News 24 |Tebogo Monama | April 16, 2022
As the world’s attention starts to move away from Covid-19 towards other diseases, senior advisor in the Office of the US Global Aids Coordinator, Jirair Ratevosian, said the African continent’s experience of the Covid-19 pandemic was unique.
This week, the US President’s Emergency Plan for Aids Relief (Pepfar) pledged to donate R6.8 billion to strengthen South Africa’s HIV prevention, care and treatment.
When the world dealt with the HIV/AIDS pandemic, Pepfar built health infrastructure in member countries, he said, and this infrastructure helped fight diseases such as ebola, avian flu and cholera. In 2020, it was used to help curb the spread of Covid-19.
“[With] Pepfar programmes and support, we actually managed to persevere [through] many of the gains before Covid. Pepfar was able to do this because we adapted the programme quickly. We made adjustments in the way that funding can be given at the country level for …Covid response. But we always wanted to ensure that they were made in a way that didn’t impact HIV response along the way.”
In Pepfar countries, they were also able to increase pre-exposure prophylaxis (PrEP) uptake.
“We put more people on PreP, and that is quite remarkable.”
When the world dealt with the HIV/AIDS pandemic, Pepfar built health infrastructure in member countries, he said, and this infrastructure helped fight diseases such as ebola, avian flu and cholera. In 2020, it was used to help curb the spread of Covid-19.
“[With] Pepfar programmes and support, we actually managed to persevere [through] many of the gains before Covid. Pepfar was able to do this because we adapted the programme quickly. We made adjustments in the way that funding can be given at the country level for …Covid response. But we always wanted to ensure that they were made in a way that didn’t impact HIV response along the way.”
In Pepfar countries, they were also able to increase pre-exposure prophylaxis (PrEP) uptake.
“We put more people on PreP, and that is quite remarkable.”
PrEP, he said, is one of the most important tools to fight new HIV infections. But the uptake of the drug has been low in most countries, he said.
In 2017, South Africa became the first country on the continent to approve a daily pill, containing the antiretrovirals tenofovir and emtricitabine, for HIV prevention. At the time, the drug was targeted mainly at sex workers.
“There are some lessons to be learnt. We made mistakes, and we made the mistakes in the US as well. Mistake is a hard word because we were following the science, and the science initially showed it was for a certain population, MSM (men who have sex with men), for example.
“We were so anxious to roll out PrEP, we only rolled it out to certain populations because that was what the science was showing. And then, when the science expanded, we realised that we stigmatised certain populations. Now, as we look to the future, the delivery for PrEP will change. There are opportunities for injectable PrEP.”
Last December, the US approved the antiretroviral injection for use. Locally, the injection, to be taken at two months intervals, is under review by the South African Health Products Regulatory Authority (Sahpra).
Ratevosian said: We have already had discussions with South African clinicians to make sure we are not making some mistakes in the rollout of PrEP. We should make it easier too for people to get PrEP. People should not have to come to the clinic; they should be able to get it from the pharmacy [instead of going to the clinic].
He said the stigma around HIV and taking PrEP were some of the same mistakes he saw happen during the Covid-19 pandemic. What the world didn’t learn from the fight against HIV/AIDS was stigmatisation, he said.
“We see that many populations, including communities of colour, struggle with misinformation and access care. We should have learnt from HIV how to reach them, how to find them and how to partner with communities. Here, HIV can offer some lessons.”
Social media, Ratevosian said, made it harder to put out a more uniform message because of misinformation.
“That is to be expected; we just have to double down on our message.”
New leader
Ratevosian said that as the organisation transitions out of the Covid-19 pandemic to continue to focus on HIV, it is keen to welcome new leadership in Dr John Nkengasong.
Nkengasong has been leading the continent’s Covid-19 response as the head of the Africa Centres for Disease Control and Prevention. He appeared before the US Senate Committee on Foreign Relations before a vote to confirm his nomination by US President Joe Biden.
The position has been vacant since Deborah Birx stepped away from the post to join President Donald Trump’s Covid-19 response team two years ago.
“Are we excited and anxious to have Dr Nkesamong? Absolutely. I hope that Senate confirms him very soon. You now have the leader of the Africa CDC coming to his HIV programme to be able to modernise it in a way to help countries strengthen their health systems and fight HIV and Covid. I think the timing could not be better.”