Will We Achieve The UN’s 95-95-95 Goals for HIV/AIDS?

As the Omicron variant raises global health alarms, one major health inequity looms large: All of the countries with the world’s highest HIV rates are also among the countries with the least access to COVID-19 vaccines.

The threat COVID-19 poses to people living with HIV/AIDS provides a stark reminder of the dangers of vaccine inequity. In Zambia, for instance, 11% of adults live with HIV, while less than 4% are fully vaccinated against COVID-19 — an imbalance that poses a huge threat to the country’s population.

“Among the many shadow pandemics COVID-19 has caused, setbacks in HIV/AIDS treatment and prevention are of dire concern,” says Dr. Tom Kenyon, Project HOPE’s chief health officer. “Also, while people living with HIV face greater COVID-19 risk factors, many have not had equitable access to COVID-19 vaccines. Nowhere are these health equity gaps more staggering than in Africa, where less than 6% of the population has been fully vaccinated due to lack of vaccine access and supplies.”

The United Nations has set ambitious targets to end the HIV/AIDS epidemic. Called the 95-95-95 targets, these goals would ensure that 95% of people living with HIV know their status, 95% of people who know their status are receiving treatment, and
95% of people on HIV treatment have a suppressed viral load by 2030.

But after two years of COVID-19, are we on track to achieve them? Learn more in this Q&A with Project HOPE’s Chilobe Kambikambi in Zambia.

The UN has said that it is worried that COVID-19 could lead to a spike in HIV infections. How has COVID affected HIV services in Zambia, and are you concerned that it could lead to a rise in infections?

There is little data yet to show how COVID-19 has affected HIV services in Zambia. At the moment, COVID cases are down, but there is an expectation of a fourth wave. [Note: This interview was conducted before the discovery of the Omicron variant in South Africa, which has prompted preventative measures across Zambia.]

Generally, people have still accessed HIV services during the COVID outbreak and partial lockdown. A few studies have shown that during the first, second, and third-wave lockdowns, some clients indicated that they could not leave their houses to access health services, sexual and reproductive services, and HIV services at the clinics. The most common barrier was the fear of being quarantined and getting COVID-19 from the health facility. In addition, there has been an increase in adolescent girls’ alcohol consumption, which increases their vulnerability to sexual exploitation, abuse, and potentially an increase in HIV infections.

For HIV treatment, the Ministry of Health introduced a model where clients are given extended dispensing intervals (multi-month) to reduce the number of facility visits. A recent study showed that participation from stable antiretroviral therapy clients in Zambia increased after COVID-19, but dispensing intervals were reduced. This was mainly due to supply chain issues.

The World Health Organization has said that HIV infection increases the risk of severe COVID-19. But most people may not realize there’s a connection between HIV and COVID. Why is it particularly important that people with HIV are able to access the vaccine?

Like many sub-Saharan African countries, the prevalence of HIV in Zambia’s general population is very high (around 12%) and its health care system’s capacity to treat severe COVID-19 is limited. It’s therefore important for the community to understand whether HIV increases the risk of severe COVID-19 and death in our context.

Information on the relationships between HIV and COVID is just now beginning to be disseminated, and there is a need to have this information available to all Zambians. In Zambia, a study earlier this year found no link between HIV status and COVID-19 severity, but the risk quadrupled for people with severe HIV infection. The study authors, however, underscored “the importance of Zambia’s progress toward ending the HIV epidemic and of efforts to maintain HIV services during the COVID-19 pandemic.”

Having said that, vaccines are especially important for people with chronic health conditions that include HIV, which can make it harder to fight off vaccine-preventable diseases like pneumonia. HIV can also make it more likely for someone to have serious complications from those diseases, which is the reason why it’s important to get recommended vaccines as part of HIV medical care.

What must be done to ensure that the world reaches the UN’s 95-95-95 goals? Do you think it’s possible to still achieve these goals even after COVID?

Yes, it is still possible to achieve the UN’s 95-95-95 goals. But now the world has two pandemics: HIV and COVID-19. Governments around the world must balance investments in both. It’s important that the world doesn’t lose the gains we’ve made toward achieving the 95-95-95 goals while at the same recognizing that COVID-19 still remains a threat and needs to be addressed as such. Governments need to ensure that HIV services are maintained and not disrupted during and after COVID for this to be achieved.

What is Project HOPE doing to end the HIV/AIDS epidemic in Zambia? Why is it important to focus on vulnerable children and adolescents?

