to collect their medications. It could be that people don’t know the importance of taking the medication consistently. We have realised that we need to give people medication that last them for long periods so they don’t have to keep coming back to the health centre. You might know that from April this year people have been getting three-months’ supply and that has really helped.

 

A lot of money has been used in the fight against HIV but the results remain modest. In some cases nothing much has been achieved. Have we used the money wisely?

 

I don’t think so. A lot of money has been used for workshops, per diems, flights and salaries. We are not investing our money in the things that really matter in the fight against HIV.  The bulk of this money comes from the government. For example 47 percent of the money used in the response to HIV comes from the government. Nearly 70 percent of the money used to buy HIV medication comes from the state and so does 100 percent of the money used for TB medication. The government is funding the primary health care. We need to start investing our money in areas that bring results. We need to channel our money to areas where it is needed the most. That means putting money at primary health care level. I mean the villages.

Important stats

25 percent – HIV prevalence

13-24 – the most affected

70 percent – HIV prevalence in sex workers and gay man

57 percent – number of children on treatment

45 percent – adults on treatment

70 percent – pregnant women of medication

 

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