Are TB and HIV rates declining fast enough to meet SDGs by 2030?

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
Like a yoyo statistics, new HIV infections show a decline while sexually transmitted infections show an upward trend. This is true of Zimbabwe where new HIV infections are on decline among the general populace, but not in the young females aged 15-24 years, in whom the rate of new infections is worryingly going up. Statistics show that new HIV infections for males of the same age-group stands at 3%. The age group  below 14 years also has a rate of infection of 3%. So there is a tap that is leaking there.

Who is bedding the females of the 15-24 age group if their male counterparts remain stable at 3% while females climb to a dangerous 11%?  There is also trans-generational sex where the females aged 15-24 years are bedding older men over 40 years. SAfAIDS (Southern Africa HIV and AIDS Information Dissemination Service) communications manager, Tariro Makanga said in a television programme ‘Positive Talk’, that trans-generational sex is to blame for new HIV infections in young females. “What is it that young women are lacking and is provided by sugar daddies, that in the end, the young women are infected with HIV? As parents, despite the difficult environment, let us try to provide the financial needs of our children so that they do not end up at risk,” said Makanga. Some 30 years ago when the AIDS pandemic peaked, there were lost generations. These were generations of sexually active people aged 20–50 years. If the leakage in the 15 to 24 years females is not plugged a lurking disaster occurs. Leave no one behind, if we are to end AIDS by 2030. The young females have challenges, which need urgent addressing. What is it that makes them to not use condoms, thus making them more vulnerable to sexually transmitted diseases? Is it the knowledge gap or is it lack of access to contraception and protection? The 15 to 24 years old females are in high school and colleges and the prevailing economic conditions in most state universities in Zimbabwe put them at increased risk.

Lack of accommodation in most universities leaves the females scrounging for lodgings within the university vicinity. In the absence of enough financial support, they have no power to demand safe sex. When the older men demand unprotected sex for a fee, in most cases the risk is taken. Right now at the on-going United Nations General Assembly taking place in New York, malaria and AIDS are on the official provisional agenda of the 71st session. Strategies to end TB are also in place globally e.g. WHO End TB strategy, and in Zimbabwe there is the End TB programme. All these sound noble. However, ground realities tell a different story. For example, in Zimbabwe, just 17.5 km from the capital city of Harare, there are brick-making projects. Some of them are run by reputable names but the accommodation they offer the workers leaves a lot to be desired. Unhygienic slums with no piped water and sewage facilities are the order of the day. The only recreational facility is a bar where the men drown their sweat and sorrow before walking to a shack of a home. A recent visit to the area showed that TB is rife and the workers have come to accept that the men will die before 50. Jackson Phiri, born and bred in the slums, said that his father succumbed to TB and did not live beyond 45. Jackson too is resigned that the age of 50 is not reachable for him. “My father died aged 43 and that is normal for men working in the brick moulding projects. The work is hard and the environment is dusty. No protection is offered when working and the levels of dust are high. We flush out the dust from our lungs at the local pub after work,” said Phiri. The Global Fund replenishment programme that recently ended in Montreal, Canada managed to reach the US$13 billion funding target that was sought. With funding commitments made at that high level, what remains is to have advocacy work demand that no one be left out in the programmes to end TB, HIV and malaria in their respective countries. If a community as that mentioned above, just less than 20 km from the capital, is ‘forgotten’ then what about the hard-to reach areas rural and hilly areas where roads are in bad shape and the transport network nil at times e.g. Kanyemba area in Mashonaland Central. Kanyemba is just one of the many hard-to-reach areas where mobile clinics would serve the purpose effectively.

Stanley Takaona of the community monitoring team lamented the distances walked by people in Kanyemba to get to health centres. “Patients in Kanyemba have to walk 10km or more to the nearest health centre. Some have to cross the Zambezi River to get medication from Zambia, risking life to being eaten up by crocodiles or getting swept away in the floods. To them it makes more sense to cross to a health facility 4km into Zambia than to walk 10km,” said Takaona. With new cases of MDR-TB recorded globally in 2014 at 480 000 it appears there is a missing link in the jig saw puzzle and this will defeat the success in ending TB by 2030. If we do business as usual, we sure will miss the targets to end TB, HIV by 2030. In 2015, new child-friendly fixed dose combinations formulations for paediatric TB were made availed on the market. Now activists have to demand them for their countries. How? By making key decision makers aware that there are these new wonder medications and garner political will to treat TB in children. The new formulations are child-friendly and flavoured. The first line drugs have been in use since 2001, second line availed 2008 and ending last year, new child-friendly formulations which are highly effective were unpacked. For MDR-TB treatment, more tolerable treatment is needed urgently if patients are to adhere to treatment and complete the full course. Current recommended treatments are lengthy and often difficult to tolerate. It not just about having new regimens available but also accessible to thos in need of them. If people living with HIV continue to die of TB, the gains made in the fight against TB will be eroded.

Catherine Mwauyakufa, Citizen News Service - CNS
September 21, 2016