Published on The Financial Gazette – 15 -21 October 2020
Published on The Financial Gazette – 15 -21 October 2020
“TB ANYWHERE IS TB EVERYWHERE”. It spreads from person to person and can move across borders.
Fighting TB ensures a safer world.
Keeping the Promise to END TB
The clock is ticking!
In the race to ending tuberculosis (TB) by 2030, the disease remains one of the world’s fatal infectious killers. Each day, nearly 4 000 lose their lives to TB, and close to 28,000 people fall ill with this preventable and curable disease (WHO, 2020).
Sadly, TB is the primary cause of mortality in people living with HIV (PLHIV) worldwide, with 79 percent of the estimated 1.37 million new cases of TB/HIV occurring in sub-Saharan Africa (WHO, 2019).
The close relationship between TB and HIV/AIDS poses a significant burden on Zimbabwe’s health system. About 60 percent of TB patients are also living with HIV. WHO cites Zimbabwe as being among the 14 countries with a triple burden of TB, TB-HIV co-infection, and drug-resistant TB (DR-TB).
In Zimbabwe, approximately 1,4 million people are living with HIV (National HIV Estimates). And TB continues to be the leading cause of death among people living with HIV with 60 percent of Zimbabweans suffering from TB are co-infected with HIV.
According to the Global TB Report of 2019, Zimbabwe recorded a total of 25 775 cases, and of those 15 062 were in PLHIV.TB is an infectious disease caused by Mycobacterium tuberculosis bacteria. While TB typically affects the lungs, it can affect any part of the body. TB spreads from person to person through the air when someone sick with the disease coughs, sneezes, or spits. Another person needs only to inhale a few of these germs to become infected.
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The crucial question to ask is what needs to be done to end TB?
Prevention, prevention, and prevention!
People with impaired immunity, such as people living with HIV, children under five years, and those on certain medications that affect the immune system have a much higher risk of developing TB disease. The key to TB prevention is reaching people with preventive therapy (TB preventive therapy) before the infection develops into an active infectious disease.
There are no scenarios in which we can end the global TB epidemic without a much greater focus on TB prevention. But there is still an opportunity to substantially reduce the death toll by prioritizing the most critical services: antiretroviral therapy for HIV and timely diagnosis and treatment of TB.
There is a need to ensure that people have access to diagnosis and appropriate care at the earliest stage after exposure to TB. This is critical to reducing TB transmission and ending the epidemic.
And as the world comes together to tackle the COVID-19 pandemic, it is important to ensure that essential services and operations for dealing with long-standing health problems continue to protect the lives of people with TB and other diseases or health conditions.
Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained.
Each year, we commemorate World TB Day on March 24 to raise public awareness about the health, social and economic consequences of TB and to step up efforts to end the global TB epidemic.
TB INFECTION: KEY FACTS
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Zimbabwe remains one of the countries burdened by HIV/AIDS globally with 1.4 million people living with HIV (PLHIV). Annually,12.8 percent of adults are living with HIV between the ages of 15-49, and 40,000 new HIV infections are being realized (UNAIDS 2020). People are still dying of HIV/AIDS-related diseases with an estimated number of 20,000 people while 86 percent of adults in Zimbabwe living with HIV are on life-saving antiretroviral treatment. Children as well are not being spared as 71 percent of children living with HIV, are on antiretroviral treatment. (UNAIDS Data 2020)
“My people are destroyed for lack of knowledge”-Hosea 4:6, There is hope for everyone living with HIV and communities should help fight HIV. According to AIDSinfo (UNAIDS), a third of all new HIV infections in people above the age of 15 in Zimbabwe were among young people (under the age of 24). 9,000 new infections among young women, and 4,200 were realized in 2018. Young men are still less likely to get tested, as 52 percent of young men had tested for HIV compared to 65 percent of women. (ZIMPHIA 2016).
In Zimbabwe, of the 1.4 million PLHIV, 97 percent are on the antiretroviral therapy (ART) program. Among PLHIV (15-64 years) who self-report current use of ART, 90.3 percent are virally suppressed (ZIMPHIA, 2020).
Though HIV/AIDS is nearing epidemic control, some sections of the population still lag in terms of accessing services, thereby derailing the gains achieved so far in the fight against HIV/AIDS. Globally, young people are more likely to engage in risky sexual behaviors than older adults, making them vulnerable to HIV, and yet some fear testing positive and eventually disclose their status. However, new choices of HIV/AIDS diagnostic tests have been brought up in healthcare systems to address the challenges of fear of discrimination, and concerns about confidentiality. Through the use of HIV self-testing kits, one can test in the privacy of their own homes. HIV self-testing is very safe, accurate, and easy to use. There are different kinds of HIV tests which include blood tests and saliva tests, and some are performed by healthcare workers. HIV Self-test kits are offered for free in all health facilities (clinics and hospitals).
Unprotected sex is the most common route of HIV infection among young people and some this is the result of being forced to have unprotected sex or to inject drugs, and for some, it may be a lack of having the correct knowledge about HIV and how to prevent it. (WHO 2013). Though still experiencing a low uptake, Pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis are among the HIV/AIDS prevention strategies for high-risk populations as well as for adolescent girls and young women as they are among the HIV prevention strategies priority list. Both PEP and PrEP are daily dose courses of antiretroviral drugs (ARVs) taken by an HIV-negative person to protect themselves from infection.
