HIV treatment and care should be part of a wider health system that supports related diseases and conditions, instead of excluding them, as is the case in most countries, the new Lancet Commissionreport launched at the International Aids Conference on July 26 has recommended.
The Lancet Commission was tasked with assessing and strengthening the future of HIV response in an integrated global health and development agenda.
HIV interventions can be combined with programmes for sexual and reproductive health, programmes for associated diseases such as hepatitis or tuberculosis, health services for young men, and even programmes for non-communicable diseases because people on long-term antiretroviral therapy are susceptible to cardiovascular and other non-communicable diseases.
However, inclusion is a capital-intensive plan. If HIV treatment were to be covered by the national health insurance package, Kenya would need Sh86.3 billion for it.
The proposed National Hospital Insurance Fund (NHIF) comprehensive HIV package to cover in- and outpatient, HIV testing and counselling, antiretroviral therapy (ART), pre-and post-exposure prophylaxis, tuberculosis prevention and care, non-communicable diseases and maternal healthcare, will cost Sh42,000 per patient.
Besides, as the burdens of infectious and non-communicable diseases converge with HIV, the community of people with HIV will need special attention and care throughout their lives.
Kenya is highly dependent on donors who provide Sh7 out of every Sh10 set aside to address HIV.
However, HIV funding has remained flat in recent years, at about Sh191.9 billion, which is about Sh703 billion short of the amount needed to achieve the UNAIDS 90-90-90 targets. That is, 90 per cent of people will know their HIV status, 90 per cent of HIV-positive people will be on ARVs and 90 per cent of those on ARVs will have viral suppression by 2020.
Money is needed to ensure that all people diagnosed with HIV receive ART as long as they live.
In June, approximately 20.9 million people (57 per cent of people with HIV) worldwide were receiving the drugs.
To ensure sustainability of HIV control efforts, the International Labour Organisation (ILO) is pushing for increased domestic financing.
“Currently, ART accounts for more than half of the total HIV budget, mainly covered by international aid. It is not included in the essential health benefits provided by NHIF. With dwindling donor funds, ART must be covered under the essential benefits package for universal health coverage in Kenya,” says Hellen Magutu, the programme co-ordinator for HIV/Aids in Kenya at the ILO, adding that no country should depend on donor funding for ART treatment, which is lifelong.
Further, the Lancet Commission notes that the world is not on track to end the HIV pandemic by 2030, and that current approaches for HIV control are not enough to control the pandemic. In particular, high HIV rates persist in high-risk and marginalised populations. Therefore, the Commission warns that a resurgence of the epidemic is likely, as the largest generation of young people move into adolescence and adulthood.
At the same time, the population of people with HIV is steadily growing older, due to the effectiveness of antiretroviral therapy. Between 2012 and 2016, the number of people over 50 years living with HIV increased by 36 per cent around the world.
In Kenya, researcher Jepchirchir Kiplagat notes that 5.6 per cent of older people are HIV-positive but HIV services continue to target adolescents and young adults, women of reproductive age and key populations (men who have sex with men, intravenous drug users and female sex workers).
Kiplagat recommends HIV prevention messages and testing services that include older adults, who are also at increased risk of age-related diseases such as cardiovascular disease, neuro-cognitive disorders, renal disease and some cancers.
There is also need for focus on prevention and management of non-communicable diseases for people with HIV.
Scientists seek end to 'unscientific' HIV laws
Experts have called for an end to laws that can see HIV-positive people jailed for exposing others to the virus, saying the approach was “unscientific” and worsening the killer epidemic.
At least 68 countries have legislation that criminalises HIV “non-disclosure”, exposure, or transmission.
To begin with, the immune system-wrecking virus that causes AIDS “is not easily transmitted from one person to another. It cannot be passed on if a condom was correctly used and did not break during sex, while people in whom the virus is suppressed thanks to anti-retroviral therapy, can most likely not pass it on.”
HIV-negative people who use the same drugs as a preventive measure also have a lower chance of getting HIV.
The scientists also stressed that genetic virus testing cannot prove beyond a reasonable doubt that one person infected another. - AFP