Ending Acquired Immune Deficiency Syndrome (AIDS) as a public health threat here by 2030 will take much effort as it will all around the world.
The key, of course, is halting new infections particularly among the young and ensuring that all of those with the Human Immuno-deficiency Virus (HIV) are aware of their status, are receiving sustained antiretroviral therapy and have attained viral suppression.
A recent report from UNAIDS has underlined the challenge that faces the global community: the decline in new HIV infections among adolescents and youth has not been fast enough to effectively rein in the epidemic.
The report said that globally young people, 15-24 years, accounted for 28 per cent of new HIV infections in 2023 while in the Caribbean, they accounted for 27% of the 15, 000 new infections, up from 15% in 2020.
This rising proportion of total HIV incidence among young people which ranges from 14% in Suriname and Guyana to 37% in Barbados, is concerning and warrants further investigation, the report said. Relatively speaking, Guyana did far better than the rest of the Caribbean when compared particularly to Barbados where the new infections in the 15 to 24 cohort was at 37% and 35% for The Bahamas.
It must mean that the government and NGOs are getting their message across to youths about transmission of HIV and the mortal threat that it poses. Since the start of the AIDS epidemic, roughly 40 million deaths have occurred and this has created devastation in all parts of the world. Efforts have to be redoubled here to ensure that complacency among the 15-24 cohort and the rest of the populace is dispelled.
The UNAIDS report pointed to structural problems in reaching youth and the authorities here should be addressing these. It cited social norms, vulnerability, high-risk sexual behaviours, policy barriers, limited access to healthcare services, and poor care-seeking behaviours. Further, the lack of comprehensive knowledge about HIV transmission, prevention, and treatment increases risky sexual behaviour, fuelled by myths and misconceptions about the virus. It further noted that many schools lack comprehensive sexuality education and there are few youth-friendly facilities to engage and educate young people about HIV.
Social stigma surrounding HIV continues to deter young people from seeking testing, counseling, or treatment services. Fear of rejection by peers and family members forces many young people to hide their HIV status, further preventing them from accessing the necessary healthcare.
The report underlined a number of strategies which could be pursued to reduce infections in the 15 to 24 category and the authorities here and NGOs should be investing in these.
Keeping youth in school was pinpointed as important. Every dropout is immediately at greater risk of infection. The report said that governments should address the challenges in education, for both boys and girls, given the impact it can have on delaying sexual debut, and reducing early pregnancy. In school education campaigns should focus on increasing knowledge of HIV prevention methods and dissolving misconceptions. Governments were advised to integrate rights-based Comprehensive Sexuality Education or Family Life Health Education into all schools, tailored to the cultural context of the Caribbean. These programnes should empower young people with knowledge about HIV, sexual health, consent, and prevention tools such as condoms and pre-exposure prophylaxis (PrEP).
It was further recommended that public health systems create a safe, non-judgmental environment for young people, especially in rural areas, to ensure they can access confidential, non-discriminatory HIV, sexual health, and mental health services.
The report added that HIV programmes should prioritize vulnerable young people using differentiated service delivery models that meet their needs. Young people should also be involved in addressing legal and policy barriers they face, such as age restrictions for accessing HIV services to create the enabling environment necessary to reduce stigma and improve access to essential HIV and sexual reproductive health services.
The report contended that young people must be empowered as leaders in the HIV response and should be involved in designing and implementing HIV programmes.
“Building the capacities of young people through youth advisory boards/groups and peer-led initiatives can help make interventions more relevant and effective in responding to their needs. With HIV and health seen as a development issue, it is important to amplify the unified political voices of young people through institutional capacity building of youth entities…”, the report added.
There is good news on another front even if its impact will not be felt right away. The medical community is abuzz with recent findings that the HIV drug lenacapavir can prevent new infections via sex but at this point the cost of the treatment is prohibitive.
According to National Public Radio (NPR) PURPOSE 2, the name of the latest trial sponsored by Gilead Science, the California-based maker of lenacapavir, found the drug to be 96% effective in preventing HIV infections. The clinical trial involved more than 3,200 cisgender men, transgender men, transgender women and gender non-binary individuals who have sex with partners assigned male at birth. The study was conducted across sites in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.
These results followed equally stunning findings from a previous lenacapavir trial called PURPOSE 1 which followed 5,300 cisgender women in South Africa and Uganda. NPR said that early results indicated 100% efficacy, after Gilead Sciences revealed that not a single woman who had received the drug since the trial began in August 2021, had contracted HIV.
NPR said that Ethel Weld, an assistant professor of medicine at the Johns Hopkins University School of Medicine, described both sets of results as “a thrilling game changer for HIV prevention.” Lenacapavir is administered via a twice-yearly injection and is seen as more efficacious than the standard pre-exposure prophylaxis (PrEP), Truvada.
An NBC report said that lenacapavir’s current list price for use as HIV treatment is US$3,450 per month and Gilead has not yet indicated whether it will set a different price for the drug’s use as PrEP.
While lenacapavir could be on the horizon there is still a lot more nuts and bolts work to be done here to limit new HIV infections in the 15 to 24 group and across the board.