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World AIDS Day 2020 – WHO calls for global solidarity

WHO (30.11.2020) – https://bit.ly/2Jt8f8z – On 1 December WHO is calling on global leaders and citizens to rally for “global solidarity” to maintain essential HIV services during COVID 19 and beyond – and to ensure continued provision of HIV services for children, adolescents and populations most at risk for the disease. The Organization also calls on countries to provide health workers with greater protection and support so they can continue their work safely during the pandemic.


Protecting people from HIV during the pandemic, and ensuring they can maintain treatment, is critical. Researchers are currently investigating whether people with HIV have an increased risk of poor outcomes with COVID-19. Preliminary evidence of a moderate increased vulnerability of people with HIV makes it even more urgent that people with HIV have access to antiretrovirals (ARVs)  and treatments for co-morbidities – such as treatment for non communicable diseases (NCDs), chronic obstructive pulmonary disease (COPD), diabetes and tuberculosis.


WHO and partners sounded the alarm earlier this year, concerned at the impact of reported disruptions in service delivery. But now, thanks to the unstinting work of health and community workers, the number of countries reporting disruptions in HIV services has declined by almost 75% since June. Only 9 of the 152 countries surveyed are still reporting disruptions (maps: June 2020November 2020); and in June, 24 countries reported less than 3 months supply of ARVs, while now only 12 report a critically low stock.


This is mainly due to the implementation of existing guidelines, including providing multi-month dispensing (MMD) of ARVs for 3-6 months to patients who did not have access to health facilities; strong WHO-led global, regional, country, manufacturer and partner coordination to ensure adequate supply of drugs stocks, and sustained provision of facility-based essential health services and community delivery mechanisms.


But countries have also introduced a number of effective adaptations and innovations in service delivery during COVID-19. These include:


  • In many countries in sub-Saharan Africa, testing for COVID-19 has heavily relied on the laboratory systems built and developed by HIV and TB programs. Devices have been shared across programs as well as infrastructure, sample transport systems, and highly skilled staff.
  • In Thailand, PrEP services have been delivered through key population led health services providing multi-month dispensing, telehealth, Xpress service, self-sampling, and counselling.
  • In Bulgaria, a demonstration project showed strong community demand for HIV self-testing which also led to expansion of testing services to reduce inequalities between rural and urban areas.


“On World AIDS Day 2020, we pay tribute to the communities and countries who have shown resilience and innovation – often spearheaded by people themselves living with HIV,“ says Dr Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and STI Programmes. “This is vital, because while we focus on fighting this new pandemic, we must not drop our guard on a twin pandemic that has been with us for 40 years and which is far from over.”


Progress towards global targets for diagnosis and treatment has slowed down considerably this year.


New data shows that an estimated 26.0 million people were on antiretroviral treatment as of mid-2020, up only 2.4% from an estimate of 25.4 million at the end of 2019. This increase is too slow by comparison to last year where treatment coverage increased by an estimated 4.8% between January and June of 2019.  Among 24 countries with monthly data reported to UNAIDS and WHO, people currently on treatment have been supported and maintained, but testing has declined in all and newly enrolled on treatment has been halved. In the last few months; however, there positive signs of rebound in testing and treatment services.


WHO hopes that some of the innovative approaches adopted during COVID-19 can help the world catch up and accelerate progress towards our new 2025 targets and the SDG goals of ending AIDS as a public health threat by 2030.

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Global HIV response found to neglect gay and bisexual men, trans women

Gay and bisexual men account for about one in five new HIV infections, but they were only allocated 1% of the $57 billion spent to fight the virus between 2016 and 2018.


By Rachel Savage


Thomson Reuters Foundation (20.10.2020) – https://bit.ly/3dZa2NB – Funding to fight HIV among gay and bisexual men and transgender women is a fraction of what it should be, researchers said on Tuesday, with advocates blaming stigma for the shortfall.


