From Manhiça, Mozambique. Goal: Change the December 1st Slogan

[This article has been published in Spanish in El-País-Planeta Futuro on the occasion of World AIDS Day]

Illustration by María de la Fuente Soro

This year, once again, the population of Manhiça located south of Mozambique is preparing, as in other places of the world, to celebrate World AIDS Day

It is 7 o’clock in the morning, the temperature is 23 degrees Celsius, and the bright light reveals the agitation of the people that gather in front of the Manhiça District Hospital. This year, once again, the population of this city located south of Mozambique is preparing, as in other places of the world, to celebrate World AIDS Day. This syndrome, caused by the Human Immunodeficiency Virus (HIV) has led to 35 million deaths in just a few decades.

Dozens of people, mostly women, wait for the cars that will take them to the meeting point. Medical doctors, traditional healers, healthcare workers, political leaders, military staff, policemen, community leaders, conselheiros, NGO representatives, citizens and activists are determined to parade under the same slogan that this year will be: “Priozando a prevenção para acelerar o combate ao HIV e sida” (“Prioritising prevention to accelerate the fight against HIV and AIDS”).

Almost 37 million people are living with HIV across the world

They will walk together, once again, along with millions of people worldwide, to spread messages like this one. Messages that transmit the voice of almost 37 million people living with HIV across the world. Messages of struggle, of empowerment, of defence, of de-stigmatization.

In 2014, the United Nations Programme for HIV/AIDS (UNAIDS) published its 90-90-90 target. If by 2020 90% of people infected with VIH know their VIH status, 90% of them receive antiretroviral treatment, and 90% of these have viral suppression (i.e. undetectable virus levels in the blood), virus transmission could be stopped. This ambitious strategy, which all countries should achieve by 2020, could avoid millions of new infections and control the epidemic at the global level.  

Localising, diagnosing and maintaining treatment adherence in HIV-infected people are among the main challenges faced not only by Mozambique but by the governments of all endemic countries

Mozambique, where 13.2% of the adult population was estimated to be infected in 2015, is still far from reaching the 90-90-90 target. Localising, diagnosing and maintaining treatment adherence in HIV-infected people are among the main challenges faced not only by Mozambique but by the governments of all endemic countries. A 2014 study led by ISGlobal researcher Denise Naniche together with the Manhiça Health Research Centre (CISM), indicated that in Manhiça, even though 86.8% of HIV-infected people knew their status, only two of three attended their first hospital consultation. Of these, only 25.2% initiated treatment in the first three months after diagnosis.

While high-income countries pre-exposure prophylaxis (PrEP) is being considered, in endemic countries, where most of the infectious burden lies, the question is how to progress towards “universal treatment”: how to scale-up care and treatment to all people living with HIV, regardless of how weakened their immune system is.    

In 2016, almost 20 million people had access to antiretroviral treatment. In four years, this number should double if the UNAIDS target is to be met

In 2016, almost 20 million people had access to antiretroviral treatment. In four years, this number should double if the UNAIDS target is to be met. The challenges for these coming years are many and they are not only logistical but also social, medical, political and ethical.  

Why aren’t we capable of diagnosing 100% of the infected population, if the diagnosis is made with a simple rapid test that anyone anywhere can interpret in less than 15 minutes? Where does the chain of care fail? Why do people stop taking the treatment? Is there enough treatment for everyone? And why don’t they use condoms? All these questions, plus all those you can imagine, need to be urgently answered. 

Although considerable scientific progress has been made, an estimated 2 million new infections occur every year worldwide

Although considerable scientific progress has been made towards a possible cure, new drugs, and diagnostic and follow-up tests, an estimated 2 million new infections occur every year worldwide. If so many people live with HIV across the world, why are they still stigmatized and discriminated? Why is personal consent still necessary to diagnose the disease? Why does the infection remain a secret? Prevention Access Campaign is a health equity initiative to end with the dual epidemics of HIV and its related stigma. Last year it launched the U=U campaign (Undetectable=Untrnsmittable) with the aim of empowering HIV-positive people and people at risk with accurate and meaningful information about their social, sexual and reproductive health.

Only through a holistic approach and a large effort of all the stakeholders – governments, NGOs, civil society, scientific community, etc. – will it be possible to see on the Manhiça banners on December 1st, 2030,  "Felizmente o fim da luta atingiu-se, 0 novos casos de HIV e sida” ("Happily, the battle has been won: 0 new cases of HIV and AIDS”).