Stakeholders have warned that COVID 19 disruptions are likely to set back efforts made in curbing HIV infections back to ten years or more. According to UNAIDS’ new report released in July 2020, while securing antiretroviral therapy has been steadily improving, the progress is inequitable. In its report, Seizing the moment, the World Bank warns that if we don’t act, even the gains made will be lost. To reach the Millions still left behind, nations must double down and work with more urgency.

Unequal progress

Prevention of new HIV infections in Africa is far behind the rest of the world. Nearly two million people were newly infected with the virus, more than three times the global target. Seizing the moment report shows unequal progress, leaving behind vulnerable people and populations. For example, infected key populations such as gay men and their partners, men who have sex with men, sex workers, drug users and people in prison, accounted for 62 per cent of these new HIV infections. Women and girls from marginalised communities face barriers to accessing reproductive health services, especially contraception and HIV services. Those living with HIV/AIDS face stigma. A total of 59 per cent of all new HIV infections in Sub-Saharan Africa in 2019 were among women and girls, with 4500 girls and young women between 15 and 24 years old becoming infected every week. Thus, a growing number of young women are getting HIV infection, despite only making up 10 per cent of the population in sub-Saharan Africa.

Exclusion, stigma and discrimination

Social inequity and exclusion, stigma and discrimination have proven to be significant obstacles in curbing the new HIV infections. At least 82 countries criminalise HIV transmission, exposure, or non-disclosure, 103 criminalise sex work, and 108 criminalise the use, possession, or consumption of HIV related drugs.

 

Progress in targets

There is, however, a significant reduction in HIV transmission levels where comprehensive HIV services are provided. In addition, combining proactive medical practices with social and economic support for young women in Eswatini, Lesotho, and South Africa has narrowed inequality gaps and driven down the incidence of new HIV infections. Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. The expansion of antiretroviral therapy has saved countless lives.

 

However, in 2019, 690 000 people died of AIDS-related illnesses 2019, and 12.6 million of the 38 million people living with HIV did not receive life-saving treatment. Although progress has been made, it is masking the lack of progress and challenges that continue to persist, threatening the progress made during the past decade, with tragic consequences for people’s lives, economies, and health security. Again, Sub-Saharan Africa is most affected.

 

A case for biomedical research

Reducing new HIV infections need to be a deliberate act in Africa. It is imperative that the locally tailored, evidence-based, and community-owned programs be tailored to sustainably reduce new HIV infections.

In the just-concluded 5th Biomedical HIV Prevention Forum (BHPF) hosted virtually in South Africa which focused on Financing of HIV Prevention Research in Africa, findings revealed that most countries did not have funding for biomedical research, and where research happened, it was mostly donor-driven.

To achieve Africa free of New HIV infections (AfNHi)’s vision of ending new HIV infections in Africa, the BHPF aims at mobilizing scientific knowledge and building bridges between science and policy. In addition to mapping potential for collaborative national and regional activities within the AfNHi network, the forum looks to strengthen connections between policy and research through information exchange with HIV prevention advocates.

 

Reporting on the state of funding biomedical research in Africa, Dr Caleb Mulongo, in his research findings based on four countries; Kenya, Rwanda, Eswatini and Malawi noted that none of the four countries met the recommended allocation of two per cent of a country’s domestic budget to biomedical research.

 

While the Abuja Declaration targets that 15 per cent of the national budget be allocated to the health docket, none of the four studied countries (Kenya, Rwanda Eswatini and Malawi) met the target. The highest was Malawi with 11.5 per cent, with Kenya reporting the lowest allocation at less than seven per cent. Rwanda allocated about eight per cent while Eswatini allocated about nine per cent of their national budget to health.

When it comes to research allocation, Malawi set aside 1.06 per cent, which was the highest allocation from the studied countries. Eswatini had the least allocation, at 0.3 per cent.  Kenya allocated 0.79 per cent while Rwanda 0.27 per cent. It is evident low allocation in the health sector which is not adequate to support quality and universal coverage of health means there is very little if any funding to allocate to biomedical research.

More than underfunding

The mini-BHPF conferences held in Rwanda, Zimbabwe and Cote d’Ivoire, presented during the main BHPF forum had similar findings, that their respective countries had not prioritized biomedical research for preventing new HIV infections. More challenges beyond funding were nevertheless noted. There was a lack of expertise in writing proposals, those in charge do not know how to bind for funds to support their activities and where research was conducted, it was noted that because it was donor-driven, it did not particularly priorities local issues, but rather ran with the donors’ agenda.

 

Own the process

A challenge has been thrown to African governments to invest more in biomedical research for HIV prevention funding, as well as invest in making sure systems are in place for translating findings into actions. A case of Malawi was noted, whose National Research Council of Malawi (NRCM) is domiciled in the Office of the President. This positioning is thought to be responsible for the higher allocations in the Health docket, hence elevating research as a national priority.

