Some 38 million people have HIV. 70% live in Africa, which shows that there will be no solution to the pandemic if it is not remedied on this continent. The great challenge is to face the double reality of the large number of people who continue to die from AIDS and the large number of new infections. In 2016, many countries agreed on a global strategy to end AIDS by 2030. Researcher Salim Abdool Karim, director of the Center for AIDS Research Program in South Africa, explains in this article how to combat the disease.
What are we doing wrong?
It’s not that we’re making a mistake, but it’s always possible to do better than we’re doing now. Most new infections come from two different groups. The first is key populations. The highest number of new infections is among men who have sex with other men. Especially in young men, often black. These infections occur mainly in Eastern Europe and Russia.
The second priority is the large number of new infections in young women in Africa. If we don’t deal with these two groups, we won’t solve the problem. However, serving these two groups is not easy. The challenges in much of Eastern Europe and Russia relate as much to their marginalization and discrimination as to the services provided to key populations.
The truth is that in Africa we have not been able to contain the number of young women infected to the extent that we had hoped. The problem lies in the way in which society has supported or strengthened sexual relations with age differences, where adolescent girls have sexual relations with men between eight and ten years older than them.
Likewise, the means we have to curb the rate of new infections in young women are not well adapted to the need. It is not feasible for a young woman who neither thinks about HIV nor is aware of her risk to regularly take a pill every day, or even give herself an injection. Therefore, we have to develop new technologies.
Reducing the age gap between men and women requires a combination of approaches new to our society. Also, we need new technologies to protect young women. And third, we need to get more young men and more men in their 20s and 30s to go to health services for testing and treatment before infecting young girls.
How can we improve this situation?
We have to think about three things.
The first thing is that we must be aware that each of us is mutually interdependent, that is, the risk that each person runs affects the risk that others run. Hence, solutions are needed in which we all work for a common goal. We saw it very clearly with COVID-19.
The omicron variant was first detected in South Africa, in November 2021. Within a week, this variant had been detected in 16 countries. Within two weeks, the omicron variant had been detected in numerous countries on all continents. This shows that we are all interconnected and dependent on each other. We have a shared responsibility to address the problem.
We cannot adopt the mentality that it is someone else’s problem. In many ways, the response to HIV has taken into account our interdependence. For example, rich countries contribute resources to the Global Fund to Fight AIDS, Tuberculosis and Malaria so that poor countries benefit. It is a shared responsibility. These countries are not saying, “It’s an African problem, we don’t care.” No, they are saying: “We understand that if we don’t control HIV in Africa it will affect the whole world.”
Secondly, we have to mobilize the necessary resources so that, at least, the treatment achieves the results set in our objectives. In other words, we have to ensure that 95% of people know their serological status, that 95% of those infected receive treatment, and, finally, that 95% of them achieve viral suppression. This is the global goal for 2025. We have to help each other to reach that goal.
We have to improve prevention work. This is the third point. Treatment alone is not going to be enough to allow us to reach the 2030 target. We need to improve prevention. That means we’re going to have to continue our efforts on circumcision and condom promotion, and improve PrEP.
What will be the next steps?
We have to take advantage of the momentum of the COVID-19 pandemic. The introduction of new technologies such as mRNA is a good example. This is a technology that we can take advantage of to improve vaccine research against tuberculosis and malaria, and in particular against HIV. We do not yet have an HIV vaccine, but new mRNA candidates are currently being developed.
At the very least, we can improve existing tuberculosis and malaria vaccines with a new tool like mRNA technology. It is also one of the most important platforms for HIV vaccines under development.
This article has been translated with the collaboration of Casa África. Translation: Paula Rodríguez Guerreira.