Name of person responsible /Facilitator: Esther Nakkazi
Café Name/Title: HIV Prevention
- Dr. Bernard Kikaire; Uganda Virus Research Institute
- Patricia Magoba; Aids Orphans Education Trust
- Edmund Tayebwa; The Aids Support Organization (TASO)
The speakers came from the Uganda Virus Research Institute, The Aids Support Organization, and the Aids Orphans Education Trust.
Date Cafe held: April 10, 2018
Café objectives (The learning objectives should be tailored for each specific café)
- To introduce the journalists to Hejnu and its activities, especially the science cafes and build a working partnership.
- To interest journalists based outside Kampala in covering HIV issues—especially the new prevention interventions.
HIGHLIGHTS, KEY QUESTIONS /THEMES
Dr. Bernard Kikaire, HIV NODE coordinator: Uganda Virus Research Institute The café started with Dr. Kikaire giving a history of HIV prevention interventions in Uganda, explaining that the ABC model—Abstain, Be Faithful and use of condoms was for a long time at the center of Uganda’s HIV fight. It is this model that is also credited for helping Uganda reduce its HIV prevalence from over 30 percent in the early years of the epidemic to six percent by 2011.
He explained that while being HIV positive two decades ago came with a lot of fear, stigma and was almost a death sentence, the advent of anti-retroviral treatment that keeps people healthy and gives them longer lives has removed away from the fear. As a result, some of the risky behaviors that expose people to HIV have returned. “We have to keep promoting condom use on top of other newer prevention interventions,” he said.
According to Dr. Kikaire, ARVs which are used for treatment are now considered among the top prevention interventions because they suppress an HIV person’s viral load, which in turn reduces their chance of passing on the virus to another person when exposed.
“HIV is different from so many other diseases. For a person to get infected, the one who is positive must have a certain level of virus in their body in order to pass on the virus,” noted Dr. Kikaire. Here, he outlines the key interventions.
He noted that a number of studies, some conducted in Uganda have shown that if an HIV positive person is on ARVs and takes their medication as recommended, they cut the risk of infecting another person by up to 96 percent. However, he added that the four percent risk of infection is still high, and a challenge which ought to be addressed.
Interventions such as the Prevention of Mother-to-child Transmission (PMTC) have also helped Uganda reduce the number of children who are born with the HIV virus over the years.
According to Dr. Kikaire, another HIV prevention intervention which Uganda is now rolling out is PrEP (Pre-Exposure Prophylaxis). He noted that as a start, this intervention is mostly targeting high-risk groups such as discordant couples, men who have sex with men and commercial sex workers. According to Dr. Kikaire, studies are currently being undertaken to come up with an injectable version of the ARV, which could be administered every three months.
Post Exposure Prophylaxis (PEP): This is an ARV given to people who have been exposed or are suspected to have been exposed to HIV. It has to be taken within 72 hours after exposure. According to Dr. Kikaire, this intervention is mostly given to people who have been defiled or raped.
Medical male circumcision (MMC)
According to Dr. Kikaire, research to establish the effectiveness of medical male circumcision was conducted in several countries, including Uganda. The results showed that circumcision reduces the risk of HIV acquisition by up to 65 percent. Medical male circumcision also has the additional benefit of reducing the risk of other penile infections, for which the foreskin is a common reservoir. He said Uganda has been performing well in terms of uptake for medical male circumcision services.
While several clinical trials have been undertaken, with others still in clinical stages, Dr. Kikaire explained that the world has not yet been successful in finding an effective vaccine for HIV. He explained that the complexity of the HIV virus partly explains why there hasn’t been a success with finding a vaccine. However, he noted that the various clinical trials that have been conducted so far add to the knowledge that is guiding scientists in their search for an effective vaccine.
Edmund Tayebwa: Area Manager-The Aids Support Organization (TASO) Jinja
Mr. Tayebwa noted that while the national HIV prevalence stands at six percent, Busoga region, which constitutes several districts, including Jinja, continues to have a high burden of HIV and a prevalence rate of 4.7 percent. Nationally, according to Mr. Tayebwa, several strategies have been developed to get people tested so that they know their status. This, in the long run, is expected to contribute to reduced infections if people know their status, with the negative ones protecting themselves against risky behavior that exposes them to HIV, while those that are positive take ARVs to keep healthy and also reduce the risk of infecting their negative partners.
He also noted that when it comes to interventions such as the eliminating mother-to-child transmission of HIV, the Busoga region still performs dismally because many expectant mothers are still reluctant to seek care from health facilities, where those who test positive can be helped to give birth to HIV negative children. “We challenge parents, and especially HIV positive mothers to come to the facility because we have interventions that can help them give birth to negative children,” said Mr. Tayebwa.
He added that the focus now is on trying to achieve the UNAIDS target of ensuring that by 2020, at least 90 percent of all people living with HIV get to know their status and start treatment immediately. To reach that target, he said several interventions have been put in place. For instance, there are deliberate efforts to reach more men with HIV testing and counseling services. It is said that often times, men are less likely than women to seek care at health facilities or test for HIV. “Let us take the message out there that people who think they have a high risk of being exposed to HIV should test and know their status,” said Tayebwa.
He said as a service provider, TASO is currently undertaking a number of initiatives to reach out to more men, including finding them at their places of work, and or encouraging them to come to the facilities on weekends in case they are busy during the weekdays. So far, he said they have reached out to different categories of men, including boda-boda riders at different stages. At these spots, TASO also carries out HIV counseling and testing. Those who test negative are linked to care immediately.
Patricia Magoba: Aids Orphans Education Trust
As an organization working in the community, Ms. Magoba said their major aim is to create demand for HIV services, including testing, treatment, and care. “We believe the first prevention intervention we have is for a person to know their status. If they know their status, then they are likely to make more informed decisions about their lives compared to a person who does not know,” said Ms. Magoba.
Through a campaign known as Test and Treat, she said many high-risk groups such as fishing communities, long-distance truck drivers and commercial sex workers are being reached with testing services and those that are found to be positive are linked to care.
Questions and answers
Qn: Why is HIV still higher among women than men yet you say many men are not seeking services?
It is easier for men to transmit HIV to women than women to men because of the biological makeup of the different sexes. And for the younger girls, often because of factors such as poverty and lack of empowerment, they stand a higher chance of becoming infected compared to their male counterparts.
Qn: Since PrEP is given to people who are considered at risk of HIV, will there be no cases of abuse of the medication once it is rolled out?
Ideally, it should be a prescription-only medication. We hope even if there is an abuse of the medication, it will be on a small scale. But if people use it to actually prevent themselves from becoming infected, there is no problem with that.
Qn: Why do some people suffer drug resistance, is it because the drugs are not good enough?
Most resistance to drugs results from people not taking their medication as prescribed by the health worker. Yet the first-line drugs are a lot easier to take and are readily available compared to the second and third lines. They also have fewer side effects. So, we always advise people on ARVs to stick to their medication to reduce the risk of drug resistance.
Qn: You say over 300,000 people who are HIV positive do not know their status. How do you plan to reach them?
TASO is currently engaged in a number of innovative ways to reach more people with testing services. One is the assisted partner notification—where those who come to our facilities and are HIV positive can be used as index cases to help us reach their sexual partners who are out in the community and may not know their status yet. When we go to such communities, we encourage them to test without telling them their sexual partners are positive. Often times they have tested and those who have been found to be positive have been put on treatment. We hope to reach more people, especially men, through this kind of initiative.