An extract from the online campaign to ‘Kick Big Soda out of sport’.

Leading global health organisations have called for Coca-Cola to be removed as a major sponsor of the Olympic Games and an end to sponsorship by “Big Soda” of all other sporting events.

Sixty organisations and over 35,000 people have signed an online petition as part of the “Kick Big Soda Out of Sport “campaign, ahead of the opening of the Olympic Games in Paris on Friday (26 July).

“Sugary drinks harm people and our planet. By accepting billions from Coca-Cola to sponsor the Olympic Games, the International Olympic Committee (IOC) implicitly endorses a world where health and environmental harms are ‘sports-washed’ away, undermining commitments to use sport to create a better world,” according to the petition.

It adds that sugary drinks are a major contributor to rising rates of obesity, Type 2 diabetes and heart disease and that Coca-Cola targets children with its marketing.

The petition also says that Coca Cola is damaging the environment with “plastic pollution, carbon emissions and water depletion”.

“With continued Coca-Cola sponsorship, how does the IOC intend to meet its commitment to WHO to promote a healthy society through sport, to advance Sustainable Development Goal 3 (“Good health and well-being”) and prevent non communicable diseases (NCDs)?” it asks.

It urges the IOC to “prioritize the health and well-being of people and our planet over Big Soda’s corporate interests” by terminating Coca-Cola’s Olympic sponsorship, and committing to not accepting future sponsorship from corporations that harm public health and the environment.

“Serving as a major sponsor of the Olympics allows companies to blanket venues and events with their logos, reaching an audience of over 3 billion watching at home,” said Trish Cotter, global lead of the food policy program at Vital Strategies. 

“Alongside growing opposition to soda’s involvement in sport, athletes themselves are beginning to speak up about which companies should be permitted to sponsor sporting events. For example, at Euro 2020 Cristiano Ronaldo made a strong statement when he pointedly removed two bottles of Coca-Cola that were placed in front of him at a news conference.”

‘Contradicts IOC’s mission’

“The link between sugary beverages and chronic and largely preventable diseases such as diabetes, cancer and heart disease is well established,” said Dr. Barry Popkin, W. R. Kenan Jr. Distinguished Professor of nutrition at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. 

“Allowing Coca-Cola to continue as a key sponsor of the Olympic Games directly contradicts the IOC’s mission and undermines the efforts and achievements of Olympic athletes.

“The most insidious actions of the beverage industry, however, are their marketing strategies, which disproportionately target children and adolescents. These tactics perpetuate unhealthy consumption patterns, setting young people up for lifetimes of poor dietary habits and health risks.”

“This campaign is bringing much-needed attention to the ways sugary drink companies use sport to add to their bottom line,” said Nzama Mbalati, Chief Executive Officer of HEALA, a civil society coalition in South Africa advocating for a more just food system.

“This petition underscores the need for the IOC to prioritise the health of people and the sustainability of our planet over commercial interests,” said Alejandro Calvillo, Director of El Poder del Consumidor, a consumer rights nonprofit in Mexico. 

“By distancing itself from Big Soda, the IOC has an unprecedented opportunity to uphold its reputation as a beacon of integrity, excellence and social responsibility.”

“Kick Big Soda Out of Sport” is the beginning of a movement to remove all sugary beverage sponsorship from sport. The campaign is led by concerned global health organizations and advocates and highlights the harmful effects of sugary drinks on our health and the planet.

Lezzita Mphundi, a health worker in rural Malawi, HPV vaccine demand has rebounded – stockouts are now the problem.

After experiencing the distress of caring for a loved one with advanced cervical cancer, Edna Maloya vowed to take proactive measures to ensure that her family and friends would be protected. 

“I was my cousin’s caregiver. I can’t take chances with cervical cancer,” says Maloya, who lives in Blantyre, Malawi’s second largest city.

She happily supported the Ministry of Health’s (MoH) human papillomavirus (HPV) school vaccination campaign aimed at girls aged nine to 14, consenting to her 13-year-old daughter receiving the HPV vaccine.

But some of the other parents in her daughter’s class had reservations and chose not to have their daughters vaccinated -–even though they could have done so either during the school vaccination campaigns or in community health facilities. 

