Moving forward in the fight against AIDS
Anurita Bains is the Regional Adviser for HIV/AIDS, UNICEF Regional Office for Eastern and Southern Africa. The office oversees programming in 21 African nations, including those in Ethiopia. Anurita’s experience within the NGO sector is wide, including with the Clinton Health Access Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria and with the office of the UN Secretary General Envoy for HIV/AIDS in Africa among others. Having attended the 22nd International AIDS conference in Amsterdam, she reflects with The Reporter’s Samuel Getachew on the highlights of the conference, the activities of UNICEF, on how the AIDS epidemic continues to disproportionately affect women and girls and on the challenges and successes of fighting a disease which is affecting the lives of millions. Excerpts:
The Reporter: You attended the AIDS International conference in Amsterdam last week. What were some of the highlights for you?
Anurita Bains: I have been attending the international AIDS conferences since 2004 and what strikes me this time is that while we have made a lot of progress in HIV response, AIDS is not over. We’ve seen massive scale up of lifesaving treatment, attention paid to the impact of HIV on women, who are disproportionately affected by HIV, but there are still children, young women who are at-risk of HIV or do not have access to the services they need. Adolescents are the only age group where deaths have not declined since 2010.
UNICEF is known to have a vision of an AIDS Free Generation. How is the institution addressing the issue of AIDS – not just through lofty slogans but also in a practical way?
UNICEF has long led efforts to prevent mother-to-child transmission of HIV and ensure that all children and women have access to lifesaving antiretroviral treatment. We have come a long way in terms of the PMTCT response – UNICEF has supported governments to invest funding, develop plans and provide services so that all pregnant women are tested for HIV and those found to be positive receive ARVs – for their own health and well-being, and to prevent transmission of HIV to their babies.
UNICEF has been the “go to” for governments to compile and analyze the data. This critical work has helped inform countries on the situation of HIV among adolescents and young people, and importantly has helped ensure that programmes are based on what the data and evidence are telling us.
Through our comprehensive programming in health centres, schools, in communities and in policy discussions, UNICEF has been able to support a comprehensive response to HIV. Lastly, thanks to UNICEF’s advocacy in countries, children and adolescents have been squarely on national AIDS agendas.
There are a number of UN linked organizations advocating the epidemic. What makes the work of UNICEF different than, let’s say, UNAIDS?
UNICEF’s mandate is on children and adolescents and our role is to focus on the well-being of children. Children and adolescents affected and living with HIV are part of UNICEF’s agenda (while UNAIDS is the coordinating body for UN agencies on the HIV response). UNICEF is a co-sponsor to UNAIDS (there are 11 UN agencies which are co-sponsors).
A report released by UNICEF at the conference indicated that there are 30 teenagers becoming infected with the virus every hour. That is a high number. Tell me about that?
Of the 30 teenagers infected every hour, 20 are girls. There are a number of biological and social factors that put girls at risk – gender inequality, being pulled out of school early, being exposed to sexual violence, resorting to transactional – or “survival sex”, not being able to access sexual and reproductive health services, sex with older males who may be already infect – these are some of the factors that put adolescent girls and young women at risk of HIV.
Henrietta Fore, the head of UNICEF said, “Women must be at the heart of the AIDS response”. What do you think she meant by that statement?
Women have been at the forefront of the HIV response. In Africa, they have been most affected – more women than men are living with HIV in ESA region, the global epicenter of the epidemic, and it’s women have cared for sick family members, and been on the frontlines of the community response.
Women such as the late Prudence Mabele of South Africa, and others, have played vital roles, as activists, scientists, political and organizational leaders and as mothers, grandmothers and aunts. Without women, we would not have come this far; without them, we will not progress. We still need that dedication and energy and focus if we are to move forward in the fight against AIDS.
Focusing on the East African region, what is the current situation like?
