Tuesday, December 7, 2021

PEPFAR’s New Directions to scale up fight against HIV-AIDS

As long as Botswana continues to register new HIV infections every day, the disease will always remain a threat and its debate will always be new and relevant.

Though we have been fighting this scourge for close to half a century now, its repercussions are still being felt throughout the country, which makes it imperative for all stakeholders to continue with information dissemination and public education. Education on HIV and Aids is still relevant today and there is need to pump more resources into communities and new techniques of driving the message home. No doubt, these efforts must be sustained until we attain the zero new infections.

The United States of America (USA) through the President’s Emergency Plan for AIDS Relief (PEPFAR) has launched a new addition to its global health program, New Directions, which is entirely aimed at ultimately achieving an HIV free generation. Currently there are at least 45 new infections occurring on a daily basis, which translates to 9,000 new infections annually in Botswana alone. This is despite all the measures that government and its stakeholders have taken to create awareness.

As part of the New Directions schedule, the PEPFAR team alongside other relevant stakeholders hosted a seminar in Selibe Phikwe where they addressed issues pertaining to the fight against new infections. Selibe Phikwe, a small mining town in Botswana, has also not been spared from the scourge. At some point Phikwe was notorious for its extremely high infection rates, once the highest in the country. It would not be wrong to say Phikwe has been one of the hardest hit regions and at the centre of controversy due to the many contributing factors pertaining to the contraction and spreading of HIV in the area.

It therefore came as no surprise when it was selected as a strategic location from which the launch and roll out of the New Directions Program will be staged. The program will address the pandemic and disseminate as much information as possible to help people living with HIV, those living positively with it and those still HIV negative to remain uninfected.

PEPFAR is a global initiative put in place to control and curb the spread of HIV and AIDS and has to date spent well over 700 million United States Dollars on the fight against Aids. Statistics show that since its conception in 2001 there has been a significant drop in new infections and an extremely drastic drop in mother to child transmission from about 40 percent to only 2 percent, which is significantly lower than even in some of the western countries. The Anti Retroviral Therapy Program in Botswana has over the years managed to establish itself as a model to reckon with and benchmark from not only for Africa but globally as well.

The motto at the PEPFAR program is currently “Focus on the right things, in the right places at the right time.”

One may wonder which the right things are. Well there is the option known as the B+ 500 which is the lifelong treatment of pregnant women regardless of their CD4 count. PEPFAR has also introduced the combination prevention which entails reducing transmission of HIV by implementing a combination of behavioural, biological, and structural interventions that are carefully selected to meet the needs of a population. Also, because individuals’ HIV prevention needs change over a lifetime, combination approaches help ensure that people have access to the types of interventions that best suit their needs at different times.

The combination prevention will include addressing the Safe Male Circumcision which is one of the ongoing surgical procedures believed to reduce transmission of HIV cells during sexual intercourse. Safe male Circumcision can reduce the risk of heterosexually acquired HIV infection in men by approximately 60 percent, according to the HYPERLINK “http://www.who.int/hiv/topics/malecircumcision/en/” \t “_blank” World Health Organization (WHO). There are a lot of CD4 cells (cells carrying the virus) in the foreskin of a penis thus making it easier for an uncircumcised penis more susceptible to contract and transmit the virus than it is for a circumcised one.
The combination also includes prevention of mother to child transmission (PMTCT) and Tuberculosis and HIV AIDS co- infections.

The right places are identified through specific statistics which diagnose the geographic areas marred with the highest disease burden. In these areas there is a need for better monitoring, emphasis on strategic information surveillance and evaluation of partner progress in communities. As an example, mining towns are often comprised of predominantly male inhabitants thus providing a conducive place for commercial sex workers to convene in pursuit of money for their services rendered. The men residing there will have reasonable disposable income and some, having left their families back in the villages or other parts of the country, will indulge in purchasing of sexual intercourse. Another demography which will find themselves in a male dominated environment is the men who have sex with other men. They could be because they are homosexuals or for whatever reason but they do indulge in such an activity.

Instead of shunning the above mentioned practices, in order to curb the spread of HIV and AIDS and the creation of new infections, health workers need to first of all acknowledge them and deal with their needs accordingly.

The reality is that a man who shows up at the clinic with a sexually transmitted infection in the anal area will not receive the same treatment as a woman who is infected in the vagina or a man on the penis. There will be eyebrows raised, nasty remarks passed and judgement all the way to the dispensary cabinet. Therefore some may shy away from getting the necessary treatment for their infection and it could be detrimental to their health and possibly fatal. The timing of the program ensures implementation of new policies and international guidelines aiming at preventing new infections in the most vulnerable populations and high burden areas scaling up the core interventions to control this pandemic. The key objectives were outlined as expanding public awareness, highlighting development successes and sharing best practices among the relevant stakeholders. Other objectives may include underlining evidence based planning in targeted locations and influencing key policy makers.

“The United States (U.S.) is proud to support Botswana‘s leadership in the global HIV/AIDS response. With strong support from the national government, civil society, and development partners, Botswana has made notable progress toward epidemic control ÔÇô the point at which new HIV infections have decreased and fall below the number of AIDS-related deaths,” read a statement from PEPFAR.

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