Tembisa, South Africa (CNN) 14-year-old Philasande Dayimani carries a burden no child should carry.
Last year she started having pains in her mouth and had trouble breathing. She says doctors at her clinic told her to test her for HIV.
“It was not easy to accept. A lot of people cry when they hear their status. I sat down and said
Dressed in a crisp brown school uniform, she returned to her bedroom behind a curtain with a canvas shopping bag containing three pills.
“These are the most important things,” she told CNN, pointing out antiretrovirals.
A few years ago, Daimani’s mother died of suspected AIDS. Currently she lives with her brother. Her doctor told her that she contracted her HIV from her mother when she was born.
Firasande’s life changed in 2022 when she found out she was HIV positive.
The human immunodeficiency virus (HIV) attacks the body’s immune system. If left untreated, it can lead to AIDS, Acquired Immune Deficiency Syndrome. statistics By 2021, approximately 38 million people worldwide will be living with HIV.
Twenty years ago, HIV/AIDS was a death sentence in this region. Every weekend the cemetery was packed. Children who die without treatment. The virus has permeated every aspect of life.
Today, the HIV epidemic has disappeared from the news headlines. Much like diabetes, it is considered a manageable condition. This is thanks to a highly successful US public health initiative that most people in the US have never heard of.
The roots of its success began 20 years ago.
a bolt from the blue
President George W. Bush’s State of the Union address in January 2003 was dominated by Iraq, a pivotal moment leading up to the US’ disastrous invasion of Iraq.
But few could have predicted the impact of the President’s Emergency Plan for AIDS Relief (PEPFAR), which Bush announced that day.
at the time, <50,000 people living with HIV An estimated 2.75 million people were receiving treatment in sub-Saharan Africa, died of AIDS last year globally. Antiretroviral drugs (ARVs) have been available in wealthy countries since the mid-1990s.
Bush’s plea during the speech seemed genuinely personal.
“Many hospitals tell people, you have AIDS, we can’t help you, go home and die. You don’t have to listen.” Said.
“I didn’t know anything about it. It was a complete surprise. (CDC) told CNN in South Africa.
Blandford has been HIV positive since the mid-1980s. He was deeply aware of the inequality of treatment because of what he saw in the United States.
“I saw the effect in 1996. People were living with advanced AIDS and dying. They had access to these drugs and we saw this change. “People are thriving from serious illnesses, gaining weight and going back to work. It’s been hard not to have that happening on the African continent where the need is greatest,” he says.
Focused, data-driven
PEPFAR stepped up the US response, pouring in millions and billions of dollars. over 100 billion To date, in treatment and prevention. From the beginning, the initiative has been highly focused and data-driven.
“It was, ‘There’s a huge problem out there, so where can we have the greatest impact?’ The most influential public health leader.
Of the 15 countries initially supported by PEPFAR, South Africa was perhaps the most important.of the world, past and present highest HIV loadAnd in the early 2000s, the South African government was in deadly denial.
About 6 million South Africans are receiving treatment for the HIV virus. The country still has the highest HIV burden in the world.
South African President Thabo Mbeki at the time resisted the deployment of antiretroviral drugs, despite pleas from activists, overcrowded cemeteries, and widespread evidence of the treatment’s effectiveness.
Health Minister at the time was suggested That beets and garlic can have a real impact on your results.
“Our president was in denial, our health minister was in denial, so it was a very unique problem that PEPFAR had to overcome, and it worked,” Karim says.
He says it demonstrates one of the program’s greatest strengths: just getting things done.
Karim and his team have started offering ARVs. A rural clinic in Kwa Zur Natal in 2004 And in an atmosphere of fear and prejudice, he launched a treatment campaign.
“It was very impressive. No one said they had HIV. But it was just word of mouth and patients started pouring in. He said he would come back later and say he had HIV, and it was great to see,” he says.
After intense international criticism and aggressive civil society protests and lawsuits, government inaction was one of the things that changed around the time PEPFAR was launched. The World’s Most Impressive Treatment DeploymentCurrently, about 80% of treatment costs are borne by South African provinces.
An unmistakable success story
Some countries cannot afford that cost. Patients wait on wooden benches at Lesotho’s Motebang Hospital, just a few minutes’ drive from the South African border.
Julius Molepi, 64, has been in treatment for 10 years.
“I was feeling weak and tired all the time, so I came to the clinic to get tested. That’s how I found out,” he told CNN.
Julius Molepi receives an antiretroviral prescription at Moteban Hospital in Lesotho.
