HIV in West Africa
The HIV-AIDS epidemic in West Africa has always had a rather low prevalence rate in the general population, unlike the Eastern and Southern Africa’s one. As a result, the first massive response efforts focused mainly on the south of the continent.
Today, while the overall situation in the fight against AIDS is showing encouraging results in terms of screening, access to treatment and viral load monitoring, West Africa is lagging behind in achieving the targets.
A “silent” epidemic has continued, particularly among vulnerable populations, and access to testing remains the most important objective to be achieved in order to also improve therapeutic management and viral load suppression.
In West and Central Africa, 5 million people are living with HIV, representing a prevalence of 1 %. In 2019, 240,000 new infections and 140,000 deaths were recorded.
IN 2019
%
of the world population
BUT
%
of new infections
AND
%
child deaths from HIV/AIDS-related cause
Source : Unaids Data 2021.
Populations at higher risk of infection remain vulnerable populations, due to persistent stigma and discrimination and the criminalization of certain behaviours in some countries in the subregion (in 2017, at least 11 countries in the region had laws criminalizing same-sex relationships or expression).
Key populations at high risk of infection
Relative risk of HIV acquisition by population group compared to the general population worldwide 2017 :
- Sex workers 13%
- Drug users 22%
- Men who have had sex with men 28%
- Transgender women 13%
Source : A long way to go, UNAIDS, 2018
The 90-90-90 Strategy at global and regional level
While many strategies are needed to close the chapter on the AIDS epidemic, one thing is certain : it will be impossible to end the epidemic without providing HIV treatment to all those who need it. To achieve this, UNAIDS launched the 90-90-90 strategy in 2015. By 2020 :
- 90% of people living with HIV know their HIV status.
- 90% of all HIV-infected people tested receive sustainable antiretroviral treatment.
- 90% of people receiving antiretroviral treatment have a permanently suppressed viral load.
In 2019, in the world
38 million people are living with HIV
- People living with HIV know their status 81%
- People who know their positive status have access to treatment 82%
- People on treatment have an undetectable viral load 88%
Source : Unaids Data 2021
In West and Central Africa
5 million people are living with HIV
- People living with HIV know their status 68%
- People who know their positive status have access to treatment 85%
- People on treatment have an undetectable viral load 78%
Source : Unaids Data 2021
Prevention and risk behaviours
Risks of HIV infection
Unprotected sexual intercourse
There is a risk of HIV infection during unprotected sexual practices because the virus, present in sexual secretions, enters the body through a mucous membrane.
Blood and/or skin route
The risk of contamination is very high when syringes and/or objects contaminated with contaminated blood are shared.
HIV-positive mothers to children
All babies born to HIV-positive mothers are HIV-positive at birth. They have HIV antibodies, which are transmitted to the fetus during pregnancy. There is about a 20% risk of transmission of the virus if the mother is not treated, and about 2% if she is treated during the third trimester. A high risk remains with breast milk during breastfeeding.
Zero risk of HIV transmission
HIV is not transmitted through saliva, tears, kisses, urine, sharing cutlery and/or glasses, mosquito bites, everyday actions (shaking hands, using public facilities such as toilets, showers, swimming pools, etc.).
The use of condoms, male or female, is the safest way to protect yourself from HIV during sex.
Treatment as Prevention (TASP)
Detecting HIV infection makes it possible to set up antiretroviral treatment early for both individual and collective benefit : effective for the person being treated, treatments also considerably reduce the risk of HIV transmission. Treatment as prevention works if the HIV-positive person is treated effectively, with an undetectable viral load*; the risk of transmitting HIV to a sexual partner then becomes extremely low.
* Viral load is said to be undetectable when the level of viral particles circulating in the blood is so low that it becomes undetectable. An undetectable viral load does not mean that the virus is absent, but that the amount of HIV has reached a level below the detection threshold by testing.
PrEP (Pre-exposure Prophylaxis)
What is PrEP ?