Maloya is firm in her views: “This is my only child. If we have an opportunity to prevent illnesses, let’s utilise it. I’m certain that those who are hesitating now will someday wish they had let their daughters have this vaccine.” 

Malawi’s HPV vaccination rates – rebounding from Pandemic era turmoil 

HPV vaccination rates plummeted during the COVID pandemic, but now have rebounded sharply.

When Malawi first introduced the HPV vaccination in 2019, the uptake was dramatic with 85% of the first group of eligible girls, nine-year-olds, getting their first dose.  

Then the COVID-19 pandemic hit, followed by Cyclone Freddy, which left more than half a million people displaced – and following that, outbreaks of polio and cholera. 

HPV coverage rates plummeted sharply to just 13% in 2021 and 2022, according to WHO’s immunization dashboard that tracks HPV vaccine uptake around the world.  

Rates are finally rebounding with  a dose of the vaccine reaching 68% of eligible nine-year-old girls in 2023.  And according to the new WHO guideline, approved in 2022, one dose is sufficient to provide lifelong protection. 

The rebounding vaccination rate is good news for Malawi, which has the world’s highest incidence and mortality rates of cervical cancer. The disease is also the leading cause of cancer deaths amongst women in the country, according to the national Cervical Cancer Strategic plan 2022-2026. About 4,000 women are diagnosed every year, while nearly 3,000 women annually die from the disease, according to WHO data. 

In 2023, the WHO African region’s HPV vaccination rate was second highest in the world 

HPV vaccination rates in Africa have rebounded in 2023 and are on an upward swing. 0

Throughout Africa, a positive trend can be observed in the 2023 HPV vaccine data, just released by the World Health Organization (WHO). 

After a slight dip in vaccination rates during the pandemic year of 2021, rates rebounded quickly reaching 40% of eligible girls.  

That places WHO’s Africa region as second only to the Americas, which had a 68% uptake, in vaccine roll-out last year. It slightly exceeds the WHO’s European Region, whose 53 member states extending from the United Kingdom to Central Asia and Russia registered a 39% rate for HPV jabs. 

These three regions remain far ahead of the others including: South-East Asia, with a 16% uptake; the Western Pacific, including China, Japan and Australia (11%); and the Eastern Mediterranean Region, extending from Tunisia to Afghanistan, which had a woeful 1% rate of HPV vaccination in 2023. 

WHO’s Africa Region has the best first-dose coverage of HPV vaccine than any other region in the world – except the Americas.

Simultaneous vaccine campaigns confused parents

Malawi’s Ministry of Health first introduced the HPV vaccine in 2019 through campaign mode focusing on schools. 

In 2021,the vaccine was incorporated into the country’s Extended Programme on Immunisation (EPI) schedule. This meant that girls can now get the vaccine in school during campaign days, which occur quarterly, or in community health facilities. 

However in 2021 and 2022, the COVID-19 pandemic led to school closures. It was followed by Cyclone Freddy, and in its wake, outbreaks of polio and cholera. These led to multiple new vaccine campaigns for older children and adults occurring at overlapping moments, something that confused and put off many parents.

“The parents literally accused us of tricking them into giving COVID-19 vaccine to their girls…. We don’t force them to receive the vaccine if they don’t want,” said Florence Nasava, a senior Disease Control Surveillance Assistant (DCSA) for the Zingwangwa Health Centre in Blantyre. 

Nasava adds that local health workers redoubled their efforts with community volunteers, traditional and religious leaders to help in demystifying the vaccine myths – and explain the difference between the HPV vaccines, COVID jabs and others to parents.

“Since its [HPV’s] introduction, Malawi has grappled with multiple and unforeseen crises such as the COVID-19 pandemic and Cyclone Freddy – which left more than half a million people displaced, and outbreaks of polio and cholera,” noted a spokesperson from Gavi, the Vaccine Alliance, which is providing the vaccines to Malawi and 38 other low-income countries worldwide.    

Stockouts are now the major problem 

A young girl receives a single dose of HPV vaccine at Lisawo primary school in Chiradzulu Malawi in 2020, just before COVID sent vaccine rates plummeting.
Florence Nasava, of Zingwangwa Health Centre vaccinates a young girl against HPV in 2024.

Nasava also perceives that demand has now rebounded, reflecting the new 2023 data. Overall, the local health centre typically sees two to three girls a day for the HPV vaccinations, she says, adding that “many more girls get vaccinated during mass school campaigns, where an average of 300 to 400 girls are vaccinated per day.” 

