South Africa, 16 June 2024: If we are to end the spread of HIV in our lifetime, we must focus on closing the prevention and care gaps among infants and young people, care groups say this Youth Month. Young people make up one of the most important ‘priority populations’ that need extra support with HIV/Aids – and are therefore key to stopping this three-decade pandemic for good.
According to the United Nations’ children’s agency (UNICEF), Sub-Saharan Africa is the region most affected by HIV, and more needs to be done to get young people into clinics to be tested and onto treatment for HIV. Their data shows that adolescents and young people made out a “growing share of people living with HIV worldwide” and that in Southern Africa only 25% of adolescent girls and 17% of adolescent boys aged 15-19 years were being tested for HIV.
“South Africa still has some of the highest rates of HIV among young people in the world, but we are changing this by specifically focusing on our young people. In Mpumalanga, for instance, we have ‘health influencers’ who are community health workers on the ground, who make it their mission to reach young people to create better health outcomes for our communities,” says Dr Ziyanda Makaba, Clinical Specialist for HIV and Paediatrics at BroadReach Health Development.
BroadReach is an organisation which places specialist doctors, nurses and community health workers in rural clinics, in partnership with the Department of Health (DoH) and
international funders such as USAID and PEPFAR. One of their most successful joint programmes is DREAMS, a USAID-led peer support initiative to encourage young girls to get tested, onto medications for the prevention or treatment of HIV, and to maintain ultra-low, and therefore undetectable and untransmittable, HIV viral loads so that they can go on to pursue their dreams and live fulfilled lives. DREAMS stands for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) and is supporting high-risk young women and girls around the country.
“We use the Undetectable = Untransmittable (U=U) model of care. The U=U campaign is an internationally recognised tool to reduce stigma and increase demand for service and linking people to care. On this Youth Day, my message to young girls and boys, you are the architects of change, educate yourself, support other young people and break the cycle of stigma to build a healthier world for all,” says Dr Veni Naidu, HIV Community Services Lead with BroadReach.
“As we mark Youth Month 2024, let’s acknowledge young people as pivotal forces in our drive to end HIV. Through partnerships like DREAMS, we empower them to lead healthier
lives. Our commitment at USAID, on behalf of all Americans and the U.S. government, is to Media release: Influencers for Good Page 2 of 3 swiftly close gaps in HIV services for youth, utilising community-driven approaches like U=U. Together, we can realize an HIV-free future,” says Heather Smith Taylor, USAID Southern Africa Bilateral Health Office Director.
A reflection on local numbers
According to the latest data from the Human Sciences Research Council (HSRC), the percentage of people living with HIV in South Africa has decreased from 14% in 2017 to 12.7% in 2022. In total about 7.8 million people are living with HIV in the region today.
Viral suppression was higher (83%) among women when compared to men (79%) and lower (70%) among younger adults aged 15–24 years. The lowest percentage of viral load suppression (66%) was among men aged 25–34 years old.
The HSRC warns that the most pronounced differences in HIV prevalence by sex were seen among younger populations which calls for focused interventions. Compared to teenaged boys, HIV prevalence was approximately twice as high in girls aged 15–19 years (5.6% vs. 3% respectively) – partly because of power dynamics in relationships with older partners. In the 20–24 years age group the ratio was also two to one, with 8% of young women being HIV positive compared to 4% of men the same age. The numbers spike three-fold higher in females aged 25–29, with 20% of them being HIV+ compared to 6% of men that age.
Dr Makaba adds that due to a complex set of factors, women and girls accounted for more than 60% of all new HIV infections in sub-Saharan Africa in 2022. Six out of seven new infections among 15-19-year-olds in the region are among girls, but the tide is turning as more young girls are supported through peer networks like the DREAMS programme.
The power of fighting stigma
Dr Makaba explains that a Differentiated Models of Care framework is best when reaching out to young people. “This means you look at the community to identify who is most vulnerable to HIV and reach out to them in ways that support them in their unique contexts. There is no judgment, patronisation, shame or stigma. Young people are supported in ways that make them feel seen, understood and held.”
“The goal is to get everyone to take their ARVs every day so that they can become virally suppressed. Suppose someone is HIV negative but in a relationship with someone who is
HIV positive or injecting drugs. In that case, they might be encouraged to take preventative PrEP – a medication that if taken 7 days before HIV exposure, can prevent the HIV-negative person from getting HIV,” says Dr Makaba.
Proof in the pudding: HIV numbers are improving in Mpumalanga
The data shows that influencer interventions, coupled with other community health interventions at clinics, have resulted in huge improvements in HIV rates. In the Nkangala
and the Gert Sibande districts in Mpumalanga, where BroadReach and their community brigades have been working for five years, the numbers speak for themselves.
In 2018, 1 520 people were initiated on PrEP and that number has reached 30 094 in the last year. “This tells you our outreaches are working and we’re convincing a lot more people to get onto life-saving preventative medications,” says Dr Makaba.
Mother-to-child (perinatal) transmissions have also halved, thanks to more mothers taking ARVs today than five years ago. “In Year One, 251 HIV+ infants needed ARVs and now we
have half that at 124 infants. That means the ARVs that more moms are taking while pregnant are effectively protecting babies.”
ENDS
About BroadReach Group and HIV:
BroadReach Group is a group of social impact businesses focused on harnessing innovation and technology to empower human action. Since 2003 BroadReach Group has worked in over 30 countries to support governments, international NGOs, public and private sector to improve health outcomes for their populations.
BroadReach has been at the forefront of developing innovative approaches to improve the outcome of people living with HIV and TB for more than 17 years. For example, currently in South Africa, as part of the PEPFAR-funded, USAID program, Accelerating Program Achievements to Control the Epidemic (APACE), BroadReach Health Development supports the South African Government in achieving the UNAIDS “95-95-95” targets towards HIV epidemic control. BroadReach implements APACE in two HIV-burdened districts of Mpumalanga, covering 203 fixed and mobile facilities.
For more information visit www.broadreachcorporation.com