The Zimbabwe Association of Church-Related Hospitals (ZACH) in partnership with Africaid – Zvandiri is expanding targeted index case testing for children and adolescents at Community Post and other health facilities through Community Adolescent Treatment Supporters (CATS). This is aimed at addressing barriers to testing access. According to WHO, index testing is when members of a household, biological children, and partners of people diagnosed with HIV are offered HIV testing services. Partner notification services are offered by asking people who have been diagnosed with HIV to list their sexual partners; a trained healthcare provider then contacts and offers those partners an HIV test.
Stigma and discrimination have for years been a stumbling block in the lives of young people living with HIV, and healthcare workers are pivotal in offering to counsel, and providing support and life skills required to cope with stigma. Most people living with HIV /AIDS who take antiretroviral drugs assume that they shall be stigmatized if seen taking many pills.
A survey by ZNNP+ established forms of stigma as ranging from exclusion from gatherings, discrimination by partners, exclusion from family activities, dismissal or suspension from work or educational institutions, exclusion from religious activities or places of worship, and sexual rejection to discrimination from among PLHIV.
Despite the rampant stigma, HIV also gave rise to resilience, courage, and willpower.
So how do we, the HIV community – affected by HIV, who are living with HIV or who are vulnerable to HIV – move beyond stigma to normalizing HIV?
It is, however, everyone’s responsibility to fight HIV stigma and discrimination!
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INCLUSION OF KEY POPULATIONS CRITICAL IN HIV FIGHT
MILESTONES such as the decrease in HIV/AIDS-related mortality by 45 percent and a spike in antiretroviral therapy (ART) uptake; with more than 25 million people living with HIV (PLHIV) currently on ART, has inspired global confidence that the epidemic control of HIV is achievable by 2030 (UNAIDS, 2019). In Zimbabwe, there are an estimated 1.4 million PLHIV and of these, 97 percent are on the ART programme. Among PLHIV (15-64 years) who self-report current use of ART, 90.3 percent are virally suppressed (ZIMPHIA, 2020).
Despite the accomplishments, key populations are still faced with limited access to health services, increasing their likelihood of developing one or more of the HIV/AIDS-related diseases.
Key populations are sub-groups of the population at higher risk of being infected by HIV/AIDS, who play a key role in how HIV/AIDS spreads, and whose involvement is vital for an effective and sustainable response to the pandemic. Too often, people most affected by HIV/AIDS and tuberculosis (TB) are the same people who do not have access to health care.
Widespread stigma and discrimination, harassment, restrictive laws, and policies, as well as the criminalization of behaviors or practices that put key populations at heightened risk, are among the barriers that prevent them from accessing health services.
According to the UNAIDS (2019) estimates, Zimbabwe has 23 000 men who have sex with men (MSM) and 45, 000 sex workers.
In the context of HIV/AIDS, Zimbabwe considers MSM, sex workers and their clients, transgender people, and people who inject drugs as the four main key population groups. However, groups such as prisoners and people with disabilities are also acknowledged as at-risk populations as they are also particularly vulnerable to HIV/AIDS and frequently lack adequate access to health services (ZNASP3).
These populations are socially marginalized, often criminalized, and face a range of human rights abuses that increase their vulnerability to HIV/AIDS.
To overcome these barriers, the Zimbabwe Association of Church-Related Hospitals (ZACH) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/CDC supported health sites tailor services to the specific needs of these populations, as well as invest in programs that address the underlying causes of discrimination.
ZACH offers friendly clinical and support services like HIV testing services (HTS), sexually transmitted infections (STI) screening, and treatment and management of co-infections, such as TB and viral hepatitis. On the provision of HTS, ZACH is scaling up innovative and differentiated HIV/AIDS testing models. And treatment and care support is offered to those living with HIV.
The organization is also strengthening community systems through advocacy structures, peer groups, and networks. These provide the space and opportunity for the key populations to act together, and to campaign for their rights.
ZACH also offers pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and condoms to the vulnerable groups.
The COVID-19 crisis has exacerbated the previous inequalities for key populations affected by HIV/AIDS, thereby rolling back the wins gained in the fight against HIV/AIDS. Indeed, the abuse that these populations suffer as well as stigmatization, and criminalization impacts negatively on the health of these already vulnerable populations as they will also be less willing to engage with the health services. Key populations may also be vulnerable to mental health problems and poor mental health may be a barrier to testing or treatment for HIV/AIDS, and to continue in care for those who are living with HIV.
Despite the efforts by ZACH to reach out to the key populations with health services, a lot still needs to be done.
A call is being made to development partners and the Government to develop strategies to reduce stigma and discrimination including self-stigma of the key populations, as well as conduct awareness campaigns and decriminalization to promote access to health care.
Though several behavioral, biomedical, and structural interventions operating at an individual and population/community level are being widely used for HIV/AIDS prevention and support, the best way is to involve key populations in the design, implementation, and monitoring of those health services, as well as in policy decisions that affect them.
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