In rural areas, appreciation for the vaccine is also spreading  – in light of the large cervical cancer burden that exists.  

“This vaccine is a life saver for our girls’ generation. I was motivated to have my two daughters vaccinated against the disease since this is an incurable disease,” Zione Limitedi told Health Policy Watch.  She is a DCSA in Gwilima village in Malawi’s southern region.

“I know of a woman from my village who died of cervical cancer…. It’s difficult to manage in a poverty stricken rural area, so the vaccine is our only hope to protect the future,” adds Limitedi.

Lezzita Mphundi, a DCSA based in Chikwawa, a rural area about an hour’s drive from Blantyre, says parents seem to be most comfortable having their girls receive the vaccine with their classmates during school campaigns rather than going alone to the outreach clinics or at a facility.

“Many parents consented to having their girls vaccinated. I vaccinated over 200 girls before supplies ran out,” she said of a recent campaign day. That reflects a new problem. Now that demand is high, stockouts are a growing problem. 

LMICs have the highest rates of cervical cancer deaths

Dr Atupele Kapito Tembo – Malawi was an early adopter of the HPV vaccine.

The WHO says nearly 94% of the cervical cancer deaths in 2022 occurred in low- and middle-income countries (LMICs), where the burden of cervical cancer is greatest, due to limited access to routine screening tools and treatment services for the disease at early stage. These are almost universally available in developed countries. 

That’s what makes HPV vaccination, which sharply reduces risks of developing cervical cancer from the most common cause, human papillomavirus, all the more important in Malawi and other African countries.

Rwanda was the first African country to implement the HPV vaccination program successfully in 2011, followed by Zambia in 2013, then South Africa in 2014, which even managed to maintain an 80% vaccination rate through the pandemic years.  In November 2023, Togo became the latest country to introduce the HPV vaccine, following Nigeria, in October. 

All in all,  27 African countries have incorporated the HPV vaccine into their routine immunization programmes, with a primary focus on girls aged 9-14.  

Malawi was also an early adopter, launching an HPV vaccination pilot program for adolescent girls in Rumphi, a district of northern Malawi, and Zomba, in the country’s eastern region. That scored an early success, achieving 80% coverage, said  Dr Atupele Kapito-Tembo, epidemiologist and public health specialist at Kamuzu University of Health Sciences (KUHes).  

“This demonstrated the country’s capacity and ability to cover the targeted population,” she observed.

As for the sharp decline seen during the pandemic years, she said, “In my view and experience, Malawi needs more engagement with stakeholders since girls and their caregivers may not be fully aware of their HPV vaccine eligibility and benefits.

“They might have heard about the vaccine or cervical cancer, but made no initiative to get screened or have their daughters vaccinated because they haven’t been exposed to enough information.”

“There’s a need for more sensitisation to restore confidence in vaccines,” she urges.

Cancer also takes time to manifest and therefore it can be difficult to appreciate the impacts of the vaccine right away, Tembo observes.

“If we compare with high income countries, they introduced this vaccine in the 1990s and the impact is seen now. For us it may take a decade or two from 2017/2018 [when vaccination began] to see the impact.”

MOH aims to reach 90% coverage goal 

HPV vaccine

In 2020, the World Health Assembly approved a global strategy to eliminate cervical cancer by 2030, setting out the so-called ‘90-70-90’ targets. Those aim to have 90% of girls worldwide fully vaccinated with HPV vaccine by age 15; 70% of women are screened with a high-performance test by age 35; and 90% of women identified with cervical cancer receiving treatment.  

Last March, governments, donors and other partners pledged some $600 million at the first-ever global forum on cervical cancer in Cartagena de Indias, Colombia – putting those  goals closer than ever within reach.

In Malawi’s Ministry of Health, EPI Programme Manager Dr Mike Chisema says the ministry aims to reach the 90 percent vaccination coverage target by 2030, perceiving it as a key lever in the country’s cervical cancer elimination strategy. 

Additionally, if cervical cancer deaths can be reduced, that can also help reduce HIV-related deaths insofar as there are significant co-morbidities, he points out. 

