Everyone counts in HIV fight

Today is the World Aids. With only eight years left before the 2030 goal of ending Aids as a global health threat, our Staff Writer JAMES CHAVULA highlights how data helps equalise access to HIV services.

Reliable data helps deliver HIV services to those who need them without leaving anyone behind.

Blantyre Prevention Strategy coordinator Yohane Kamgwira keeps an eye on numbers, dotted maps and graphs on a laptop. He closely monitors the spread of the virus that causes Aids to strengthen Blantyre District Health Office’s systems and service delivery.

Blantyre is Malawi’s city with the highest HIV prevalence, with 14 in every 100 people living with HIV. The virus affects nine percent of Malawi’s population.

Every Wednesday, coordinators of HIV-related services at Blantyre Health Office meet to crunch the figures, discuss red flags and trigger responses for the benefit of the people behind the numbers.

“Credible data helps us equalise access to vital services because we can tell who needs them most and where they are. We don’t discriminate against any group or location,” says Kamgwira.

The dashboard seen on his computer is part of the five-year study by Ministry of Health and National Aids Commission in partnership with Georgetown University’s Centre for Innovation in Global Health.

The project funded by Bill and Melinda Gates Foundation is strengthening systems to respond better to HIV infections in the city at the centre of sexual transaction fuelled by massive urbanisation. It targets populations most at risk, including sex workers, the youth and men having sex with men (MSM).

“Blantyre is a unique setting,” says Kamgwira. “The commercial city is the epicentre of a region with high population and poverty rates. It also sits on a corridor of infection with links to Mozambique, South Africa and Zimbabwe.”

About 140 000 people in the city are living with HIV.

When the dashboard recorded a surge in sexually transmitted infections (STIs) in Bangwe, the coordinators dispatched vans to share information, condoms and Prep, the antiretroviral drugs taken before sex to reduce the risk of catching HIV.

Additionally, the mobile teams also offered HIV testing, an opportunity to know one’s status and start taking antiretroviral drugs that have more than halved Aids-related death rates since 2005 when Malawi rolled out free HIV treatment for all.

The data-driven approach helps health workers and partners find people most at risk and ramp up demand for services from HIV prevention to treatment.

“If the new approach works, we can replicate it in other high-risk cities of Lilongwe, Mzuzu and Zomba so that no one is left behind,” Kamgwira states.

NAC head of coordination and capacity building Tione Chilambe says the real-time indicators improve efficiency in service delivery.

“The epidemic is high in Blantyre, but many people do not know.

“The dashboard helps us hit the bull’s eye. We deliver services to the right people regardless of who they are and where they live. It also tells us where current strategies are working or not. When STIs spike, we know people aren’t using condoms and HIV infections could follow.”

Pakachere Institute for Health and Development Communication works with sex workers, one of the populations highly at risk of HIV infections. The nongovernmental organisation has established drop-in safe spaces in HIV and Aids hotspots, including Bangwe. It also trains sex workers to deliver HIV messages and services, including condoms and prep, to their peers.

The peer educators and navigators direct fellow sex workers to HIV services offered in the discreet drop-in centres that refer complicated conditions to the nearest health facilities.

Similarly, Centre for the Development of People (Cedep) has deployed 26 peer educators and six peer navigators living with HIV to reach out to MSM and transgender persons.

The sexual minorities often shun public health facilities due to fear of arrests, discrimination and stigma.

Fyness Jere, Cedep district coordinator in Blantyre, says the peer-to-peer outreach helps the underground sexual minority get assistance without fear, stigma or discrimination.

“Sexual minorities are key players in spreading and eradicating HIV. Our discreet efforts are equalising access to HIV services for the key population with low access to healthcare because they are usually marginalised and discriminated.

Cedep runs four specialised clinics in Blantyre, Mzuzu, Zomba and Mangochi. The safe spaces have helped over 2100 people access sexual health services, including HIV information, prevention, testing and treatment.

Jere explains: “The data from our work with sexual minorities shows us that there are more MSMs and transgender persons in hard-to-reach areas as well as in high places.

“Our trained peer educators, navigators and health workers help them access services freely and without fear.”

According to UNAids, only a third of people in key populations— including MSM, transgender people, people who use drugs, sex workers and prisoners—have regular prevention access.

“We can end Aids if if we end the inequalities which perpetuate it,” says UNAids executive director Winnie Byanyima. “This World AIDS Day we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities,” “To keep everyone safe, to protect everyone’s health, we need to Equalise.”