Pre­vent­ing new HIV in­fec­tions in women is key in curb­ing virus

Dis­ease re­mains a ma­jor pan­demic and there are miles to go to end the health threat

Pretoria News - - OPINION - QUARRAISHA AB­DOOL KARIM Pro­fes­sor Karim is the as­so­ciate sci­en­tific di­rec­tor of Caprisa and the UNAids spe­cial am­bas­sador for ado­les­cents and HIV

AS WE cel­e­brated In­ter­na­tional Women’s Day and ap­plauded the many suc­cesses that women have, and con­tinue to achieve glob­ally, we are also re­minded of the many chal­lenges that re­main. HIV/Aids con­tin­ues to be one such chal­lenge.

Ac­cord­ing to UNAids, in 2018, there were about 38 mil­lion peo­ple liv­ing with HIV, 770 000 Aids-re­lated deaths and 1.7 mil­lion new HIV in­fec­tions – a star­tling re­minder that HIV re­mains a ma­jor pan­demic and that we have miles to go in sus­tain­ing our cur­rent treat­ment suc­cesses, strengthen our preven­tion ef­forts and ad­dress con­tin­ued hu­man rights vi­o­la­tions and re­search gaps be­fore we achieve con­trol of this dev­as­tat­ing virus.

Women ful­fil many and mul­ti­ple roles in so­ci­ety, in­clud­ing be­ing care­tak­ers and ed­u­ca­tors in for­mal and in­for­mal set­tings, which largely goes un­recog­nised and is un­re­warded.

Mov­ing to­wards the UN 2030 goal of end­ing Aids as a public health threat calls for new and con­certed ef­forts to en­sure that: 1) in­no­va­tion in preven­tion and treat­ment ef­forts in­clude women across their life­span, 2) HIV preven­tion ef­forts in ado­les­cent girls and young women (AGYW) ad­dress the un­der­ly­ing gen­der-power dif­fer­ences at the root cause of their vul­ner­a­bil­ity, 3) in­vest­ments in re­search and care for all women of all ages to pre­vent or treat HIV are in­creased, and 4) in­no­va­tion for less user-de­pen­dent women-ini­ti­ated HIV preven­tion tech­nolo­gies con­tin­ues.

A nu­anced and gran­u­lar un­der­stand­ing is crit­i­cal for the de­vel­op­ment of ef­fec­tive re­sponses to re­duce their vul­ner­a­bil­ity and so­ci­etal im­ped­i­ments to em­pow­er­ment and gen­der equal­ity.

Sub-Sa­ha­ran Africa bears a dis­pro­por­tion­ate 70% of the global bur­den of HIV that is spread pre­dom­i­nantly through sex with a con­comi­tant epi­demic in in­fants born to moth­ers liv­ing with HIV. A unique char­ac­ter­is­tic of this gen­er­alised epi­demic is the high rate of HIV in AGYW aged 15 to 24 years, who are up to six times more likely to have HIV com­pared to their male peers. This early ac­qui­si­tion of HIV in young women, of­ten from men who are five or more years older than them, is cen­tral to the con­tin­ued spread of HIV in this re­gion. Four out of five of all in­fec­tions oc­cur­ring among ado­les­cents in sub-Sa­ha­ran Africa are in girls aged 15 to 19 years.

UNAids es­ti­mates that in South Africa, which is home to one in five of the world’s peo­ple liv­ing with HIV, 1 500 AGYW ac­quire HIV ev­ery week.

Over­all, AGYW are twice as likely to be liv­ing with HIV and ex­pe­ri­ence higher rates of mor­bid­ity and mor­tal­ity com­pared to their male peers.

Be­havioural and bi­o­log­i­cal fac­tors such as age-dis­parate sex­ual cou­pling be­tween young women and older men, gen­i­tal in­flam­ma­tion and vagi­nal dys­bio­sis con­trib­ute to a young woman’s vul­ner­a­bil­ity for ac­quir­ing HIV.

These fac­tors are dif­fi­cult to mit­i­gate against the back­drop of struc­tural chal­lenges of poverty, so­cial in­co­he­sion due to mi­gra­tion and con­flict, gen­der-based vi­o­lence and gen­der-power dy­nam­ics, in­clud­ing a woman’s lim­ited abil­ity to ne­go­ti­ate safer sex with preven­tion tech­nolo­gies that de­pend on male co-op­er­a­tion.