Morepi complains to the nurse about anorexia. They chat about his medical history and the results of his viral load. Nurses recommend eating porridge for a week or two.
“The people who are dying are the ones who deny that they are sick. If you believe in medicine, they will work for you,” he says.
Molepi hobbled to the clinic window to get another ARV treatment.
Despite being one of the poorest countries in the world, Lesotho is a success story.
In 2005, according to UNAIDS data, nearly 20,000 people died from HIV in a small country. That number he cut by a quarter.
the country has arrived important milestone UNAIDS setting: 90% of people living with HIV know their status. 90% of patients with confirmed HIV infection are on treatment, and 90% of those on treatment are virally suppressed.
Lesotho was part of the country’s first group PEPFAR was targeted from the beginning due to the high prevalence of HIV and the lack of ability to target the virus.
A life-saving antiretroviral drug dispensed at Motebang Hospital HIV, Maseru, Lesotho.
Public health workers say the aggressive rollout of testing and treatment has helped change the treatment curve. He was also one of the first countries in Africa. Guarantee treatment for those who test positiveregardless of viral load.
But health workers here say the prevalence remains stubbornly high, not when the status quo is complacent. See UNAIDS link first
“I can’t keep my feet off the gas. People are still dying from AIDS. Yes, not as many as before. There are still children born with HIV and we cannot forget it,” says Maheta Moshavesha, leader of the Basotho NGO Karabo Air Bofero.
He said the work of PEPFAR, the Global Fund, and other organizations has helped turn the course of the epidemic, not just through treatment, but through significant advances in prevention and behavior change.
Epidemic at a crossroads
Public health officials in Africa and the United States say the epidemic is at a critical crossroads.and Over 600,000 dead Given the AIDS epidemic and millions of people without treatment, there is a significant risk of relapse, they say.
More than 2 million people in South Africa alone are living with HIV, Blandford says, but are not receiving treatment despite free and readily available treatment.
“One of the challenges we are still seeing with new HIV infections is that not everyone is aware of the benefits of treatment,” he says.
One of the most important non-personal health benefits is that the current generation of ARVs reduces a person’s viral load to almost zero, essentially negating the risk of transmitting disease.
But complacency is starting to set in for many.
“The HIV epidemic is not over. The fear around HIV and death is gone. That’s what we wanted. We didn’t want people to be scared by the thought of HIV.” said Dr. Moya Mabitsi, executive director of the highly funded ANOVA Health Institute.
“If we don’t address this, new infections will start to emerge again, and the gains we have made so far will be lost,” she says.
The impact of PEPFAR cannot be denied. According to the U.S. government, the program has saved more than 25 million lives and has grown in scope and impact over the past 20 years. It also has a very durable bipartisan support.
Last year, US President Joe Biden appointed Dr. John Nkengason as PEPFAR leader. The respected Cameroonian-born public health expert recently headed the Africa CDC during the Covid-19 pandemic.
Nkengasong said it’s important not to lose focus in the fight against HIV despite fears of the recent Covid pandemic and acute outbreaks like last year’s Mpox and monkeypox.
“HIV/AIDS has dropped a place or two from the public eye thanks to the spectacular success of PEPFAR and others, but the virus remains a serious health concern in Sahara Africa,” he says.
One reason, according to public health experts, is age and power imbalances in sexual relationships. A man, an older partner who doesn’t know his status, is infecting a young woman.
70% of the region’s population and Under 30he says the continent is entering a period of particular vulnerability.
He also said PEPFAR is trying to shift some of the burden of HIV onto governments, raising some concerns that governments are not prepared.
But Salim Abdool-Karim thinks it’s a good thing.
“PEPFAR has to move soon. Probably not soon, but soon they have to move to another mode. It has to be a 10-year strategy called an exit strategy. should be transferred to local governments,” he said. he says.
Without a cure or an effective vaccine, HIV/AIDS will be a multi-generational effort.
According to the latest science, many children born with HIV are now in college and living full lives. If they maintain their medication carefully.
In Tembisa, teenage Deimani is still coming to terms with her HIV infection.
“The virus isn’t actually in my blood, so the doctors told me not to stress. They’re ordering me to get rid of it,” she says. , actually, she is right.
ARV can now achieve an undetectable viral load if the treatment regime is maintained. HIV-positive Do not pass the virus on to an HIV-negative partnerAIDS could be overcome if everyone with HIV had access to treatment.
“It’s just a small part of my life right now. I can live without thinking about it,” she says.
