«We will not achieve control of the HIV/AIDS epidemic if we forget the most vulnerable groups»

by time news

The Zimbabwean immunologist Linda-Gail Bekker She is a leader in the fight against HIV/AIDS in Africa. It defends the access of the most vulnerable to all health and social services to deal the definitive blow to the HIV and AIDS pandemic. He has seen with a certain feeling of deja vu how the same mistakes have been repeated with the coronavirus, due to the appearance of false news or the unequal distribution of vaccines and treatments. She was president of the International AIDS Society (IAS) until 2018, the year in which she received the Desmond Tutu Award for Research in HIV Prevention and Human Rights. She recently participated in the meeting “Milestones in Basic and Clinical Research in HIV” organized by the pharmaceutical company Gilead.

The 24th International AIDS Conference, held this week in Canada, has been divided into these main areas: presenting evidence, learning about Covid-19 and HIV, or promoting the next generation. Why are these points so relevant?

Public health responses are best evidence-based, with research to ensure they are feasible and scalable. We must always learn from current experiences and science is repetitive; you have to build on past experience. Furthermore, we are in a long-term process and therefore we need the younger generation to step up, receive guidance and be encouraged to take the reins in a smooth and sustainable way.

People have not fully realized the I=I concept: if a person is positive but has a suppressed viral load, HIV cannot be transmitted

Bringing HIV prevention to the most disadvantaged population is one of the objectives that it has pursued the most. Do you think it is one of the burdens that prevents controlling the epidemic?

There is no doubt that we will not gain control of this epidemic if we leave the most vulnerable groups without services and access. The key to ending the epidemic is to leave no one behind.

Another challenge is to bring all medical advances closer to the population at risk of exclusion. How to address this problem that is still present more than 40 years later?

It’s true. The populations hardest hit by HIV and most at risk of contracting HIV are the same ones that most often have the most difficult access to health care and services. These populations have been called ‘key populations’. They are considered key because unless we figure out how to reach and bring those services to them, the epidemic will continue to fester. These populations are often the most marginalized and are often criminalized and persecuted. For example, youth who inject drugs, sex workers, transgender people, or who are incarcerated.

‘Breaking the silence’ was the theme of the XIII Durban Conference, the first held in Africa. 22 years later, how much do you think the HIV/AIDS situation has changed in Africa, and especially in Zimbabwe, your country?

We now have one of the largest HIV treatment programs in the world…it’s huge! Our life expectancy has increased and we are seeing far fewer people die of AIDS. We have not made much progress in primary prevention, in stigma and in curbing the epidemic in women and young girls and the most vulnerable youth. We have reduced vertical transmission, which is very important, but we still have too many babies born with HIV because we have not reached all women to prevent vertical transmission, especially during breastfeeding.

Why is it so important to protect the rights of all those affected by the epidemic?

Protecting the human rights to health, safety and basic access to services are fundamental to the response to HIV. When people feel that they have no rights, they end up in hiding and away from care, prevention and health services. This simply allows the epidemic to continue

When people feel that they do not have rights, that they are violated, they end up in hiding and away from care, prevention and health services

Are you optimistic about future infection control?

I am inherently optimistic! In the last 40 years we have made tremendous progress in science and innovation in understanding the virus, treatment, prevention and diagnosis. Although we do not yet have a vaccine or a scalable cure, we do have excellent tools that, if properly implemented, could make great strides in disease control. For example, HIV in children… we have all the necessary tools to stop vertical transmission, but there are still 150,000 children born with HIV each year and another 150,000 who become infected. These 300,000 children will need treatment for the rest of their lives. This is our responsibility!

You are an expert in HIV prevention, what is the best tool to prevent further infections in Africa?

Every day we have more options, beyond the use of condoms. The introduction of antivirals to prevent infection has been very good. This includes post exposure prophylaxis (PEP) [medicamentos que se toman después de una relación de riesgo] and pre-exposure prophylaxis (PrEP) [medicamentos que se toman para prevenir la infección].

And while first-generation PrEP with daily pill-taking isn’t ideal or feasible for everyone, we’ll soon have a vaginal coating for women and an injectable that can be dosed less frequently and will be a game changer. It is hoped that with multiple options, people are more likely to find a method that works for them at every point in their lives. This will lead to the elimination of the transmission of the AIDS virus.

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