By Kemo Cham
Sierra Leone has set in motion efforts to decentralize
its anti HIV battle in line with the Paris Declaration on the Fast-Track Cities
Initiative.
The heads of 15 local councils, at a landmark ceremony at
the end of last month, signed the agreement which aims to accelerate global
efforts against the AIDS pandemic.
At the ceremony in the northern city of Makeni, which was
presided over by the country's First Lady, the mayors and council chairmen
expressed commitment to the initiative whose main targets include ensuring that
by 2020 90% of people living with HIV know their status; 90% of those living
with the virus and who know their HIV-positive status be put on antiretroviral
therapy (ART); and 90% of these people on ART to achieve viral suppression.
These golden commitments also constitute the UN’s target of ending HIV
transmission by the year 2030, in line with the Sustainable Development Goal 3
which envisages healthy lives and wellbeing universally.
The Fast-Track Cities Initiative, launched in 2014 in
Paris, France, adds to the fold the goal of attaining zero stigma and
discrimination. The initiative notably emphasizes the need to focus on the
grassroots level - counties, cities, districts and other local communities most
affected by HIV - and recommends that resources be concentrated on the areas
with the greatest impact.
The idea behind the Cities Initiative is that cities are
home to some of the most vulnerable segments of the population, including slum
dwellers, sex workers, migrants, drug users and same sex people. Mayors and
chairmen are therefore expected to provide leadership in ensuring that their
cities have the tools and support needed to accelerate their local AIDS
responses. They are expected to help mobilize resources for the better
integration of public health and development, to build and accelerate urban HIV
strategies and to use the AIDS response as a catalyst for positive social
transformation.
The UNAIDS, alongside partners, like the International
Association of Providers of AIDS Care (IAPAC), are supporting the initiative
through technical assistance to local health departments, encouraging
consensus-building and coordination among key local stakeholders, as well as
with capacity-building support for clinical and service providers,
community-based organizations, and affected communities.
As of May 1, 2017, more than 70 high HIV burden cities
around the world have signed the Paris Declaration. Among these are 29 African
cities: dubbed the Fast-Track Cities.
IAPAC which keeps a web portal housing city-specific
dashboards tracking progress against the initiative’s targets, also maps HIV
services and share best practices across the Fast-Track Cities network. Its
President, Dr. José M. Zuniga, hailed the move by the 15 Sierra Leonean cities
as the most recent African cities to join the network.
“We are committed to working in collaboration with local
stakeholders, including government officials, community representatives, and
clinical and service providers to address gaps across these cities’ HIV care
continua and thus facilitate attainment of the UNAIDS 90-90-90 targets by
2020,” Zuniga said in a statement forwarded to Politico.
HIV in Sierra Leone
The Cities Initiative was inspired by a UNAIDS finding on
HIV, which outlines the important role that urban areas can play in ending the
AIDS epidemic by 2030.
The report, 'The OUTLOOK': sheds light on how cities and
urban areas are particularly affected by the disease. It notes that the 200
cities most affected by the epidemic are estimated to account for more than a
quarter of the 35 million people living with HIV around the world at the time.
In many countries, cities are home to more than half of
all people living with HIV across the country, and in sub-Saharan Africa, 45%
of people living with the virus reside in cities, the report showed.
It says more than half the world’s population lives in
cities, with the proportion set to expand to 60% by 2050. The vast majority of
megacities, defined as having populations of more than 10 million people, will
be in low- and middle-income countries like Sierra Leone by then.
"Fast-tracking HIV responses in cities—without
neglecting efforts in rural and other areas—will therefore be crucial to ending
the AIDS epidemic," it stresses.
Dr. Michael Gboun, UNAIDS Country Director, is
spearheading the implementation efforts of the Cities Initiative in Sierra
Leone. He told the Makeni forum that countries in the West and Central Africa
region were lagging behind and needed to accelerate their responses to the HIV
epidemic.
Dr Gboun later told Politico in an interview that the key
populations are in the cities where the style of living leaves the inhabitants
highly vulnerable to HIV and other diseases.
“There is a reason why all mayors came to Paris in 2014 to
sign their commitment. One of the principles is that cities have a lot of
opportunities, high migration for young people, where the population is largest
and vulnerability higher…,” he said.
“If you want to fight this epidemic, if you don’t use the
differentiated approach in terms of prioritization where the biggest problem
is, you can’t win,” Dr Gboun added.
The most recent assessment by the UNAIDS and the government
show that there are an estimated 65, 000 people living with HIV/AIDS in Sierra
Leone in 2017, compared to 51, 000 in 2016.
Annual AIDS deaths is at 2, 502, according to the HIV
epidemiology report of 2016 jointly published by the government and the World
Health Organisation.
Dr Gboun attributes this increase in new infection to the
failure to identify the “missing” cases, noting that it’s because of the low
coverage in essential services.
Most vulnerable
The national strategic plan to combat the disease
provides for extensive sensitization to have people who do not know their
status go for test.
Seven districts: Western Area Urban (Freetown), Western
Area Rural, Bombali (Makeni), Tonkolili, Bo, Kenema and Kono were identified as
having the highest HIV burden in the country. The ministry of health and its
partners plan to concentrate most of the available resources in these districts
with emphasis on behavioral communications.
The prevalence of
HIV among women is the highest among all categories; they account for over half
of the total cases at 30, 438, compared to 20, 444 for men, according to
the 2016 epidemiology report. Women, it notes, are more vulnerable than men to
HIV infection, with females from 15 to 19 years of age being the most
vulnerable.
First Lady Sia Nyama Koroma sounded the alarm bell over
this at the Makeni launching of the Cities Initiative.
“In Sierra Leone
for every two men affected, three women are also affected, which clearly
exposes the vulnerability of women and children,” she said, calling for greater
attention to be paid to women.
As part of the
fast-track approach to HIV, Sierra Leone has since adopted WHO’s recommendation
to put every HIV positive person on ART. This way, according to the Ministry of
Health, about 18, 000 are on treatment. But this represents only 30
percent of the total estimated cases.
The major
challenge facing the country now is case identification, said Dr Gboun of
UNAIDS. He also cited the issue of stigma and discrimination.
[First
published on www.politicosl.com]
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