What lies ahead as Tanzania battles new HIV infections

It’s now three days into December and the clock is ticking towards the end of 2018, yet, as we count 28 days left to wind up the year, those watching HIV trends in Tanzania may—before the end—count an extra 6,000 new HIV cases in the country.

Every day in Tanzania, it is estimated that more than 200 people catch HIV, the virus that causes Aids. This, according to the Tanzania HIV Impact Survey (THIS) 2016-2017, translates into 81,000 new HIV cases annually.

Dr Faustine Ndugulile, who has chaired the Inter Parliamentary Union (IPU) Advisory Group on HIV/Aids, believes that through index testing—tracking down of sexual partners of those who already know their HIV status and major campaigns to encourage testing, the cutting down of new HIV infections can be scaled up.

“…we [as the government] are now focusing on how to ensure that we reach the men with current interventions. Most men are still holding back when it comes to testing. It’s also the men who delay to seek treatment,’’ says the medic who is Deputy Minister for Health, Community Development, Gender, Elderly and Children.

“…[ to curb] new infections, we still have a task of carrying out interventions in minority groups such as sex workers, men who have sex with men…these have high rates of new HIV infections…we have so far done a lot on adolescents and young people,” he says.

Dr Ndugulile points out that efforts would also focus on people who inject drugs. Data collected in Dar es Salaam and Zanzibar points out that injecting drug users are another risky group to new HIV infections.

Previous estimates revealed that around 1 in 6 people who live in Zanzibar and inject drugs is infected with HIV but some researchers believe this figure may have risen in recent years.

Basing on the UNAids targets, Tanzania projects that in less than a year ahead, 90 per cent of People Living with HIV (PLWH) should have known their HIV status by 2020.

However, the time limit is close and according to THIS-2016-2017, the country has been able to achieve the target to 52.2 per cent so far.

Statistics from Tanzania Commission for Aids (Tacaids), show that an estimated 1.4 million people, aged 15 to 64 years in Tanzania, are living with HIV.

The country seeks to attain the goal ending the AIDS epidemic by 2030 through improvement in targeted HIV testing, in men and women. Men, according to data are lagging behind in the efforts to tackle HIV spread.

However, women are heavily burdened by HIV in Tanzania where 780,000 women aged 15 and over are living with the virus. In 2016, UNAids reported that the HIV prevalence for women was 5.8 per cent, compared to 3.6 per cent for men.

Why women?

Researchers have established that women experience great difficulty in negotiating safer sex because of gender inequality.

Further, the studies show that women often accept the sexual advances of older men for a variety of reasons including money, affection and social advancement.

UNAids’ 90-90-90 targets sought to achieve 90 per cent of all HIV positive individuals knowing their status, 90 per cent of those diagnosed with the virus being put on ARVs and 90 per cent of them having viral suppression.

So far, data show that Tanzania is progressing well on the second and third 90 target, with a 90.2 per cent success of putting people living with HIV on treatment and 87.7 per cent achieving viral suppression.

Creativity, professionalism are key

Dr Adeline Saguti, from Benjamin Mkapa Foundation (BMF), a leader in projects that aim to improve health and community systems for maternal health and HIV/AIDS, says new HIV infections can be cut down if experts give emphasis to community interventions.

She suggests sticking to the guidelines which say new HIV clients must be identified and initiated on treatment within two weeks from the time of diagnosis and then retain them for care until they attain viral suppression, but also ensure creativity.

“The communities should receive constant behavioural change interventions to ensure that they take effective preventive measures. This will help those who are negative to remain negative but also those who are positive to stay safe by not transmitting infection to others,’’ she says

“Interventions that aim at empowering the vulnerable population, especially adolescent and young women both in school and out of school should be scaled up including provision of youth friendly services both at the facility and community level,” she explains.

Creativity is key

According to Dr Saguti, there is need to ponder on ways of curbing spread of the virus by going beyond what is already known. “We should be able to think beyond the normal approaches by quickly learning the epidemic distribution as well as the epidemic drivers in and across regions and at the community level and act accordingly,’’ says the medic who is also BMF’s Programme Manager for Health Service Delivery at BMF.

“There is no one perfect approach so we should be able to quickly recognise what works well, where and go with a specific and responsive focus,’’ she points out.

“We should employ targeted approaches that will help us to reach the right population. In this case I will say innovative approaches will help us to reach high risk groups within the general population with targeted HIV testing as well as identification of areas with high prevalence will help us achieve the first 90,’’ suggests Dr Saguti.

Civil society organisations are now appealing for increased domestic investment in HIV/Aids programs. There has been a clamour from stakeholders on the need to keep HIV/Aids funding sustainable.

Mr Patrick Kinemo, the Head of Programs for Sikika, a health advocacy NGO, called for doubling of the efforts to increase domestic resources for HIV/AIDS and TB in the country.

Mr Kinemo was presenting the Civil Society Organisations’ statement during the Joint Annual Health Sector Review 2018 but explained that the efforts to curb HIV have resulted in significant achievements in terms of the number of patients on treatment and a reduction in HIV prevalence.

Workers at risk

The 2018 International Labour Organisation report shows that a number of workers living with HIV was 26.6 million in 2015, globally, and is projected to rise to close to 30 million in 2020.