When ado­les­cent girls be­come preg­nant, they are more likely to drop out of school and not com­plete high school. This lim­its their em­ploy­ment op­por­tu­ni­ties, lead­ing to vi­cious cy­cles of de­pen­dency on older men, and in­creases their risk of hav­ing a re­peat preg­nancy within a year and of ac­quir­ing HIV if not al­ready liv­ing with HIV.

Pre­vent­ing new in­fec­tions in this group is there­fore a high pri­or­ity to al­ter the cur­rent epi­demic tra­jec­tory in sub-Sa­ha­ran Africa and get it on the path of epi­demic con­trol.

The Pepfar-funded Dreams Project is an ex­cel­lent ex­am­ple of an in­ter­ven­tion tar­get­ing be­havioural, bi­o­log­i­cal and struc­tural driv­ers of ado­les­cent vul­ner­a­bil­ity, un­der­scor­ing the im­por­tance of com­plet­ing school­ing, avoid­ing un­planned preg­nan­cies and grad­u­at­ing from high school HIVfree. These in­vest­ments will strengthen so­cial co­he­sion and re­alise the con­ti­nent’s full po­ten­tial of youth as its de­mo­graphic div­i­dend.

Trans­gen­der women are among the most marginalis­ed in so­ci­ety due to the gen­eral lack of le­gal gen­der recog­ni­tion and crim­i­nal­i­sa­tion of their gen­der iden­tity. Stigma, dis­crim­i­na­tion and un­avail­abil­ity of trans­gen­der-com­pe­tent health care are key bar­ri­ers for trans­gen­der women to ad­dress their ba­sic health needs. Meet­ing their health needs to­gether with strength­en­ing le­gal pro­tec­tions and ad­vo­cacy around their hu­man rights is crit­i­cal.

Mil­lions of women world­wide over the age of 50 are liv­ing with HIV, but their suc­cesses, chal­lenges and fu­ture prospects are rarely heard.

The ma­jor­ity re­side in sub-Sa­ha­ran Africa, but there are hun­dreds of thou­sands liv­ing in high-, low- or mid­dle-in­come re­gions around the world.

Con­gru­ent with ex­panded an­tiretro­vi­ral treat­ment ac­cess, their num­bers will con­tinue to in­crease over the next decade. We have been com­pla­cent about un­der­stand­ing the biomed­i­cal changes and so­ci­etal bar­ri­ers for these women; and re­search in­vest­ment is lack­ing. Women, like men, are at in­creased risk for car­diac dis­ease, ma­lig­nan­cies and bone dis­ease as they age; some con­di­tions such as bone dis­ease are am­pli­fied among peri- or post-menopausal women.

Knowl­edge of the con­se­quences of the ex­tra­or­di­nary weight gains as­so­ci­ated with Do­lute­gravir are un­known, but dif­fer­en­tially af­fect women.

There are enor­mous un­met be­havioural health needs for women through­out life where de­pres­sion and lone­li­ness, cou­pled with cog­ni­tive de­cline, can lead to a down­hill spi­ral and pre­ma­ture death. The health and well-be­ing of women age­ing with HIV is also par­tic­u­larly af­fected by cul­tural norms that vi­o­late their fun­da­men­tal hu­man rights. Lack of prop­erty own­er­ship and gen­der-based vi­o­lence can pre­cip­i­tate or ex­ac­er­bate poverty, food se­cu­rity and ac­cess to care. Women in polyg­a­mous mar­riages may lose stature and re­sources as they age.

Around the world, women over 50 who do not have HIV are of­ten not con­sid­ered “at risk” to ac­quire HIV, are tested less fre­quently than men, and are less likely to seek PrEP (pre-ex­po­sure pro­phy­laxis). In 2018, 22 000 women over the age of 50 ac­quired HIV in south­ern and eastern Africa.

By en­sur­ing that no women ex­pe­ri­ence bar­ri­ers to ac­cess to the full range of HIV preven­tion and care ser­vices or vi­o­la­tion of their ba­sic hu­man rights, all of so­ci­ety ben­e­fits.

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.