As part of the main drivers of the BAM Group of Companies, this being the umbrella company within which Informative Newspaper operates, alongside sister brands Finite Magazine, Finite Lifestyle Club, BAM Promotions and Twin Talk, Informative Newspaper takes particular interest in social issues and causes created to advance the development of young girls and women and their participation in the global space.
To advance and cement the organization’s support for women and young girls, the Sexual and Reproductive Health and Rights is today, through this issue introduced. Its purpose is to advance knowledge and create further awareness on developments surrounding the said community sector and to help audiences stay updated on such, further guiding means of both action and reaction to these developments.
This week we discuss Human rights barriers to ART
People living with HIV face barriers to both starting ART early enough and to treatment adherence. Treatment adherence among young people is generally lower than the general population and treatment failure rates are comparatively higher, especially among adolescents who are transitioning from paediatric to adult care. Studies in Kenya, Uganda and Tanzania indicate that young people aged 15 – 19 years are more likely to drop out of HIV care, both before and after starting ART, than are those aged 10 – 14 years or those older than 20 years. Studies suggest that stigma, discrimination and disclosure issues, as well as travel and waiting times at clinics, are among the reasons.
Stigma and discrimination
Stigma and discrimination and fear of stigma and discrimination prevent many people living with HIV from accessing ART and TB treatment. Key populations living with HIV experience double stigma which affects their access to treatment. There are currently no reliable estimates of the numbers of people living with HIV who are also gay men or other men who have sex with men, sex workers, injecting drug users or transgender and who are accessing ART, but the 2014 UNAIDS treatment progress report for Africa states there “are strong indications that key populations face substantial barriers to accessing essential health services and have extremely low access to antiretroviral therapy”.
Discriminatory laws and policies, including laws that criminalise HIV transmission, sex work, same sex sexual conduct and drug use, drive people away from HIV related services and may make it difficult for health care workers to know what services they may legally provide to sex workers, gay men and other men who have sex with men and people who inject drugs. Health care workers may themselves stigmatise key populations and thereby undermine their access to ART.
Gender-based abuses
High levels of violence against women and girls, including domestic violence and other gender based violations, affect women and girls’ access to HIV testing and treatment and their adherence to ART. Fear of violence and abandonment discourages women from seeking and accessing HIV testing and sexual and reproductive health care, placing their health at risk. Fear of violence may force women to hide their HIV status from their sexual partners which can undermine treatment adherence.
Poverty, which disproportionately affects women and girls, may force them to miss appointments at hospitals and clinics and they may run out of ART and miss doses.
Women and girls also struggle to access comprehensive SRH care which in turn undermines their access to ART.
Lack of access to HIV and viral load testing
HIV testing is a key access point to ART, and yet more than half of people living with HIV do not know their HIV status. Key populations experience particular challenges accessing HIV testing, counselling and information and there are too few programmes that target their specific needs for HIV counselling and testing. Research shows that in some countries, including in SADC, less than half of key populations know their HIV status. Adolescents and young people also struggle to access HIV testing. The 2017 Global AIDS Update states that “large proportions of young people living with HIV have not been diagnosed.”
Studies conducted in Malawi, Zambia and Zimbabwe indicate that less than half young people living with HIV know their status. The Stigma Index reports show that fear of HIV-related stigma and discrimination causes many people to delay or avoid having an HIV test.
Access to routine viral load testing
Monitoring ART is an essential part of access to treatment. The most effective way to monitor the effectiveness of ART is through RVLT which has been routinely used in high-income settings for many years. RVLT is however not freely available in SADC countries and many people living with HIV do not have access to regular viral load monitoring or cannot afford it where it is available.
The goal of ART is to reduce the viral load in your body so that you have as few copies of HIV in your blood as possible, achieving viral suppression. Ideally there should be so few copies of HIV in your blood that they cannot be detected by a viral load test, resulting in an undetectable viral load. A low or undetectable viral load is a strong indication that ART is working, but it also reduces the risk of HIV transmission.
In October 2015, ARASA and the International Treatment Preparedness Coalition (ITPC) launched the Be Healthy, Know your Viral Load campaign. The ongoing campaign aims to inform people living with HIV about the value of viral load testing, to mobilise people to demand routine viral load testing and to urge governments to make sure the tests are routinely available, accessible and affordable.
Lack of targeted services for key and vulnerable populations
ART is a lifelong commitment and people living with HIV who are on treatment require supportive health and other services to help them to adhere to treatment and achieve viral suppression. Key populations may face particular challenges with adherence to both ART and TB medicines: people living with HIV who use injecting drugs are more likely to adhere to ART and TB if they can also access opioid substitution therapy (OSI) and other harm reduction services – these are however not readily accessible in SADC countries; adolescents living with HIV often struggle to access sexual and reproductive health care and information, including because of a lack of trained counsellors that can assist with their particular adherence challenges.
Next we discuss What parliamentarians can do to advance access to treatment.
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