PrEP, or Pre-exposure Prophylaxis, is for people who do not have HIV and consists of taking a drug to avoid becoming infected. Several studies have proven the effectiveness of Prep in continuous and on-demand use : Iprex Ole (United States), Partners Prep (Kenya, Uganda), Proud (United Kingdom), ANRS-Ipergay (France, Canada). These studies were conducted mainly with men who have sex with men (MSM), but some also involved transgender people and heterosexual couples. All these tests show that when the drug is taken correctly according to the indicated regimen, the risk of contamination is minimal. On the basis of these good results, the Prep is now recommended by many national and international bodies.
Screening : the different strategies
Testing is used to check for the presence of HIV antibodies in the body. Antibodies are used to defend the body against disease :
- If the test detects the presence of antibodies, it is positive and you have HIV
- If the test does not detect antibodies, it is negative and you do not have HIV
Antibodies do not appear directly and that is why it is necessary to wait a certain time to do the test after taking a risk.
There are several possibilities for a screening test :
Traditional screening test
Blood test
6 weeks after taking the risk
About a week after the test
Rapid result screening test
If the test is positive, it must be confirmed by a traditional screening test (blood test)
Blood or saliva collection
3 months after taking the risk
Blood : a few minutes after sampling
Saliva : 20 minutes after sampling
Self-test
If the test is positive, it must be confirmed by a traditional screening test (blood test)
Oral or blood self-test
3 months after taking the risk
A few minutes (blood) to 20 minutes (oral) after sampling
Benefits of screening
Protecting yourself from HIV
Protecting your loved ones
Ending transmission to babies
Saving lives : people screened can start treatment
Knowing earlier to treat yourself earlier
Stay alive and healthy
The test of the test
If you are not sure if you should get an HIV test, answer the following questions :
- Do you live in an area with high HIV prevalence rate ?
- Have you or your family ever lived in an area with a high HIV prevalence rate ?
- Have you ever paid or been paid for unprotected sex or traded goods or services for unprotected sex ?
- Have you ever been diagnosed or treated for another sexually transmitted infection ?
- Have you ever had tuberculosis ?
- Are you a man who had sex with another man without a condom ?
- Are you a transgender person who had sex without a condom ?
- Have you exchanged injection equipment with other people ?
- Have you had sex without condom with someone who could answer yes to any of the above questions ?
- Have you ever had sex without condom with a person living with HIV whose viral load is undetectable ?
- Are you pregnant or planning to get pregnant ?
If you answer yes to any of the above questions, it would be better to have an HIV test. Knowing your HIV status will give you access to the knowledge you need to continue to make informed choices about your health, as well as access essential treatment if necessary.
If you answer yes to several of the above questions, it is strongly recommended to have an HIV test. If you feel that you may be permanently exposed to HIV risk, it is recommended that you seek HIV prevention services and be tested for HIV every six months.
If you answer no to all of the above questions, your risk of HIV infection should be low ; however, if you are concerned, getting an HIV test is quick and easy and will confirm your HIV status while providing you with the knowledge you need to stay healthy.
Support : the modalities
After a positive screening, the health worker must refer the patient to a structure to enter care. However, the initiation of treatment must remain the patient’s choice.
Since the identification of HIV and the beginning of therapeutic research, many advances have been made in terms of efficacy and intake. HIV drugs belong to different classes and therefore act in different ways. Treatment with at least three molecules (triple therapy) has now become the norm for anyone newly diagnosed. Their combined actions prevent the spread of the virus, overcome possible infections and prevent the development of AIDS. Treatment taken according to strict medical prescriptions can reduce the viral load (amount of virus) sufficiently so that the HIV-positive person is no longer contaminant.
To ensure the success of the therapy, regular testing must be carried out, including viral load measurement. This is very important because it makes it possible to assess whether or not it is necessary to modify the treatment. If therapy is no longer appropriate, the patient may see the replication of the virus resume. Follow-up is therefore as important as treatment !