 

Other stakeholders including advocates for change, Civil Society and communities, Researchers and Front-line providers were called upon to keep the momentum for biomedical research HIV prevention funding, by pushing for better allocations of funds, elevating the discussion to the national level where policymakers sit and as well as information sharing across the countries.

On 28th October 2021, WACI Health launched an African youth advocacy and leadership program for global health, which defines, creates, and implements change while equipping young African advocates with skills to make a global impact on health.

Under the Tree brings together all of WACI Health’s youth leadership programs, including AfNHi Youth Cohort, YL4H (Youth Leaders for Health), RUN4TB Youth and AGYW Voices. Through these programs, we have witnessed the power of youth advocacy and leadership in policy change.

Rosemary Mburu, executive director at WACI Health, says, “By fostering youth leadership, WACI Health acknowledges that young people should lead today, not wait for tomorrow. As an organisation that mentors youth to drive advocacy, we help develop knowledgeable, bold and accountable youth leaders for global health.”

We are inspired by Youth Leaders for Health, a joint program by WACI Health, RESULTS UK, Health Promotion Tanzania-HDT, Hope for Future Generations, and CISMATSL. In addition, YL4H was an 18-month journey of skill development, mentorship, and influence for policy change, which demonstrated the power of youth voices in advocacy.

The project ended in March 2021, and 25 Youth Leaders passionate about health and healthcare systems were trained to advocate for policy reform. Under the Tree will contribute to the YL4H goal of more decisive youth leadership for better and more equitable systems for health in Africa.

Under the Tree will apply three key strategies: (i) structured module-based training (ii) continuous group coaching (iii) facilitates and connects young people to advocate for policy change at crucial national, regional and global advocacy moments.

Currently, Under the Tree is training and mentoring a group of 12 young people drawn from the AfNHi Youth Cohort. These12 young people from Nigeria, Ghana, South Africa, Zimbabwe, Tanzania and Uganda attend weekly online classes covering a range of topics from advocacy, engagement with communities, policymakers and civil society, media engagement, data advocacy and understanding the global, regional and local financing mechanisms.

The module-based online classes are combined with group coaching on specific skills to expand their capability to advocate for policy change at key national, regional and global advocacy moments. Additionally, Under the Tree hosts a monthly virtual Youth Forum, which is open to all young people passionate about health advocacy. It is a space for peer-to-peer learning and mentoring.

Using youth voices to advocate for and create community change is an outcome we strive for. Youth, adults, and their communities can potentially benefit from these interactions in significant ways.

Close to 4,000 people die each day from tuberculosis, which is the fourth leading killer among infectious diseases. There have been 10 million tuberculosis infections in 2019 alone, and 1.4 million have died from the disease. There were approximately 140,000 cases of TB in Kenya in the same year.

Around 32,000 TB-related deaths occurred in Kenya in that year alone. This could have been prevented through more targeted programming.

Male tuberculosis survivors from Kenya, Nigeria, and South Africa participated in the Just Men forum to share their stories with celebrities and become Male champions for TB advocacy. A live Facebook session complemented the event with Ambassador for Youth and Adolescent Rep Health Programme (AYARHEP), which is an adolescent and youth reproductive, health rights organisation, focused on gender advocacy on TB.

It is estimated that TB is more prevalent in men with approx. 60% of cases are diagnosed in men. According to Kenya’s 2016 prevalence survey, the disease killed the most productive population (18-44 years), and men were two times more likely to be infected than women.

The 2018 High-Level Meeting of the United Nations (UNHLM) focused on eradicating TB by 2030. To contribute to national and global goals, the commitment recommends gender-sensitive programming and innovative TB response strategies.

Due to men being more susceptible to TB, addressing gender-related barriers that prevent access to and treatment adherence is crucial. As their first remarks, Dr Waqo, Head of the National Tuberculosis Program, and Dr Kinyanjui, Country Director of the African Health Forum, highlighted financial barriers and societal norms that force men to prioritise income-generating activities over their health.

Furthermore, low levels of awareness of TB suggest that TB messaging for men needs to be creative.

As we continue strengthening the conversation around TB in women, it is crucial to ensure that men who carry the most considerable disease burden are not excluded from the discussion.

