Taken as a preventive measure, ARVs can prevent contracting HIV/AIDS - Sub-Saharan Africa

Taken as a preventive measure, ARVs can prevent contracting HIV/AIDS – Sub-Saharan Africa

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[MONTREAL] 24thme The conference on AIDS that has just been held from July 29 to August 2, 2022 in Montreal, Canada, has allowed researchers working in the field to remember the innovative tools that make the fight against this disease possible.

This is the case of PrEP (pre-exposure prophylaxis), which has been applied for about two years in several countries around the world. “It consists of giving antiretroviral (ARV) treatment to seronegative people to prevent them from becoming infected. We are going to offer it to people who are highly exposed to HIV,” says Joseph Larmarange, a public health demographer and researcher at the Institut de Recherche pour le Développement (IRD).

“In serodiscordant couples, when either the husband or the wife are infected, the other spouse can take antiretroviral treatment so as not to get infected”

Mireille Mpoudi-Étame, ANRS

The latter also specifies that the approach will be to target vulnerable people, specifically sex workers, men who have sex with men, drug users and especially young girls…

However, while the oral version of PrEP is more effective, its adoption, we learned, remains complex in Africa. In Cameroon, for example, where its implementation is not “systematic”, according to Mireille Mpoudi-Etame, a researcher at the French Agency for AIDS Research (ANRS) and a doctor at the Yaoundé military hospital in Cameroon.

“As far as I know, when it comes to HIV, we don’t routinely do PrEP in Cameroon. It is offered primarily in the context of serodiscordant couples or where there is a known post-exposure risk such as blood exposure or rape,” she says.

For example, “in serodiscordant couples, when the husband or wife is infected, the other spouse can take antiretroviral treatment so as not to become infected. This is the most classic situation where prevention with ARVs is applied in Cameroon”, illustrates Mireille Mpoudi-Etame.

In addition to PrEP, the researchers also refer to self-assessment done at the individual level, but also to “a tool that always works,” according to Joseph Larmarange, namely male and female condoms.

4,200 US cases each week in Africa

According to figures from UNAIDS, almost 38.4 million people were living with the disease in 2021. Similarly, 1.5 million people were newly infected and almost 650,000 more died from AIDS-related illnesses that same year .

With almost 25.6 million people living with HIV/AIDS, sub-Saharan Africa remains the most affected continent. In fact, the Montreal conference tells us that 4,200 girls and women between the ages of 15 and 25 in sub-Saharan Africa contract HIV/AIDS every week.

Aimable Mwananawe, national coordinator of the Rwandan NGO IMRO who participated in this meeting, confirms this trend: “In Africa, the prevalence rate is the highest, so we focus our interventions on target groups and among 15-year-olds. . at 36,” he says.To get the best results, “we try to develop appropriate messages for target groups most at risk of contracting HIV. With recent research, we are segmenting and targeting high-risk groups, for example sex workers, gay men,” adds Aimable Mwananawe.

However, the stigmatization of the target populations, the precarious economic conditions, constitute a real sprain for the implementation of the different prevention programs. According to Aflodis Kagaba, executive director of Health Development Initiative In Rwanda, the efforts of the different actors in society must be combined to achieve good results.

“We have started to target these populations, but it is complicated. In many African countries, homosexuality is criminalized. We started working in Rwanda and we have identified more than 5,000 men in this group, we also work with sex workers”, she says.

“We also started working with the government to decriminalize drugs and allow this to be done clinically. When the law sanctions, it is difficult to educate them. Because for that you have to be able to make the link between them and the health services. But we continue to educate populations, to limit stigmatization”, explains Aflodis Kagaba.

“Undetectable” equals “untransmittable”

If the different specialists agree that stigmatization in the African context is an obstacle in the fight against HIV/AIDS, the precarious economic situation also continues to be another burden.

For Joseph Larmarange, who has conducted research in several countries on the continent such as Côte d’Ivoire, Cameroon, Senegal, South Africa, Mali and Burkina Faso, faced with this difficult access to new tools such as Oral PrEP, regular check-ups and screening tests they are still the beginning of the process.“It is the admission to care for seropositive people and to prevention programs for seronegative people. Knowing your status is important, but it’s also important to challenge yourself again when you take a risk. The most important thing is to treat positive people, and you have to transmit the message that ‘i is i’, that is, that ‘undetectable is untransmittable’”, she maintains.

According to the explanations of this researcher, this specifically means that a seropositive person who is in ARV treatment, today, no longer transmits the virus.

However, it is necessary to deconstruct the unwelcome ideas about HIV, communicate about the evolutions and change the fatal perception that many people have of the disease, because the objective is not to lower the prevalence, but to achieve zero deaths. zero new infections, the researchers conclude.

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