Esther Nakkazi (Health Journalists Network In Uganda)
HIV prevention and research updates
|First café of 2017 and Participation||
· This is the first Science Café held by the Health Journalists Network In Uganda in partnership with AVAC in the year 2017.
·Science cafes bring together journalists from the print, broadcast and online platforms.
·The participation was very lively as journalists sought to understand prevention/research related interventions with regards to HIV.
|· To provide a platform for engagement between key journalists and biomedical HIV prevention scientists, program implementers, advocates, policymakers in Uganda
· To provide journalists with updates on the latest developments in research on new emerging biomedical HIV prevention options
Makerere University School of Public Health, Infectious Diseases Institute, and UNASO
|Presentations and Resouce Persons:
Dr. Noah Kiwanuka, Dr. Timothy Muwonge, Charles Brown, Sylvia Nakasi, Moses Supercharger.
Also present were Angelo Kaggwa and Kay Marshal from AVAC, Ida Jooste and ChaachaMwita from Internews, who came to observe how the science cafes are conducted.
Ida and Chaacha will also be working with journalists under Hejnu to offer training and help improve the skills of the journalists.
Key issue: HIV prevention and update on research interventions.
Dr Noah Kiwanuka (Makerere University School of Public)
Dr. Kiwanuka opened the café by giving journalists a basic history of HIV, giving a background of how the disease is spread and the different interventions that can help prevent it.
He noted that while the majority of the people contract HIV sexually, it could also be transmitted from mother to child, or by sharing infected sharp instruments such as needles.
However, he said that for the virus to be spread from one person to another, the infected person must have enough virus in the body to transmit it.
And because the forms of transmission are known, there are several interventions that are already being undertaken to help prevent its spread.
He then went ahead to explain some of the interventions/research that has been undertaken/ is ongoing in the area of HIV prevention.
As a starting point, Dr. Kiwanuka said people who are infected with HIV should know their status so that they do not spread the virus. On the other hand, those who are not infected also need to know their status so that they keep safe.
In this case, he says HIV counseling and testing becomes one of the key means to prevention.
According to Dr. Kiwanuka, when people do not test, it becomes hard to know whether they are infected or not as it takes between eight and 10 years before a person shows signs of HIV/Aids after acquiring the virus.
Testing, he said should also be accompanied by counseling to enable those who are found to be positive cope with living a positive life, as it is a life-long status.
Dr. Kiwanuka said another reason why counseling is important is that it helps in fighting stigma that is associated with being HIV positive.
“HIV is still a stigmatizing disease,” he said.
Treatment as prevention is crucial because if up to 90 percent of the population get tested, those that turn out to be positive can be put on treatment immediately. This, therefore, reduces the amount of virus in the body and subsequently the risk of passing it to a sexual partner.
“Being on treatment has another important component of improving the overall health and life of the person, compared to one who is not on treatment,” noted Dr. Kiwanuka.
Over and above, he explained that the advantage of treatment or taking ARVs helps in the general reduction of the burden of infection to the general population.
For young people, giving them information about HIV and ways to prevent it, including delaying sex is one way they can also reduce their chances of contracting HIV.
Dr. Kiwanuka explained that there are a number of biomedical interventions that are being developed such as the use of vaccines.
There are two types of vaccines in this case: the preventive vaccines—that can be given those who do not have the virus yet and the therapeutic vaccines that can be given to a person who is already infected to help block the virus in the body from spreading and thereby reducing the chances of passing it from one person to another.
Much of the research at the moment, according to Dr. Kiwanuka is on preventive vaccines.
He noted that interventions such as voluntary medical male circumcision and the use of PrEP should be promoted as research conducted on their safety and efficacy have proved that they are crucial in the HIV prevention program.
Dr Timothy Muwonge (Infectious Diseases Institute)
DrMuwonge’s discussion focused largely on pre-exposure prophylaxis (PrEP), which he said is one of the important HIV prevention interventions.
He explained that prophylaxis is a medication used to prevent or reduce the risk of infection from disease.
In the case of HIV, Truvada is the medication used as PrEP.
Studies on PrEP have been conducted in several African countries including Uganda, showing high levels of efficacy and safety among those who adhere to the treatment.
According to Dr.Muwonge, the key issue at hand now should be how to translate these research findings into practice.
Already, he said guidelines on the use of PrEP have been put in place. What remains is to roll it out.
The plan, at the moment, is to have it rolled out in a phased manner.
Dr. Muwonge said as a start, through funding from PEPFAR, six sites have been identified in specific locations where PrEP will first be rolled out. The initial target is to benefit 3,417 individuals who are at high risk of contracting the HIV virus such as people in discordant relationships, female sex workers, people who inject drugs, migrant workers and men who have sex with men.
Dr. Muwonge emphasized that PrEP is not a substitute for other HIV prevention interventions such as the use of condoms, but rather an additional safety measure. He noted that with an estimated 83,000 new infections still occurring in Uganda, every year, it is important to embrace a wide range of prevention interventions. Another advantage of PrEP, according to Dr. Muwonge is that it plays a significant role in circumstances where women have low bargaining power when it comes to negotiating for safe sex. “PrEP comes in as one of the options that women can get,” he said.
Charles Brown, civil society advocate
Charles Brown explained that the civil society has been working with the Ministry of Health to develop the guidelines for PrEP. These guidelines he says outline what is required to roll out PrEP, including whom health workers should prescribe it to.
The test and treat program, he noted should also be expanded to reach more people.
“As advocates, we want to see a rollout of the test and treat program because we think it has not been exploited,” said Mr. Brown.
Besides the test and treat program, viral load monitoring should also be expanded to ensure people can monitor their health.
He said prevention emphasis should also be put on key populations.
“There is a lot of HIV among key populations but they also interact with the rest of the population. These are the drivers of HIV,” he said.
Moses Supercharger, Advocate
In his discussion, Supercharger, an advocate and person living with HIV said drug resistance is becoming a big challenge in addressing HIV prevention.
As a person on second line medication, he said many people who fail on the first line were not being enrolled on second line or third line drugs because of funding challenges, as the drugs for the third line are very costly.
For instance, it costs the government Shs 50,000 per person per month to be on first line medication, compared to Shs250,000 per person per month for those on the second line and Shs850,000 for those on the third line.
Supercharger said poor adherence to medication is the main reason people are developing resistance. This, in turn, is driven by factors such as poverty.
He however said there is poor education about drug resistance in Uganda and many people may be failing on drugs without exactly knowing about it.
He said the government should pay more attention to the growing threat of drug resistance because it will also fuel new infections.
Stories linked to café
1-Sanyu FM (Aired 7/06/2017)—Uganda to rollout PrEP as experts call for implementation guidelines –By Damba Rogers
2-Prime Radio (aired 7/06/2017)—HIV prevention advocates warn on presidential Fast track initiative By Ben Musanje
3-Bukedde Radion–Ministry to rollout self-testing kits –By BenonNsubuga
4-Capital Radio—CSOs call for the establishment of more testing facilities—By DeoArinitwe
5-Voice of Africa Radio—People with HIV urge government on 3rd line treatment-By Muhammed Wamala
6-Radio One—Activists urge the government to develop policy on third line therapy—By Leah Kahunde
7-Bilal FM—Luganda news on PrEP –By Halima Nalusiba
8-Mama FM-Luganda news—By Regina Nassanga
9-91.9 FM-Luganda news—Activists speak out on drug resistance—By Ronnie Mayanja