[By Dr Parkie Mbozi]
NEXT week on December 1, the world will be celebrating the World AIDS Day.
By my next column article, this day will have passed. Therefore, I dedicate this article to this day. I do so not because I started my research, including for MA dissertation, and media support working on the AIDS pandemic but because I am affected. As the adage goes, in sub-Saharan African you are either infected or affected.
No doubt this year’s World AIDS Day will be like no other. This is all because of COVID-19, a cousin to AIDS. Never in its 36-year lifetime has AIDS faced so much competition for attention as this year. Both COVID-19 and AIDS are caused by a virus and both have no known cure. And it may take decades before we can witness such competition between pandemics of the same family. Bird flu also known as avian influenza viruses (H5N1) was observed in 1997 in Hong Kong and spread mainly to parts of Asia, North Africa, and the Middle East. However, its impact on humans was inconsequential.
A WHO Scientist Helen Branswell writes that, “The virus continued to kill chickens and to occasionally infect and sometimes kill people. But as the years passed, the number of human H5N1 cases subsided. There has not been a single H5N1 human infection detected since February 2017.”
The two pandemics – AIDS and COVID-19 – have stunningly split the world into two halves: AIDS for Africa and COVID-19 for the rest of the world, especially Americas and Europe. It is understandable why for the rest of world next week’s World AIDS Day will be overshadowed by their concerns about COVID-19. First, World AIDS Day almost coincides with the first anniversary of COVID-19. The first case of COVID-19 virus outbreak was announced by the Chinese authorities on December 2, 2019, in the city of Wuhan, Hubei Province, mainland China.
Second, as of 24 November 2020, the rest of the world accounted for 96.5 per cent (or 57,227,539) of the global cumulative total of 59,307,493 cases of COVID-19. Africa’s contribution is a paltry 2,079, 954 cases (again only 3.5 per cent); 68 per cent of the African cases coming from the five countries – South Africa (769,759), Morocco (327,528), Egypt (113,381), Ethiopia (106,203) and Tunisia (89,195.
The rest of the world also contributes over 96,5 per cent of the total (1,397,672) of the COVID-19 related deaths so far. Africa’s cumulative mortality of 49,986 deaths represents another mere 3.5 per cent of the global total. Americas (North and South) account for the majority (706,266 or 50.5 per cent) of global deaths, followed by Europe 376 539 (27 per cent).
Cases of the pandemic are also increasing and reaching record highs in many parts of Europe and Americas, under what has been dubbed as the second wave of the pandemic. In the USA, for instance, a week ago the Center for Disease Control (CDC) reported that, “The number of infections in the US has reached new heights in the last seven days, surpassing 150,000 cases in one day for the first time since the outbreak began.” Within seven days the US has reached new highs and accounts for the highest number of infections in the world and the spread of the virus shows no sign of slowing down.
The death toll as of today, November 25th, stands at about 285,000+ – again the highest figure in the world and about 21 per cent of the global total of confirmed coronavirus deaths. On average, more than 2,000 people are now reported to be dying every day in the USA and recent daily spikes have been higher than those seen during the summer outbreak. The IHNE model predicts that by mid-January 2021, daily mortality will go up to 2,100. Daily hospitalisation has also gone up from 60,000+ about 10 days ago to 88,000+ by press time for this article, November 24. In sharp contrast, most African countries are reporting as low as single digit daily cases and collectively Africa reports fewer daily cases than the USA alone.
The story is different with HIV and AIDS. Africa has long been described as then epi-centre of the AIDS pandemic and it continues to be. Since the start of the epidemic, an estimated 74.9 million people have become infected with HIV and 32 million people have died of AIDS-related illnesses. In 2018, 770,000 people died of AIDS-related illnesses. This number has reduced by more than 55 per cent since the peak of 1.7 million in 2004 and 1.4 million in 2010. The vast majority of people living with HIV are located in low- and middle- income countries, with an estimated 68 per cent living in sub-Saharan Africa. Among this group 20.6 million are living in East and Southern Africa which saw 800,000 new HIV infections in 2018.
In terms of Zambia, UNAIDS reports that as of 2018, cumulatively 1,200,000 people were living with HIV, with a prevalence rate – percentage of people living with HIV among adults (15–49 years) – at 11.3 per cent. It is estimated that 48,000 people were newly infected with HIV in 2018 alone and 17,000 people died from an AIDS-related illness.
There has been progress in the number of AIDS-related deaths since 2010, with a 37 per cent decrease, from 26,000 deaths to 17,000 deaths in 2018. The number of new HIV infections has also decreased, from 56,000 to 48,000 in the same period. More than 95 per cent of pregnant women living with HIV accessed antiretroviral medicine to prevent transmission of the virus to their baby, preventing 8,800 new HIV infections among newborns. Early infant diagnosis, the percentage of HIV-exposed infants tested for HIV before eight weeks of age, stood at 71 per cent in 2018.
Women are disproportionally affected by HIV in Zambia: of the 1,200,000 adults living with HIV, 700,000 (58.33 per cent) were women. New HIV infections among young women aged 15–24 years were more than double those among young men: 13,000 new infections among young women, compared to 5,600 among young men. HIV treatment was higher among women than men, however, with 83 per cent of adult women living with HIV on treatment, compared to 69 per cent of adult men.
Challenges and progress
The UNAIDS notes that despite advances in our scientific understanding of HIV and its prevention and treatment as well as years of significant effort by the global health community and leading government and civil society organisations, too many people with HIV or at risk for HIV still do not have access to prevention, care, and treatment, and there is still no cure. Further, the HIV epidemic not only affects the health of individuals, but it also impacts households, communities, and the development and economic growth of nations.
Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems.
Despite these challenges, there have been successes and promising signs. New global efforts have been mounted to address the epidemic, particularly in the last decade. The number of people with new HIV infections has declined over the years. In addition, the number of people with HIV receiving treatment in resource-poor countries has dramatically increased in the past decade and dramatic progress has been made in preventing mother-to-child transmission of HIV and keeping mothers alive.
However, despite the availability of a widening array of effective HIV prevention tools and methods and a massive scale-up of HIV treatment in recent years, UNAIDS cautions there has been unequal progress in reducing new HIV infections, increasing access to treatment, and ending AIDS-related deaths, with too many vulnerable people and populations left behind. Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Further, the COVID-19 pandemic has seriously impacted the AIDS response and could disrupt it more .
These challenges and successes are the reason for celebrating World AIDS Day next Tuesday. The day is an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. As a torch bearer of the fight against the HIV/AIDS pandemic, Africa is justified to celebrate World AIDS Day, the first ever global health day. For us AIDS is an emotional matter as we remember our departed friends, relatives, work colleagues, leaders, etc. who were prematurely claimed by the disease.
The author is a research fellow with the Institute of Economic and Social Research, University of Zambia. He is reachable on email@example.com.