We Can End HIV/AIDS by 2030- UNAIDS

The International community can end the AIDS epidemic by 2030 by working together and strengthening health systems, Michel Sidibé, the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS) says.

Sidibe said that more should be done to reach people left behind, including young women and girls, men who have sex with men, prisoners and sex workers. The call is embedded in his message on World aids day, marked annually on December 1st across the globe.

The day is dedicated to raising awareness to the Aids pandemic caused by the spread of the HIV infection.

This year, it is commemorated under the theme; Focus, Partner, Achieve: An AIDS-free generation; to highlight the need to for governments and health officials, NGOs and individuals to address Aids prevention and treatment.

Sidibé added that this day is an opportunity to reflect on the lives lost to Ebola given the outbreak’s similarities to the beginning of the AIDS epidemic. He explained that Ebola sufferers were hiding, scared, and facing widespread stigma and discrimination of the type encountered by the first people to contract AIDS.

He added that ‘now is the time’ to break the AIDS epidemic for good as it could “spring” back and be impossible to end.

Meanwhile, the World health organization-WHO is releasing new guidelines on providing antiretrovirals (ARVs) as an emergency prevention following HIV exposure, and on the use of the antibiotic co-trimoxazole to prevent HIV-related infections.

The new guidelines emphasize simplification and do not differentiate between exposure sources but rather provide recommendations across all exposures. This implies that PEP will be made available for all populations (adults, adolescents and children), for all potential types of exposure (occupational and non-occupational) in all settings for the first time.

Traditionally, separate WHO and national guidelines have been developed for PEP according to exposure type. The new guideline is based on the recognition of the need to improve uptake and completion rates for post-exposure prophylaxis.

A statement by the World Health Organization indicates that in order to improve uptake and completion of PEP, health personnel will be required to provide the full 28-day course at first visit, rather than requiring patients to return multiple times for prescriptions. It is also recommending enhanced counseling in order to improve adherence and completion rates.

Post-exposure prophylaxis (PEP) is short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally or through sexual intercourse.

For many people that are accidentally exposed to HIV, PEP provides a single opportunity to prevent HIV after exposure. Such accidental exposures may be among health care workers who had needle stick injuries or among adults and children who survived sexual violence.

However, Access to timely PEP remains challenging in many settings in particular for non-health worker exposures.

Reported issues include, missed opportunities to provide PEP following sexual exposure in the United Kingdom, lack of PEP protocols and limited compliance to guidance in China, Nigeria and UK, limited access to PEP by female sex workers in Kenya and health workers in Uganda, and structural stigma that reduces PEP uptake among men who have sex with men in the United States of America.

Key facts

• Globally, there were an estimated 35 million people living with HIV, of whom 13 million were on antiretroviral treatment (ART) at the end of 2013.
• People can be accidentally exposed to HIV though healthcare work or due to exposures outside healthcare setting, for example, through unprotected sex or sexual assault.
• Antiretrovirals (ARVs) have been used to prevent infection in case of accidental exposures for many years. This intervention is called post-exposure prophylaxis (PEP) and involves taking a 28-day course of ARVs.
• PEP should be offered, and initiated as early as possible, for all individuals with an exposure that has the potential for HIV transmission, and ideally within 72 hours
• If started soon after exposure, PEP can reduce the risk of HIV infection by over 80%. Adherence to a full 28-day course of ARVs is critical to the effectiveness of the intervention.
• Recent evidence shows PEP uptake has been insufficient: only 57% of the people who initiated PEP have completed the full course and rates were even lower at 40% for victims of sexual assault.

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