After Battling AIDS and Cancer, Kwenda Champions Integrated NCDs & HIV Patient Care
Non-Communicable Diseases 27/07/2022 •
Sally Agallo Kwenda

Sally Agallo Kwenda’s first baby only lived for two days. She fell pregnant again almost immediately but her second son was born prematurely and died soon afterwards. Shortly after his death, she learnt that she had AIDS. 

Some years later, after struggling with depression and grief, Kwenda was diagnosed with stage two cervical cancer – something to which people with HIV are far more susceptible, but which is often diagnosed late in Africa and other low-income countries because of the sharp disconnect between diagnosis and treatment of HIV/AIDs, and non-communicable diseases (NCDs) – at primary health care level.

In late May, the World Health Organization approved a roadmap to accelerate the battle against NCDs, which now claim the heaviest mortality in low- and middle-income countries ill-equipped to prevent, diagnose and treat chronic lung and heart conditions, hypertension, diabetes and cancer.  The Roadmap aims to put countries back on track to reach the SDG target 3.4 of reducing premature deaths from NCDs by one-third by 2030 -following severe setbacks created by the COVID pandemic.

But key to that aim, says the NCD Alliance and other advocates, is better integration of NCD prevention and treatment with well-established primary health care services for HIV and other infectious diseases.

“What I went through with cancer I would not wish on my worst enemy,” said Kwenda in a film produced recently by the NCD Alliance (NCDA).

Kwenda has become a vocal advocate for the integration of HIV and NCD treatment and care and was due to address an NCD Alliance event on the issue on Wednesday ahead of the International AIDS Conference in Montreal, which opens on Friday.

But, like many African delegates have reported, she was unable to get a visa to travel to Canada and will advocate for integrated care via online links to the conference.

“I would be very happy that, before I die, I would see the integration of care happen,” says Kwenda, who runs support groups for people living with HIV in Kenya.

After all that she has gone through, Kwenda says that she is not a survivor but a “warrior” for patients’ rights.

Africa’s emerging NCD problem  

NCDs now cause 15 million premature deaths of people between the ages of 30 and 70 each year, 85% of them in low- and middle-income countries.

“In most of sub-Saharan Africa, the biggest causes of death or illness have been due to infectious diseases: malaria, tuberculosis, diarrhoeal diseases in children and HIV,” says Professor Gerald Yonga, a Ugandan cardiologist who represents civil society at the World Health Organization (WHO) Working group on NCDs.

“But NCDs are an emerging problem, increasing a lot over the last 20 years such that now NCDs cause about 30 to 35% of mortality and 50% of hospitalisation and illness.”

Yonga explains that people with HIV have a greater chance of getting an NCD, and that “cervical cancer is as high as six times more likely to occur in people living with HIV”.

Professor Gerald Yonga

HIV is also a risk factor for more serious illness and mortality with COVID-19.

In 2021, United Nations member states adopted a Political Declaration on HIV and AIDS that pledged to ensure that 90% of people living with HIV have access to NCD prevention and care services, including for mental health, by 2025. 

The NCD Alliance says that the global declaration “offers an unprecedented opportunity” to build on multi-sectoral, rights-based and people-centred approaches of the HIV response and to use HIV service delivery platforms to integrate other health services, like “NCD prevention, screening, diagnosis, treatment, care, rehabilitation and palliative care”. 

“There is strong support from in-country stakeholders to pursue greater integration of NCD and HIV services as part of universal health care,” the NCDA adds.

The NCDA and HIV organisations including UNAIDS and StopAIDS have identified 15 proposals to “achieve the best possible health outcomes” for people living with HIV and NCDs globally.

These are based on applying lessons from the struggle for HIV treatment and care  – including context-responsive, human-rights-based programmes – to build integrated universal health care.

The NCDA will use the Montreal conference to build support for these proposals, including calling more more resources to address NCDs.

 

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