Almost 9 out of 10 children living with HIV are in sub-Saharan Africa, and the majority (6 out of 10) in Eastern & Southern Africa. Also in the ESA region, HIV disproportionately affects adolescent girls and young women, where 7 out of 10 new infections among 15-19 year olds are girls. That means the focus of the HIV response globally, and much of UNICEF’s programming is in the ESA region. We won’t make progress globally, unless we make progress in Eastern and Southern Africa.
We have seen remarkable progress on the scale up of programs to prevent mother-to-child transmission of HIV. Over 10 countries in ESA have over 80 per cent coverage of maternal ARVs to prevention mother-to-child transmission. In South Africa, Namibia, Botswana, we have over 95% coverage – this means women living with HIV are receiving lifesaving treatment to prevent transmission of HIV, and they are receiving medicine for their own health. UNICEF has led the charge to ensure treatment is available for children and their mothers.
With all the progress in ESA, the gains are fragile and we need to ensure we sustain the progress. In Ethiopia, which is a country with low HIV prevalence, there has been good progress but more needs to be done to ensure that women and children living with HIV receive lifesaving treatment, care, and support. In addition, that those at-risk of HIV are supported and protected. According to the 2018 estimates, almost 60 per cent of pregnant women living with HIV received antiretrovirals.
Under the leadership of government and HAPCO, Ethiopia has also taken strides in analyzing and strengthening data on and for adolescents and young people. Through All In, an initiative to end adolescent HIV, the government and HAPCO brought partners together to review and discuss the situation for adolescents. Through this important effort, there is a better sense of the issues facing adolescents. Now we have to work together to ensure programs and services are responsive to their needs.
As perhaps a solution, one of the goodwill ambassador of UNICEF, Angelique Kidjo said recently how economic empowerment and education is the best way to help change the narrative of AIDS in the world. From the perspective of UNICEF, what do you think are the solutions?
We know that to address adolescent HIV, we need to have a comprehensive response. If we want to effectively prevent HIV among adolescent girls and young women, we need to layer programs so that we respond holistically to their needs. This means keeping girls in school, preventing sexual violence, and indeed supporting economic empowerment initiatives. This may be learning financial literacy or it may be supporting and strengthening social protection efforts, as the government does in Ethiopia. This means low-income households are supported, and that education is prioritized. There is a growing body of data that shows keeping girls in school protects them from HIV.
Despite gains made in changing the statistics, at the conference, heads of organizations such as WHO’s Tedros Adhanom (PhD) and celebrities such as Elton John has indicated the dwindling funding of AIDS projects in the world in a world where foreign aid fatigue is making a comeback. What is your take on that?
Indeed! We need to ensure that global resources to address HIV, health and related issues are sustained. The last few years, global HIV funding has declined, but the Global Fund and PEPFAR have continued to mobilise resources and support treatment, prevention and care programs in Africa, which is critical. This must continue. However, we also need domestic funding to be allocated for health and social services. We do see positive trends in ESA region in terms of domestic investments in health, and this must continue and increase.
Among the African nations that are under your portfolio, which nation(s) do you think are showing promising results in terms of the quality of health afforded to its citizens as well as changing their own situation with the HIV epidemic?
In ESA region, the region carrying the global burden of HIV, we are seeing remarkable progress in addressing HIV for the first decade of life – in South Africa, Malawi, Uganda, Botswana…and more, governments with partners, including UNICEF, have really a change. Fifteen, even 10 years ago, HIV was a death sentence. I remember travelling around the continent and meeting so many women and children living with HIV, who had nothing.
Therefore, few had access to lifesaving treatment and so many lives were unnecessarily lost. We’ve made amazing strides and the scale up of treatment has changed the trajectory of HIV. We have come a long way, but we must not rest; AIDS is not over until every child living with HIV receives treatment and care, until every woman living with HIV has treatment for her own health, and until young women in eastern and southern Africa have the knowledge, agency and power to protect themselves and fulfill their dreams.