Why are HIV infections rising despite historic 95-95-95 feat?
Why are more and more people getting infected with HIV, despite the country achieving UNAIDS’ near impossible 95-95-95 target? Delegates who gathered for three days in Palapye for an HIV Prevention Symposium came up with revealing responses to the question. Mmegi Correspondent, writes
PALAPYE: Gorata ‘Queen’ Tsokwane, a sex worker and member of Nkaikela Youth Group says she knows why HIV infections remain stubbornly high in the country, with new cases rising in certain areas, despite the remarkable achievements Botswana has made elsewhere. For her, the key is greater health and legal protections for sex workers.
“The reason why HIV statistics are high amongst sex workers is because we do not get assistance from health workers,” she says. “Whenever we ask for treatment injections for Sexually Transmitted Diseases (STIs), health workers refuse and even ask why we get STIs every week.
“We actually do tell them that we get STIs regularly because we sleep with different men every day because this is our job.” She continues: “Some sex workers joined this profession while HIV negative, but two years down the line tested positive because health workers refuse to assist us and rather judge us.
“We want our voice to be heard. We are raped and hurtful things are done to us.” Tsokwane believes that making Post-Exposure Prophylaxis (PEP) and Pre-exposure Prophylaxis (PrEP) easily accessible to sex workers would help the country cut back on the rising new infections.
At the core of sex workers’ response to the question of why HIV infection rates are rising, is the fact that in many cases, their clients are either family men or those in stable relationships. With at least 50% of the country’s sex workers confirmed as HIV positive, Tsokwane and her colleagues believe a sizeable proportion of new infections are coming as a result of the lack of protections for sex workers.
“Our clients include family men and men in stable relationships, which makes it easy for HIV to spread further,” she says.
Last year, Botswana received worldwide acclaim and applause when it became just the second country in the world to reach the United Nations’ 9595-95 target for HIV/AIDS. The UNAIDS targets call for 95% of all people living with HIV to be aware of their status, 95% of those aware of their status to be on antiretroviral treatment (ART), and 95% of those on ART to achieve viral load suppression.
According to the fifth Botswana AIDS Impact Survey (BAIS V) released last September, amongst adults or those aged between 15 and 64 years living with HIV, 95.1% were aware of their status, 98% of those familiar with their status were on ART, and 97.9% of those on ART achieved viral load suppression.
The astounding achievement, however, is betrayed by the sticky infection rates, which make HIV/AIDS a never-ceasing public health threat for the country.
National AIDS and Health Promotion Agency (NAHPA) coordinator, Ontiretse Letlhare says despite the notable successes in the fight against HIV/ AIDS, Botswana failed to meet the global target of reducing new HIV infections by 2020. According to Letlhare, the country still has a long way to go in the fight against HIV and AIDS.
In fact, the BAIS V estimates that about 2,200 new cases of HIV are recorded every year amongst adults aged between 15 and 64 years, numbers which go even higher when assessed by gender and specific age group.
The net result is that while the country and its health partners pay a steep bill to support the already infected, more numbers are being added to the patient list every year, an unsustainable situation. The pace of infection, known formally as HIV incidence, also poses a threat of eventually reversing the 95-95-95 gains, as more patients default on their treatments and rates of re-infection rise.
What’s worrying HIV experts and public health authorities is the fact that most of the new HIV infections are taking place amongst women, adolescent girls, and young people in general. In addition, the HIV incidence comes as young men show little interest in health responsibility as seen in them lagging in the uptake of health services.
For Thatayaone Makabanyane, who runs an NGO that deals with Adolescent Girls and Young Women (AGYW), the missing link behind HIV incidence is the lack of communication between young people and their parents.
As a young person herself, Makabanyane shares that some young people are afraid of disclosing their HIV status to their parents or any other family members.
“Parents are not even free to talk to their children about relationships and HIV.
“For example, when a girl falls pregnant, there is no one asking if they know their status and that of their partner.
“The main focus is on being shamed and how the community will look at them after being disgraced.
“Prioritising AGYW is very important. “Let’s not take services to young people only during international commemorations like World AIDS Day, then after, making them inaccessible,” she says.
Makabanyane believes it is important to open programmes that will help parents talk about sex with their children.
She adds that it is important for service providers to come to young people’s level and use language that the youth can understand instead of office language.
“Young people like fun and therefore edutainment is important as it could both deliver messages around HIV, while also educating about different issues.
“Young people must also be included in issues that affect them like policy-making and others,” she explains.
Like sex workers, men who have sex with men (MSM) believe that the difficulties they have accessing healthcare are contributing to the high HIV infection rate.
Speaking on behalf of MSM, Alfred Mmokwa says because of poor service delivery from health workers, MSM end up defaulting on their ARV treatments.
In addition, the shortage of lubrication and condoms at local health facilities also contributes to high HIV prevalence amongst MSM, he says.
“The world has moved to a digital world and MSM do not like waiting in long queues.
“They prefer online services where they book appointments.
“Community outreach is also very vital. Take services to them. Locate where they are and go to them.
“Constantly going for ARV refills also leads to defaulting.
“We also need more information on how to use lubricants.
“Bring them in large quantities,” he says. According to a Person Living With HIV/ AIDS (PLWA), Lame Garechaba, health workers need to be taught how to talk to PLWA and work well with them.
She says sometimes when one misses his or her appointment because of work or any other pressing matter, when they show up the next day they are made to wait till all patients who were scheduled for that particular day get help, as a form of punishment by health workers. This will be despite the same person having come earlier than others.
That form of treatment has led some PLWAs to default on their treatment, running the risk of re-infection and becoming infectious to others, as the viral load grows. For Garechaba, these are some of the factors behind the stubborn HIV incidence rates.
Besides that, however, the discovery that one has HIV, especially when it is made at a young age, can often lead to a reckless, deathwish type of behaviour, which further fuels other infections.
“Adolescents end up rebelling, drinking, and wanting to infect other people because they are angry and have a mentality of not wanting to die alone.
“Some end up resorting to drug abuse. “Here in Palapye, we have young people calling themselves devils.
“They do not want to die alone and feel that infecting others is some form of revenge,” she explains.
Batswana with disabilities also feel excluded in the fight against HIV, which they believe also explains the rising incidence in the country.
Gofenyaone Letsholaphala from Kanye Independent Living Centre believes that health workers should be trained in sign language. She adds that pamphlets guiding people living with disabilities should also be written in braille so that those with visual impairment can read messages conveyed to them.
“It is sad that sometimes a person with a disability, let’s say a person with a hearing problem, goes to a clinic and tests positive.
“The nurse just writes everything down without explaining anything.
“That person will also be given medicines and not know what they are for or how to take them.”
She continues: “To make matters worse, they would not even know that they have to go back for further appointments.
“It is high time we teach health workers sign language to break the communication barrier with some people living with disabilities.
“This is also important because we also deserve some confidentiality.” She also adds that health facilities should provide appropriate access for people living with disabilities, such as those in wheelchairs.
Speaking at the symposium in Palapye, UNAIDS country director, Dr Alankar Malviya said the fight against the disease needs to move towards keeping the 95-95-95 achievement. There is no room to relax, even though the achievement is commendable.
“We do not have to double the number of reinfection.
“We have to work hard to get prevention programmes rolling.
“We cannot fall from the 95-95-95.
“We cannot afford these seven new infections per day, as is the current case.
“Let’s be clear that there are danger signs written on the wall and we have to act fast.”
The UNAIDS director had strong advice for the country.
“Look around you and use the data around you.
“Understand what is happening in your communities.
“Let’s fight against new infections and not normalise HIV.
“The best way is prevention.”