The GFF We Want is a platform for Civil society in the GFF implementing countries which begun in 2018, which aims to leverage the knowledge and capacity of the civil society coalitions working on the GFF to capture lessons learned, identify best practices and strengthen cross- learning by leveraging key relationships and moments including the GFF Resource Mobilization Campaign to drive country level work and global commitments to mobilize resources and ensure the success of the GFF. The GFF We Want has been implementing key activities to support the GFF resource mobilization throughout 2021. The campaign has leveraged key moments such as Generation Equality Forum, United Nations General Assembly and looking forward to the Nutrition for Growth. The Global Civil Society coordinating Group Jointly with the GFF We Want launched the GFF Wall of Fame in September 2021. The GFF Wall of Fame is a virtual platform which aims to highlight and celebrate GFF successes, including: donor commitments, country government commitments, CSO and youth contributions to results in GFF countries, and other GFF progress. Here are a few stories of impact which can be found on the GFF We Want Wall of Fame;

● In April 2019, Côte d'Ivoire launched a nationwide dialogue about health financing.
FENOS-CI was one of the key actors and stakeholders from the health sector involved in
discussions that led to creating the National Platform for the Coordination of Health
Financing (PNCFS). The 1.658 trillion CFA Franc investment envelope supported three
Civil Society bodies: an investment committee, a technical secretariat, and technical
working groups. Funding will be directed to the communities' needs through the
platform, strengthening the Ivorian health system. As a result of the National Dialogue
meeting, the investment file was created, giving the donors a framework for funding the
healthcare priorities of their sectors.

● GFF processes assisted youth-led organizations and policymakers at the local and
national levels in Kenya to reduce duplication of resources and enhance effective
advocacy through SMART Health Policy leadership training. In addition to the FP 2030
commitments, the national Scaling Up Nutrition strategy (2021-2025) and the
reproductive health policy (2020-2030) were developed due to knowledge gained from
this project. The partners will collaborate closely to increase county FP budgets during
the next financial year.

● As part of the Youth and Adolescents Health Forum, UYAHF fosters youth advocacy and
research initiatives that improve access to, demand, and uptake youth-friendly services
and collects evidence about young people's experiences with youth-friendly services.
The youth advocacy plan and coordinated action plan were developed based on this
evidence. As a result of this study, young people contribute to, inform, and influence
decision-making processes. Youths are also using the evidence to highlight the lack of
youth-friendly services in lower health facilities, lack of short-term family planning
services. Based on the evidence, a cost-effective implementation plan for family
planning in Uganda is being evaluated. It is important to note that now young people
can hold policy makers for their promises and demands for improved health care for
adolescents at the district and national levels. In Eastern Mbale, Busia, Tororo, and
Butalejja districts, UYAHF, in partnership with the Eastern Regional Youth Network, has
held several district-level policy dialogues to improve access to youth-friendly sexual
and reproductive health services. As a result, in Butalejja, the district has agreed to
provide family planning services, condom distribution, HIV tests, and GBV screening at
trading centers with funds from the PHC non-wage budget and the RBF. At Butalejja,
policymakers from the chief's office participated in a dialogue with education, health,
production, cultural, and religious leaders and teachers, students, and media experts.

The GFAN Torch Caravan has gained momentum since leaving South Africa in July and now spans five regions and includes 15 African countries in Africa. Southern Africa – South Africa, Zimbabwe, and Malawi East Africa – Kenya, Uganda, Ethiopia, Tanzania, Burundi, Rwanda Central Africa – DRC, Cameroon, Niger, West Africa – Senegal, Burkina Faso (Current holder) —– Nigeria, Ghana (October)
The Torch will be in West Africa during October and be received in the MENA region – Morocco, Tunisia, Egypt, in November. The engagements among key stakeholders have been remarkable with interactions from:

● MoH (Permanent Secretary) – Kenya, Uganda, Ethiopia, Malawi
● Ministers’ of Health – Uganda (Health and Finance), Ethiopia, Malawi, Rwanda, DRC
● Country Coordinating Mechanism (CCM)

WACI Health, the GFAN Africa secretariat is encouraged to see that every participating country included their CCM in receiving and handing over the Torch. Despite language barriers, political unrest, and the effects of the COVID-19 pandemic, the Torch Caravan has traversed the continent. It is impossible to suppress the enthusiasm and appreciation shown during this journey of gratitude and hope. As a result, the campaign has enjoyed traditional and social media coverage, which has raised awareness. In addition, the Torch Caravan united communities from all walks of life in celebration and acknowledgement of the impact. Through parliamentary engagement, there is an increase in political will for the GF@20 campaign and strong collaboration as we work together towards the 7 th Replenishment. In addition, working with partners and stakeholders such as the British High Commission, TB HIV care, Malaria No More has built
stronger partnerships and collaborative efforts. The campaign strengthened partnerships between civil society, making it easier for them to collaborate in-country. A special highlight was when the Torch was received by Burkina Faso’s first-ever Olympic Champion, Hugues Fabrice Zango.

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The celebrations will continue with cake cutting, dancing and hope until the Cape to Cairo Torch caravan campaign will culminate on 8 December 2021 in Durban, South Africa, alongside ICASA 2021.

