What’s in the figure 90-90-90?

There is a new HIV and Aids Campaign in town. It is called 90-90-90. But what is the campaign all about and can Malawi achieve its target by the year 2020 as the campaign envisions? EPHRAIM NYONDO begins the three-part series on ending HIV and Aids.

HIV and Aids is dying.

Well, that is the impression one gets when viewing it from a perspective of years—say its trends in the past 10 years.

The trends, studied carefully, appear to show that HIV and Aids, though still a menace to society, is losing its battle to human resilience.

Look at the figures.

Data from UNAids shows that new infections have dramatically declined from 98 000 new infections in 2005 to 34 000 new infections in 2013. Malawi has also witnessed a 67 percent reduction in children acquiring HIV, the largest country decline, so far, across sub-Saharan Africa.

Life expectancy—which HIV and Aids related deaths play a critical role—have gone up dramatically. The unreleased 2015 data from United Nations Population Fund (UNFPA) shows life expectancy in Malawi is now at 61—a dramatic rise from 37 just seven years ago. The UNAids adds that due to a successful implementation of Early Antiretroviral treatment (ART), 275 000 deaths have been averted in the past decade.

However, despite such encouraging trends, HIV and Aids still remains a menace to Malawi’s society.

Malawi prevalence rate, with 10.3 percent of the population living with HIV in the country is one of the highest in the world.

Not only that.

Malawi accounts for four percent of the total number of people living with HIV in sub-Saharan Africa. The UNAids estimate that one million Malawians were living with HIV in 2013 and 48 000 Malawians died from HIV-related illnesses in the same year.

It is against this that government has developed and embraced a National Strategic Plan for HIV and AIDS (2015-2020) which aims to meet the ambitious 90-90-90 Treatment Targets released by UNAIDS in 2014, preparing to control the HIV epidemic by 2030.

By the end of 2020, Malawi, according to the 90-90-90 Campaign, will have: diagnosed 90 percent of all people living with HIV (PLHIV); started and retained 90 percent of those diagnosed on ART; and achieved viral suppression for 90 percent of patients on ART.

Reaching these 90-90-90 targets in 2020 will result in 760 000, almost 73 percent, of the projected 1 042 000 PLHIV being virally suppressed, leading to a dramatic reduction in sexual and vertical transmission at the population level.

Early Antiretroviral treatment (ART) is the most powerful intervention available to prevent HIV morbidity and mortality, particularly in the context of Malawi’s health services with limited capacity to diagnose and manage HIV-related diseases, says Annie Banda, executive director of the Coalition of Women Living with HIV and Aids (Cowla).

“There is overwhelming evidence, including from Malawi, that early ART reduces the risk of TB and AIDS-defining illnesses,” she says.

The question, then, is: counting on the success stories of the past decade, can Malawi achieve the 90-90-90 Campaign targets by 2020—which is only five years away?

Building a consensus will help the country achieve its goals with calls for closer collaboration between stakeholders, says Maziko Matemba, executive director for Health and Rights Education Programme (Hrep).

“It is possible for the country to meet the targets as we have lessons to learn from why we failed previous HIV and Aids targets.

“As a country we need to invest more into the fight against HIV and Aids.

“Priority should also be concentrated much on areas which have high prevalence and also potential risk populations including support for organisations that use community approaches,” he says.

As noted by Matemba, Cowla is one organisation which is using community approaches in fighting HIV and Aids. Banda, Cowla’s executive director, says for the campaign to succeed, there is need to raise awareness, fight against stigma and discrimination which negatively impacts on disclosure and encouraging people to go for HIV test and adhere to drugs once they are diagnosed positive.

“Our organisation has trained women as community advocates raising awareness about the importance of going for HTC and adherence. Awareness has been created at community level as evidenced by large turnout for HTC services. However, the challenge has been high default rate of ART clients and loss to follow up of women on Option B+,” she says.

Psychology lecturer at the College of Medicine Dr Chiwoza Banda says everyone needs to play a role in the [90-90-90] awareness.

“Focus should be on letting people know there peace of mind in knowing their status—if they do not know there will always be lingering anxiety. People also need to know that testing positive is a death sentence,” he says.