At the same time, vaccines need to be deployed alongside screening and treatment for women, he notes saying: “we have to control for other factors such as HIV prevalence and [other] risk factors for developing cervical cancer.”

Important to sustain demand despite occasional stockouts

Chisema says that vaccine stock outs observed recently, especially in rural Malawi, are largely due to district internal logistical challenges and not necessarily due to inadequate vaccines at central level.

He said that it remains critical, however, for girls to continue coming forward – so that valuable supplies of the vaccine do not expire. 

In recognition of this, Chisema says that the Ministry of Health has come up with several initiatives including expansion of the age eligibility for the vaccine from 9-14 years old, enabling multi-cohort vaccination and more attention to stockouts in the “last mile”. 

The Ministry is also gearing up for a major multi-age campaign in 2025 or earlier working with both primary and secondary school teachers to identify eligible children. Although the results will be reaped decades later, Malawi sees that as a long-term investment in women’s health. 

“We just need to continuously review our health system and strengthen it accordingly, evaluating what works for us or not,” Chisema says.

Image Credits: Nadia Marini/MSF , Josephine Chinele , WHO, Josephine Chinele.

António Guterres delivering a video message during the launch of the State of Food Security and Nutrition report Wednesday.

Global levels of hunger remain stagnant at the highest rates seen in over a decade, as one in 11 people worldwide (8.9%) faced hunger, or undernourishment, in 2023, according to the latest State of Food Security and Nutrition (SOFI) report, released on Wednesday.

The report, a collaboration between the Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD), UNICEF, the World Food Programme (WFP) and the World Health Organization, summarizes the lackluster progress made toward the second Sustainable Development Goal (SDG2): “No Hunger.”

In 2023, nearly one-third (28.9%) of the global population was food insecure, lacking regular access to adequate food. A third of the world’s people ran out of food at certain times during the year, and went an entire day or more without eating, the report found.

That’s in comparison to 21.5% of people facing moderate or severe food insecurity in 2015, when the Sustainable Development Goals were first adopted.  

That growing number is a combined result of climate change, regional conflicts, economic downturns, and other destabilizing factors, found in many low- and middle-income countries. Amongst the countries with high levels of food insecurity,  74% were affected by one or more such drivers.

Regional rates of food insecurity have increased since 2020 in Africa, remained largely unchanged in Asia, and declined in Latin America – but not to 2015 levels.

“Hunger, food insecurity and malnutrition remain a global crisis,” said Antonio Guterres, United Nations’ Secretary-General, during the report launch at the G20 meeting in Brazil on Wednesday. But “we can solve this crisis and finance is the key.”

Progress made towards eradicating hunger, made in the years of the Millennium Development Goals, slumped in 2015 – paradoxically that was the same year that the 2030 Sustainable Development Goals, including SDG2, No Hunger, was adopted. Hunger rates climbed even higher during the COVID pandemic, remaining stagnant ever since. 

Overall, estimated 713-757 million people are hungry or “undernourished” – defined as habitually consuming insufficient food to provide energy levels needed for a normal active and healthy life, according to the SOFI report. 

And in Africa, the number of people who are chronically undernourished rose in 2023 to 20.4% of the continent’s population. In Asia, levels of hunger remained unchanged (8%), while hunger levels in Latin America and the Caribbean declined somewhat to (6%).

Most countries off track in reaching SDG nutrition goals as well

Few countries are on track to meet global nutrition targets: maximising exclusive breastfeeding and minimising low birthweight, stunting and wasting, anemia, and overweight.

In terms of seven nutrition goals that are also asociated with the SDG2, there has been some moderate progress on infants and children – even though most countries remain off track with respect to the goals overall.

Rates of stunting and wasting (one indicator of progress for SDG 2.2) – which means children failing to reach their height or muscle volume – declined among children younger than five years old over the last decade.

Similarly, progress has been made in exclusive breastfeeding of infants under six months of age: a practice long-recommended by the WHO because of its beneficial effects for mother and child health. 

In 2022, 48% of infants under the age of six months were exclusively breast fed only, as compared to 37.1% in 2012. 

Among children younger than five years of age, stunting and wasting rates have declined. The number of infants breastfed during their first six months increased.

The improved numbers are “showing that investments in maternal and child nutrition pay off,” stated Catherine Russell, the Executive Director of UNICEF, noting that the economic benefits of breastfeeding support programmes are just as large as health-related ones, with $35 return of every dollar invested.