In September 2021, WACI Health led a team of young women on a dialogue on women-initiated HIV prevention options and Sexual Reproductive Health Rights (SRHR). Globally, these discussions are ongoing given the approval by WHO in July 2020, for the Dapivirine Vaginal Ring (DPV-VR) as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches. Read more here. This news has since been considered a milestone in the quest to provide women with expanded choices for HIV prevention. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections. In sub-Saharan Africa, despite making up just 10% of the population, one out of every five new HIV infections happens among Adolescent Girls and Young Women (AGYW). In the worst-affected countries, 80% of new HIV infections
among adolescents are among girls, who are up to eight times more likely to be living with HIV than adolescent boys. It is estimated that around 50 adolescent girls die every day from AIDS- related illnesses. Dapivirine Vaginal Ring is intended for prevention of New HIV infection via vaginal sex in HIV Negative women 18 years and older. The Vaginal Dapivirine ring contains an antiretroviral drug
called Dapivirine which is released slowly over the course of one month directly to vaginal tissues to help protect against HIV at the site of potential infection. Little of the drug is absorbed elsewhere in the body resulting in low systemic uptake. There are studies underway
examining the safety of a combined Dapivirine-levonorgestrel ring that would protect against HIV infection and unwanted pregnancy, as well as different vaginal rings that combine antiretroviral and other medications to prevent STIs. “Unlike other HIV prevention methods like use of condoms, this female controlled innovation gives full control to women to look after their safety,” she says. Biological and social factors contribute to high rates of infections among women. “The high number of infections among women does not mean they have riskier sexual behaviors compared to men” Gloria Mululu, Program Officer WACI Health The Dapivirine Ring (DVR) in Kenya and many other countries in sub-Saharan Africa, initiative by advocates are ongoing thus calling for updating of ARV guidelines and Essential Medicines List to include Dapivirine Ring as other Regulatory national processes and approval are ongoing to
ensure access. The ring has currently been approved for use in Zimbabwe. This dialogue meeting resolved to have a campaign that looks at holistic needs of adolescent girls and Young Women’s HIV prevention and SRHR, Multipurpose HIV prevention, Protection of AGYW against Gender-based violence (GBV), and Inclusivity of women in all their diversities. “While a lot has been done to curb new HIV infections in the country, all stakeholders should move in and address the barriers to access HIV prevention options/tools by Adolescents, Girls and Young Women and be allowed to make a choice on which methods work for them. Dapivirine Ring is a game changer in women’s HIV prevention options. AGYW needs training as champions to lead on advocacy efforts towards country policy update and regulatory initiatives towards Dapivirine Ring access” Patricia Jeckoniah, Technical Advisor, Policy and Partnerships, LVCT. The vaginal ring is a complimentary prevention method in addition to other safe sex practices especially when women cannot access or use PrEP. It does not prevent infection from other sexually transmitted diseases or from pregnancy. “Four decades since the outbreak of HIV, the country has registered great strides in efforts to combat the virus. However, not much progress has been made around adolescents and young women, and time has come where scientists must include this demography as they develop HIV preventive methodologies. This subset is privy to Sexual Gender Based Violence (SGBV), and the young women movement must be well coordinated so that they are present in all spaces where their voices must be heard. They should be given opportunities to share their ideas about HIV mitigation, dealing with intimate partner violence amongst other issues related to SGBV. Further, the movement must ensure that girls are at the table every time their issues are being discussed, be ready to be mentored and ready to mentor other girls, especially in the rural communities. They must also be part of the research so that there is their representation in data gathering.” Faith FAO. Calling for safeguarding of the gains made in the fight against HIV new infections as we fight Covid 19, there is a need to invest around girls. There is a need to invest in capacity building, programs, exposure and money available to ensure that organizations can conduct their
activities. There is also a need to see how resources that are coming in are targeted to adolescent and young women programs towards building their capacity.

“For most adolescent girls and young
women, the availability of the ring
widens the pool of preventative options
to choose from. Young women are
diverse and have varied preferences.
The ring will improve the uptake and
access of HIV prevention products,”
Joyce Ouma, AVAC Fellow.

With- Me, in- me is an AGYW led campaign demanding expanded choice for HIV prevention for
AGYW and Sexual Reproductive health and Right (SRHR), Multipurpose HIV prevention tools,
protection against Gender-based violence (GBV), and Inclusivity of women in all their
diversities. The campaigns highlight challenges as faced by AGYW living with and impacted by
HIV and enhance the awareness among Health providers, policymakers, and youth-serving
organizations about the existing disparities.
“The greatest aspect about the Ring is its bodily autonomy. Nobody needs to know you are
using it hence giving you the power to be in charge of your own protection. This is a plus for
every woman and especially if you have started to develop trust issues with your sex partner”
Joyce Ng’ang’a, Policy advisor WACI Health.
For more information check this Reading Material