Gay and bisexual men account for about one in five new HIV infections, but they were only allocated 1% of the $57 billion in global donor funding to treat the virus and combat its spread between 2016 and 2018, Dutch HIV charity Aidsfonds found.


And while trans people represented about 1% of new global HIV infections in 2018, programmes targeting them received just 0.06% of the total pool – most of which is channelled to the general population in 135 lower- and middle-income countries.


The fight against HIV/AIDS could be set back by a decade by the COVID-19 pandemic, which has disrupted treatment and testing services, the United Nations said earlier this year.


Advocates for people living with HIV said health programmes needed to better target high-risk groups, including sex workers and their clients and people who inject drugs.


“Because of stigma and discrimination, because of social attitudes that are derogatory… all of these things influence the way in which development partners designate resources,” said Brian Macharia from the Gay & Lesbian Coalition of Kenya.


“We’re seeing a proportion of funding that does not comprehensively afford care to these communities,” said Macharia, who helps run programmes for LGBT+ Kenyans including HIV prevention and treatment.


About 38 million people worldwide are living with the human immunodeficiency virus (HIV) that causes AIDS, according to UNAIDS – the joint United Nations programme on HIV and AIDS, a million more than in 2018.


Many LGBT+ people are unwilling to access HIV services designed for the population as a whole because they often face discrimination, said Mirjam Krijnen, who runs Aidsfonds’ international programmes.


“Specific targeted services and safe spaces for those groups to actually access those services are necessary,” she said. “Otherwise there’s a real risk… these groups are actually not accessing the care they need.”


The funding gap for gay and bi men was widest in Latin America, where they accounted for 40% of new HIV infections in 2018 but received just 0.5% of total funding between 2016 and 2018.

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Kenya is having another go at passing a reproductive rights bill

Kenya’s Senate is considering a reproductive healthcare bill, which seeks to address reproductive health gaps. This is the second time the bill has come before the senate. It has, once again, drawn fire from religious groups, some politicians and civil society lobbies opposed to its proposals. Anthony Ajayi and Meggie Mwoka unpack the bill and the lessons from previous failed attempts.


By Anthony Idowu Ajayi & Meggie Mwoka


The Conversation (12.07.2020) – https://bit.ly/2ZqaoXK – Kenyan women and girls face an array of reproductive health risks that can be addressed by comprehensive reproductive health care services. These include sexually transmitted infections, HIV, unsafe abortion and unplanned pregnancies.


Each year, 6,300 women die during pregnancy or childbirth in Kenya. Unsafe abortion contributes close to 17% of maternal deaths in Kenya.


The bill provides a framework governing access to family planning, safe motherhood, termination of pregnancy, reproductive health of adolescents and assisted reproduction.


It makes clear that every person has the right to access reproductive health services. It also stipulates that every health care provider is obliged to provide family planning information and services to women who need them.


There is also a provision in the bill directing the national and county government to provide free antenatal care, delivery care and postnatal care for women and girls in Kenya.


In addition, the bill sets conditions under which a woman can seek abortion services. These include when there is an emergency, when the pregnancy would endanger the life or health of the mother and where there is a risk that the foetus would suffer from a severe physical or mental abnormality. It is worth noting that the bill allows for conscientious objection on the part of health providers to perform an abortion as long as they refer the patients to a willing provider. This doesn’t apply in the case of an emergency.


The bill also has provisions ensuring access to adolescent-friendly reproductive health services, but requiring parental consent.


Lastly, the bill also covers the issue of assisted reproduction services to address infertility. The sector is currently unregulated. The proposed bill sets out rules for providers as well as the rights of donors, surrogate mothers and patients.


Reproductive health has been enacted into law in different ways across the continent. A number of countries have similarly opted for a stand-alone law. They include Cameroon, Equatorial Guinea and Rwanda. But in many, various aspects of reproductive health are covered in a range of health-related bills, and sometimes in the constitutions of countries.


