PEPFAR and the 95-95-95 in Ghana, can we?

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PEPFAR and the 95-95-95

PEPFAR and the 95-95-95 in Ghana, can we? PEPFAR has for years been pushing the “Ending AIDS” agenda in Ghana with various programs. They have invested so much all in the bid to help Ghana meet various forms of targets. This includes the ambitious Agenda 90-90-90 which Ghana, unfortunately, could not meet. Now, just after the release of the 2019 sentinel survey report, we hear of the agenda 95-95-95.

Following the declaration of the new agenda, PEPFAR and its partners, Media Health Link and the African Centre for Development Reporting have spent time training Journalists again from July 21 to September 3, 2020. They have also equipped journalists on reporting on COVID-19 focusing on stigma against persons infected by the global pandemic.

The program has been a huge success with real practical touches from persons like Rev John Azumah who has reached the undetectable stage in the treatment of HIV, and Gary Al-Smith who shared his COVID experience with participants.

This piece is of a personal touch as I think aloud about the new target.

I have followed issues of HIV with keen interest from my radio days at then Vision Fm, I was the MC of the launch of the Agenda 90-90-90 in the Eastern Region, and when the region had the honour of hosting the national durbar, I was MC as well. It was such a grand event under the able organizational prowess of Golda Asante.

Thanks to her for the whipping up that interest in some of us.

Getting off the microphone and now taking to the computer keyboard to be “typing” on health issues, my focus has been on HIV ever since and the crave grows with each passing day.

This is what led me to follow Ghana’s walk towards the 90-90-90. In my curiosity to find out about how we were going to achieve this, I went out of my comfort zone to find out how others in the hard to reach areas were living with the virus. It was pretty obvious how some in our cities were living with it, they would take their treatment religiously, and they would eat well, within a matter of months they had reached the undetectable stage. Some boldly declared their status to the world without fear of the obvious stigma that was to follow.

My discovery in the village of Mangoase, an old Ghanaian village scared me, Persons Living with HIV (PLs) were not having proper diets needed for their medications to work properly, as a result, many were defaulting, and the consequences can be dreadful. In a different village, I met with a woman who can no more hear as a result of defaulting with her medications. At Mangoase, PLs, especially women were also not disclosing their status to their partners for fear of being sacked from the family or being stigmatized in the village.

This is what led to my two stories, the first one on “the diet factor” and the second one on “the challenge of disclosure” in a rural environment.

The end result would be a continuous and incessant spiral of new infections.

In the past three to four years, I have travelled with Persons living with HIV to several places for various talks, I have had the privilege of being present at several of their meetings, I have seen those who out of stigma would not visit their regular health facility anymore for medications, and because they don’t have money to travel to facilities far enough, these end up defaulting in going for and assessing. This is one of the reasons for the continuous rise in the “lost to follow up”. I have seen children who had challenges taking their medications because they didn’t know why they were given “medicine to take every day” and sadly enough, I saw some die out of relapse of stopping treatment.

What broke the camel’s back in me and gave me a resolve to continue this journey was a phone call I got from a model of hope in a health facility somewhere in my beloved Ghana telling me of the passing away of a PL who had is suspected to have passed on due to hunger! He was a teenager I had visited in the company of some officials months ago before his death. His parents had all passed on due to the virus, and he lived with his grandmother in a very hard to reach area beyond some mountains. His cousins then went to bring him to live with them in a comparatively “better condition”.

These and many more are some of the untold stories I have had to witness.

Alas! 2020 came and Ghana missed the target of 90-90-90. For those who are new to the term, It is a UNAIDS adopted goal, the Ghana AIDS Commission aimed at getting 9 out of every 10 people who are HIV positive in the country to know their status by the year 2020.

Secondly, by the year 2020, it was targeted that, 9 out of every 10 people who are living with HIV should be on sustained antiretroviral therapy.

Per the third 90, the Commission aimed at getting 9 out of every 10 people receiving antiretroviral therapy to have viral suppression. The Ghana Health Service added to their third 90 that the viral suppression should be reached “within one year”.

What this means is that, people will be living with HIV but would their viral load will be so suppressed, it would make it difficult for them to infect other people.

The Commission also aims at eradicating AIDS by the year 2030. This goal is still on.

When the target was missed, and as usual, it did not receive the “noise” that it deserved, the tail part of 2019 did not see much of HIV as was expected. The national celebration of the World AIDS day haven been merged with the Farmers day has obviously taken away the euphoria and shine that used to surround the day. Whoever brought up that idea must take a second look at it!

The reasons why the target was missed are numerous, and I tried exploring just one, my suspicion was born out of a real life situation that I bumped into, a mother brought me empty shells of emergency pills her daughter had been taking secretly on her blind side and wanted to know what medicine it was that the daughter was consuming in such quantities. After speaking to the young teen, I set out to investigate “the abuse of emergency pills”

Young ladies, instead of going for regular family planning methods to prevent pregnancies, and preferably the use of condoms which have an added advantage of preventing Sexually Transmitted Infections (STIs) would rather use emergency pills.

Going around the city of Koforidua to do some fact checks got me even more scared! One pharmacist was blunt with me. “Because of the rate at which young people buy it, I have even stopped selling them,” he told me.

Click here to listen to one pharmacist who spoke to me extensively on this issue.

Fast forward into 2020, we have a new target 95-95-95 and PEPFAR, as usual, is blazing the trail, sponsoring the training of journalists to keep the work of reportage on HIV issues ongoing.

My cogitations and musings are that we might as well have to forget about this new target if we do not consciously deal with certain variables in this huge equation. One of which is the issue of increased sexual activities of teenagers in our second cycle institutions. This is what has dovetailed into the excessive usage of emergency pills since they are not using condoms.

While applauding the efforts of PEPFAR to train and equip journalists in the area of health reporting and specifically on HIV, it must be noted that as a country, we must as well have to kiss this new target goodbye if a vigorous campaign for behavioural change is not embarked upon.

Currently, according to the Ghana AIDS Commission, more than 142,000 people living with HIV don’t know they are HIV positive because they have never tested, meanwhile more than 46,000 Ghanaians who also know they are living with the virus are not on treatment. This only means they risk infecting others.

Worse off, “nearly 190,000 persons living with HIV, who are not on treatment sustain the high level of annual new infections”

With these statistics staring us in the face I write these musings from an experiential standpoint that before we agree to these targets, there is more work that ought to be done than we know.

Speaking to an official on the issue of adolescent’s’ sexual and reproductive issue and these targets, she told me, the agenda has to be pursued with “speed and aggression.” Unfortunately, with COVID around, mass testing services which had already taken a dip has even plummeted more.

Students and their tutors still jostle each for teenage girls in our second cycle institutions, young boys still engage in multiple sexual partner relationships as though it was a championship league.

Admittedly, we have seen a steady albeit slow decline in adult prevalence, which warrants an applaud, we have also seen a decline in the number of AIDS-related deaths over the years, however, the prevalence in some areas like the Greater Accra and Bono Regions is still as high as 2.47%. This is above the national average of 1.7%, worse off is that of the Okai Koi district which recorded a prevalence of 7.50% followed by La-Nkwantanang-Madina with 6.60%

For the uninitiated, what these figures mean is that, if 100 people are randomly counted at the Okai Koi district, chances are that 7 people are likely to be living with the virus; you can try calculating the others!

Whatever is happening in these districts ought to be found out, and dealt with. As it is said, a stitch in time saves nine.

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