To end AIDS, high-risk countries will need to jab schoolgirls

Sustainable Development Goals (SDGs) and Ending AIDS

Introduction

Two decades ago, HIV was ripping across Africa like flames across a lake of petrol. In some countries, more than a quarter of adults were infected. Nearly all were expected to die, slowly, leaving families without breadwinners and forcing girls to drop out of school to care for sick parents. Sober observers predicted social collapse. However, the price of antiretroviral drugs plunged, saving an estimated 21 million lives.

The Challenge

Despite the progress, AIDS remains the top cause of death for African women and the third leading cause of death for women aged 15-49 worldwide. Approximately 30 million people with HIV are taking antiretroviral drugs, but 9 million are not. Those who are unaware of their infection can easily transmit the virus, resulting in 1.3 million new infections and 630,000 deaths from AIDS last year.

The Sustainable Development Goals (SDGs)

The United Nations (UN) has set a goal of ending AIDS as a public health threat by 2030. To achieve this, two approaches must be pursued simultaneously:

1. Identify HIV-positive individuals who are unaware of their status and provide them with medication to keep them healthy and prevent transmission.
2. Implement preventive measures to reduce the number of new infections.

Challenges in Implementation

While existing technology can theoretically accomplish these goals, there are challenges in implementation. Encouraging people to get tested for HIV is difficult, as many individuals may not experience symptoms for years. Men, in particular, may be reluctant to visit clinics when they feel well. Additionally, condom use for prevention is effective, but adherence is a challenge. Therefore, alternative methods such as pre-exposure prophylaxis (PrEP) are being explored.

Pre-Exposure Prophylaxis (PrEP)

PrEP involves taking a daily pill that significantly reduces the risk of contracting HIV during sex. While it has been successful for gay men in wealthy countries, it is suboptimal for heterosexual women in low-income countries where HIV prevalence is high. Taking a daily pill can be inconvenient and difficult to conceal from partners.

A Promising Solution

A long-lasting injection could provide a more discreet and convenient option for HIV prevention. ViiV, a British drug firm, has developed a two-month jab and licensed it to generic manufacturers. Gilead, an American firm, is testing a drug that could last for six months.

Expanding Access

Some states and non-governmental organizations (NGOs) already provide prophylaxis to drug injectors and sex workers. If the six-month injection proves effective, it should be routinely offered to teenage girls in high-risk countries. This approach may be controversial but is likely to be effective in reducing new infections.

Addressing Transmission Patterns

In sub-Saharan Africa, girls typically acquire HIV first by engaging in relationships with older men who can afford dates. As they grow older, they pass the virus on to partners closer to their age. By breaking the transmission from “sugar daddies” to teenagers, a younger age cohort could grow up with significantly lower HIV prevalence.

Economic Considerations

Negotiating drug prices will be crucial. Each new infection requires a lifetime of treatment, costing an average of $380,000 in wealthy countries and $5,000 in poorer ones. Therefore, it should be possible to design a program that saves money in the long run. Donors can leverage their purchasing power to negotiate lower prices for PrEP.

Conclusion

Ending AIDS as a public health threat requires a comprehensive approach that includes testing, treatment, and prevention. The Sustainable Development Goals provide a framework for addressing this global challenge. It is essential to prioritize access to medication and preventive measures, particularly for high-risk populations such as teenage girls in African countries. Political support and funding are crucial to achieving the goal of ending AIDS by 2030.

SDGs, Targets, and Indicators Analysis:

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities

The article discusses the issue of HIV/AIDS and its impact on public health, particularly on African women. It also highlights the need to address gender inequalities and reduce the transmission of the virus among high-risk groups. These issues are directly connected to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. Additionally, SDG 5, which focuses on achieving gender equality and empowering all women and girls, is relevant due to the disproportionate impact of HIV/AIDS on women. Lastly, SDG 10, which aims to reduce inequalities within and among countries, is connected to the article’s discussion of the need to provide access to preventive measures and treatment for high-risk groups.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.
• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.

The article aligns with Target 3.3, which aims to end the epidemics of AIDS by 2030. It also relates to Target 5.6, which emphasizes universal access to sexual and reproductive health, including HIV prevention and treatment. Additionally, Target 10.3 is relevant as it calls for reducing inequalities and eliminating discriminatory practices in accessing healthcare services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age, and key populations.
• Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.
• Indicator 10.3.1: Proportion of people who have experienced a discriminatory action or who feel discriminated against in the previous 12 months based on a ground of discrimination prohibited under international human rights law.

The article does not explicitly mention specific indicators. However, it implies the need to measure the number of new HIV infections (Indicator 3.3.1) to assess progress towards ending the epidemic. It also suggests the importance of measuring women’s ability to make informed decisions about their sexual and reproductive health (Indicator 5.6.1) and monitoring discrimination in accessing healthcare services (Indicator 10.3.1).

Table: SDGs, Targets, and Indicators

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Source: economist.com

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