Project HOPE’s HIV program in Zambia aims to mitigate the impact of HIV and improve the health and well-being of vulnerable children and adolescents through the delivery of high-impact, evidence-informed and age-appropriate interventions using a family-centered approach.

The program’s objectives are to support vulnerable children and adolescents by improving their access to health and HIV services, improving household economic security, linking them to social protection services, improving child protection, preventing gender-based violence, and improving school retention.

We work closely with the Government of Zambia’s existing structures at the community, health facility, district, provincial and national levels, as well as different community-based organizations and faith-based organizations in each site.

We have hired frontline workers, community care workers, and facility care workers who are responsible for identifying, providing services, monitoring progress, and graduating the beneficiaries from the program.

Adolescents represent a major demographic and social-economic force and are also a major factor in influencing public health trends. Zambia’s population is predominantly young, with almost half (48%) of the population under 15. HIV continues to be one of the main challenges to improving public health and economic development in the country. Despite the fall in adult HIV prevalence rate in Zambia (from 14.3% in 2000 to 11.5% in 2019), HIV continues to take its toll on children and the number of children affected by or vulnerable to HIV remains high.

Children and adolescents are also at high risk of acquiring HIV, with 30% of all new HIV infections in sub-Saharan Africa occurring in adolescent girls and young women under 25. With many children being orphaned because of HIV/AIDS, addressing the needs of vulnerable children and adolescents is important to ensure epidemic control in Zambia.

Data shows that most orphans and vulnerable children lack access to basic services such as health, social services, or education. In addition, at the national level, the provision of comprehensive prevention, care, treatment, and support services for these children and their caregivers has proven to be a critical gap. The program is contributing to the HIV epidemic control goal in Zambia by achieving its activity objectives and helping mitigate the risk and impact of HIV and AIDS among vulnerable children and their caregivers.

Nearly one-third of households in Zambia are caring for an orphaned or foster child. Is it harder for these households to make ends meet? What are the greatest challenges they face?

An average household in Zambia consists of a family of six. With Zambia’s economy not performing well and poverty levels high, it’s difficult for this family unit to meet its basic needs. In Zambia, 60% of people live below the poverty line and 42% are classified as extremely poor. Poverty rates are highest for female-headed households, with extreme poverty levels of more than 60% in rural areas.

Many households’ capacity to support and care for orphans and vulnerable children is precarious and taking in orphaned children increases the family’s economic vulnerability with most living in extreme poverty. These families are not able to meet basic needs such as food, good housing, education for children, and access to health services.

Project HOPE is using a peer-to-peer program to empower young people to help other adolescents avoid HIV. Why is it important for young people to hear from other young people?

It is important for young people to hear from other young people because young people understand their fellow peers better. Listening to peers helps you relate to your own real-life experiences. When young people listen to each other’s stories, they don’t feel judged. The experiences they go through will not seem far-fetched because they will be able to relate them to their peers and will understand each other’s language and situation.

It’s important for young people to hear from fellow young people as this gets them to ask questions and learn from each other, get the support they need, promote easy disclosure, and create a good support system that further promotes good adherence to treatment for HIV.

In addition to improving access to HIV treatment, this program also helps improve people’s livelihoods and access to education. What role do income and education have in preventing HIV? What’s the connection between people’s education, economic situation, and health?

Education and economic status are some of the key social determinants of health that influence the prevention of HIV. These are conditions in which people are born, grow up, live, work, and age which largely influence the person’s opportunity to be healthy including prevention of HIV transmission.

Social and economic circumstances affect our health throughout life. If you are poor and uneducated, you are mostly like to face health challenges and probably the risk of dying early.

Education plays an important role in the prevention of HIV. Educated children and youth have a better chance to protect themselves with access to all the facts about HIV/AIDS than their uneducated peers. In addition, studies have shown that education is an effective tool to reduce the social and economic vulnerabilities that often make girls and women more prone to becoming infected with HIV/AIDS. Meanwhile, it is recognized that economic empowerment is an effective strategy for HIV prevention. For young women and girls being more vulnerable to HIV, an empowered woman benefits from better-informed health choices if she has a sustainable livelihood.

Has the program had to find creative solutions or alter at all to continue delivering services during the pandemic?

For sure. We’ve provided airtime to frontline staff to enable them continuously to engage with households via the phone and ensure there was continued service provision. We’ve also used virtual platforms to deliver trainings and mentorship sessions, as well as social media platforms like WhatsApp to reach out to frontline staff for quality service provision. The project has also developed communications materials and used local radio jingles to promote good health. We’ve also been able to provide PPE to frontline workers to prevent COVID-19 transmission.