Healthy diet unaffordable for a third of the world’s population

For children as well as adults, an adequate caloric intake still does not equal good nutrition. More than a third of the world’s population, 2.8 billion people, could not afford a healthy diet in 2022, falling back to pre-pandemic levels. In low-income countries, the rate of “malnutrition” was as high as 71.5%. 

Rising rates of obesity, often coexisting with under-nourishment, constitute a double burden for national health systems. “This is a […] cost for the society because overweight and obesity will create non-communicable diseases that will affect our finances: we will spend significantly more on health,” said Maximo Torero, FAO’s Chief Economist, at the report’s launch Wednesday.

Healthy, nutritious food is often unavailable locally or may be unaffordable because of income inequalities. Should nothing change, 582 million people are projected to be chronically undernourished at the end of the decade, the SOFI report warns.

“We’re standing still,” said FAO’s Director-General, Qu Dongyu, during the report launch. A “real change of agrifood systems is the only way to address the major drivers of food insecurity.” Climate change, conflicts and other factors make agriculture more unpredictable, highlighting the need to build more resilient farming systems. “I appeal to donors and other international partners to be more risk-tolerant,” Dongyu continued. “We need to be ready for the unforeseen.”

Shift in the financing of agrifood systems needed to end hunger ‘in our lifetime’                                                        

The global prevalence of hunger, declining until 2014, has stalled, then increased again during the pandemic.

Between 2005 and 2014, steady progress was made in reducing hunger – from 12.2% to 7.3% of the global population. Then, from 2015 to 2019, hunger levels fluctuated only slightly between 7.7% and 7.5% of the global population – rising sharply at the start of the pandemic and still remaining higher than any time since 2008. 

Yet, agencies involved in making the report remain optimistic about reaching the SDG goals. 

“The elimination of hunger and malnutrition is not just a vague ambition,” but rather “something that can be achieved absolutely in our lifetime,” said Francesco Branca, WHO Director Nutrition and Food Safety Department, during a press conference Monday.

What’s needed to eliminate hunger is “a shift in the way we are financing Food Security and Nutrition,” said Sara Savastano, Director of IFAD’s Research and Impact Assessment Division. More long-term projects which look at food security more holistically, beyond sector boundaries are necessary to address the core drivers of the crisis instead of simply applying bandaids to crises, she said.

Consensus on such shared financial goals is needed so as to better use existing funds, SOFI’s authors emphasized at an earlier, pre-launch briefing on 18 July, on the sidelines of the UN Economic and Social Council (ECOSOC) High-Level Political Forum in New York City.

New UN Report Calls for Fresh Approach to Ending Food Insecurity and Hunger

Expand scope of food security investments 

To quantify and evaluate the programmes aimed at enhancing food security, the SOFI report says that aid and investments in food security needs to move beyond consumer-based food supports, to agri-food systems. 

Financial resources need to be “directed towards strengthening the resilience of agrifood systems to the major drivers and underlying structural factors of hunger, food insecurity and malnutrition,” the report states.

And for that to happen, a more coherent definition of a food security investments, as well as an overarching strategy, needs to be articulated for reaching the “no hunger” goal.

“Right now it’s impossible to determine how much financing is going to end hunger and malnutrition,” said Saskia Depee, Senior Nutrition Advisor at the WFP during a press briefing Monday, just just before the report’s release. 

But policies and interventions needed to end hunger and malnutrition could amount to several trillion US dollars over many years, experts agree.

“Nutrition and food security, and especially nutrition, are long term behavioral changes… requiring time and investment,” Sevastano said. 

Supporting small holder farmers 

Alvaro Lario, President of IFAD, during the SOFI report launch.

Much more funding needs to be invested in strengthening agrifood systems, which are ultimately responsible for food production, the report’s authors agree.

“The world of agrifood systems … is where most hunger is, [it is also] …a world that will be facing uncertainties because of climate change,” highlighted Torero. Donors also need to accept uncertainty in food security investments, counting on the significant benefits in case of success.

As part of investing in more sustainable agricultural systems, support for food producers that are pushed to the sides by agri-business investors should be a priority.  

Funds for women in agriculture, grants for Indigenous Peoples, or smallholder farmers could increase their crops and boost their financial independence. 

