Liesbet Ohler
Cape Town - Over the past two years, the Covid-19 pandemic has had a devastating impact globally on countries’ national communicable disease programmes, crucially including the response to HIV/Aids.
Disruptions in treatment and prevention services may have contributed to about 1.5 million new HIV infections globally that occurred last year.
A rigorous scale-up of health services by governments needs to go hand in hand with active involvement of communities to get the global HIV response back on track.
Drawing on our experience of more than two decades working with HIV and tuberculosis in South Africa, Médecins Sans Frontières/Doctors Without Borders (MSF) believes that community-led interventions such as those involving youth can significantly improve the uptake of health services and reduce the risk of HIV infection.
Young people can be extremely effective drivers of social change. In the past 10 years, there has been a global 46% reduction in new HIV infections among youths aged 15-24 years.
However, the world is still falling short of achieving the targets set for young people and achieving the goal of ending Aids by 2030.
Empowerment of the youth through proactive engagement is key not only for their health-seeking behaviour of HIV preventive services, but also to allay stigma and discrimination against people living with HIV in the wider community.
In 2019, MSF teams in Eshowe, KwaZulu-Natal, achieved the UNaids treatment target of 90-90-90 aimed at helping to end Aids.
The achieved results of 90-94-95 meant that 90% of people living with HIV know their status; 94% of those are on antiretroviral treatment; and 95% of those have a suppressed viral load.
This achievement is attributed to the strong community involvement in HIV care pioneered by the Eshowe teams. Through these results, MSF demonstrated the possibility of achieving these high targets in KZN, which has the highest number of people living with HIV in South Africa, accounting for about 18% of the country’s infection rates.
Among the various community and patient-centred interventions led by MSF that resulted in this success, engagement with youths in schools and improved recruitment for voluntary medical male circumcision facilitated in normalising HIV as a disease within the community.
In the long term, these efforts are expected to reduce HIV incidence.
MSF in Eshowe started its school health programmes in 2012, in partnership with local authorities and health facilities. The aim was to reduce new infections and promote prevention methods among high-school students in Grades 8 to12.
In more than 35 schools in Eshowe and Mbongolwane, MSF offered HIV counselling and testing services (HCT) to mobilise high school learners to know their status, increase health-seeking behaviour and offer better support and care for learners who test HIV positive.
Using the life orientation subject in the school curriculum as a platform, our teams shared health education on HIV/Aids, TB, sexually transmitted diseases and the risk of teenage pregnancies.
Youth-friendly ways of providing education through peer educators and youth camps helped in offering them a safe space and developing an understanding of how to protect themselves and their HIV-positive peers.
HCT in schools provided a valuable opportunity to promote HIV prevention among learners by enabling them to know their status and begin a long term habit of regular HIV testing.
The learners’ participation in this intervention required consent from parents, teachers, principals and officials, and tacit acceptance from institutions like churches and community-based organisations.
This led to a substantive rise in the level of acceptance of the need for health education and in breaking down common misconceptions among these groups of people and institutions.
Through school health programmes, MSF was also successful in recruiting male learners for medical male circumcision (MMC) as a life-long partial prevention strategy for those who tested HIV negative, and in supporting HIV-positive learners with medical screening prior to circumcision.
Working closely with the Department of Health and the Department of Education, MSF teams mobilised and recruited boys for MMC camps in 25 schools in Eshowe and 23 schools in Mbongolwane.
Voluntary MMC is recommended by the WHO in high HIV prevalence settings as an additional strategy for HIV prevention by reducing the transmission among circumcised men by up to 60%.
With 71% of boys between the ages of 15 and 19 years old medically circumcised in 2018 in Eshowe and Mbongolwane as per MSF’s HIV impact population survey, we expect to see a reduction in new HIV infections within the community.
Within the general male population, MSF saw a more than doubling of men who were medically circumcised between 2013 and 2018.
Our approach of using schools for recruitment for MMC ended up being a remarkable collaborative effort of community engagement across constituent groups: parents, young males, teachers, leaders, school administrators and health officials.
Since 2019, MSF has used this successful platform, working closely with schools and government officials, to also raise awareness around TB and de-stigmatise the disease that is one of the leading causes of death among people with HIV.
Globally, young people continue to face substantive challenges to accessing HIV and sexual and reproductive health services.
This, despite an extensive global call to focus on youth to control the rising number of HIV infections.
MSF’s experience in Eshowe has shown that it is critical to engage with young people in schools at an early stage to discuss HIV prevention and identify the strategies that suit them best, to affect behaviour and support their choices and future.
Focusing on increasing treatment and care services is not enough. If national health programmes want to deliver on reversing and ending HIV/ Aids, young people must engage and lead the response to this epidemic.
Dr Ohler is MSF’s project medical referent in Eshowe KZN
Cape Times
** The views expressed do not necessarily reflect the views of Independent Media or IOL.