All countries in Africa have laws regulating the termination of pregnancy. Abortion is not permitted for any reason in seven out of 54. The rest permit abortion under certain circumstances ranging from; to save the woman’s life, to preserve health, on broad social or economic grounds, and/or on request with variations on gestational age.

What are the main controversies around the current bill?


There are three main points of contention.


The first is termination of pregnancy. Opponents include religious leaders and civil society lobby groups.


There are three lines of argument against it.


The first is the assertion that the constitution of Kenya forbids abortion. This is in fact incorrect. The proposed bill simply reaffirms the legal basis for access to safe abortion, which is already in the Kenya Constitution.


The second area of contention around termination is that those who oppose the bill crudely characterise it as extending the legalisation beyond what’s in the constitution.


And finally, opponents also erroneously allege that the bill mandates all medical providers to perform abortions irrespective of their religious beliefs or values. The bill in fact allows for conscientious objection.


The second controversial aspect of the bill is on sexuality education for adolescents. It provides for vocational training, mentorship programmes, spiritual and moral guidance, and counselling on abstinence, consequences of unsafe abortion, HIV and substance use. It also mandates the government to integrate age-appropriate information on reproductive health into the education syllabus.


From the look of it, this aspect of the bill has been watered down. For example, it’s more abstinence focused than the earlier version. This flies in the face of research findings that this approach denies adolescents critical information to reduce their risk of unintended pregnancies and sexually transmitted infections.


Third is the controversy over the treatment of infertility. Opponents of the bill are against legalisation of surrogacy and “test-tube” babies, with the argument that it’s an unnatural process.

Why have previous attempts to pass such a bill failed?


This is the second attempt in six years to guarantee reproductive rights in law. The first bill was introduced in 2014.


The failure was due to a variety of reasons. These included a lack of public awareness and political will, and misinformation by well-organised and coordinated opposition groups.


Most Kenyans were unaware of the scientific basis for the bill. They were also unaware of the magnitude and cost of unsafe abortion and maternal deaths. Also the case was not persuasively made that access to quality and comprehensive sexual and reproductive health information and services is in everybody’s best interests.


This enabled local and foreign opponents to put out arguments not based on evidence. An example of misleading narratives is the claim that comprehensive sexuality education promotes high-risk sexual behaviour. This is contrary to scientific evidence which shows it delays initiation of sexual intercourse and reduces risk-taking, thus decreasing the number of unintended pregnancies and sexually transmitted infections.


Public apathy coupled with misinformation undermined the political will to push the bill through. While there were some politicians willing to champion the cause of women and girls, the vast majority were quick to withdraw their support in the face of the orchestrated public outcry.


Who suffers if the bill is shelved again or is watered down?


We know from evidence in demographic surveys and literature that socially, geographically and economically disadvantaged women and girls have worse reproductive health outcomes. They are least likely to access lifesaving reproductive health services and more likely to have early, unintended pregnancies, unsafe abortions, and die as a result of pregnancy.


Additionally, adolescents continue to suffer disproportionately from poor sexual reproductive health outcomes, as indicated by the high rates of teenage pregnancies and HIV infection.


HIV and pregnancy are the leading causes of deaths among adolescents and young women aged 15-24 years in Kenya. Over half of the 46,000 new HIV infections in 2018 occurred among adolescents and young people. Over 378,397 teenage pregnancies were recorded between July 2016 and June 2017 and 28,932 of these pregnancies occurred among girls aged 10-14.


The perception of adolescents as lacking political power often makes politicians reluctant to act in spite of the obvious need for intervention.


What to do?


Rather than shelving the bill, as recommended by the opposition, the senate must work with reproductive health experts to strengthen the bill in alignment with existing national laws and policies such as the National Adolescent Sexual and Reproductive Health Policy, 2015.


Learning from the previous attempt, it’s imperative to improve public engagement and to communicate scientific evidence in a way that people can easily understand.

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