”Small farms under five hectares produce almost half of our food on less than one fifth of the farmland,” said Alvaro Lario, President of IFAD during the ECOSOC meeting. “Imagine what they could achieve if we invested in them much more.”

Image Credits: SOFI 2024.

Professor Linda-Gail Bekker from South Africa presents the results of the PURPOSE 1 trial at the conference.

MUNICH – Delegates at the International AIDS conference leapt to their feet in delight after results from one of the most promising HIV prevention trial in the history of the epidemic – a twice-yearly injection of lenacapavir that prevented 100% of new HIV infections – were presented on Wednesday.

Principal investigator Professor Linda-Gail Bekker from South Africa told the conference that none of the 2,134 women aged 16 to 25 who had received lenacapavir on the PURPOSE 1 trial contracted HIV.

The results, also published in the New England Journal of Medicine, compared the injectable lenacapavir with two regimens involving daily pills that have previously proven to be effective as HIV pre-exposure prophylaxis (PrEP).


However, by the end of the trial, the 3,204 women in the two pill groups reported HIV cases similar to projected population-based HIV acquisition – not because the pills didn’t work but because participants’ adherence was “low”.

Young people generally find it difficult to take daily pills because they fear being questioned about it, according to another trial from Uganda due to be presented at the conference.

Describing the results as “stellar”, Bekker said that the medicine offers “a highly effective, tolerable and discreet choice that could potentially improve PrEP uptake and persistence, helping us to reduce HIV in cisgender women globally”.

“PURPOSE 1 also sets a new standard for person-centered HIV prevention trials, demonstrating what can happen when a thoughtful scientific and community-focused trial design, a promising drug candidate and an inclusive trial implementation plan come together,” added Bekker, who is director of the Desmond Tutu HIV Center at the University of Cape Town. 

Results from the PURPOSE 2 trial testing lenacapavir in men, transgender and non-binary people who have sex with men in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the US is expected by early 2025. 

International AIDS Society president Sharon Lewin described the trial results as “a breakthrough advance with huge public health potential”.

“If approved and delivered – rapidly, affordably, and equitably – to those who need or want it, this long-acting tool could help accelerate global progress in HIV prevention. We all owe a debt of gratitude to the thousands of young women in South Africa and Uganda who volunteered to be part of this study,” said Lewin.

Gilead under pressure to lower price

Activists at AIDS2024 protest against the high price of lenacapavir

HIV leaders, activists and researchers have called on lenacapavir producer Gilead to make its medicine widely accessible.

“We still have 1.3 million new HIV infections per year. UNAIDS wants this ‘miracle’ prevention drug to reach all those who need it, now, not in six years’ time,” said UNAIDS executive director Winnie Byanyima at a media briefing on Wednesday.

She urged Gilead to “move quickly to licence lenacapavir to generic producers” via the Medicines Patent Pool.

“Generic producers bring prices down and serve all countries where the majority of people who are at risk live,” added Byanyima.

On Tuesday, activists protested at Gilead’s conference booth demanding that the company make the medicine 100% accessible.

At present, lenacapavir is licensed in the US as Sunlenca for people with drug-resistant HIV and sells for $42,000 a year – yet generic companies can make it for as little as $40, according to research conducted by Dr Andrew Hill. 

Doctors, researchers and activists all want easy access for those who need lenacapavir for HIV prevention – and that means lower prices.

AIDS Healthcare Foundation (AHF), which supports two million patients in 47 countries, said that Gilead’s failure to make its HIV medicines accessible is “costing lives”.

AHF associate advocacy director John Farina described Gilead’s pricing as “arbitrary”, aimed at profiteering rather than protecting lives.

“What is the point of 100% efficacy if nobody can access it?” asked AHF India director Dr Sam Prasad at a media briefing on Tuesday.

“The US has the high price of $42,000 for the package [of two shots]. How many people can afford it?” added Prasad, who warned Gilead not to “come to India with lawyers and try to influence our patent laws”.

Dr Helen Bygrave of Medecins sans Frontieres (MSF) Access Campaign said that lenacapavir could be “life-changing for people at risk of getting HIV and could reverse the epidemic if it is made affordable in the countries with the highest rate of new infections”.

“Gilead has a long track record of undermining global access by excluding middle-income countries from voluntary licensing deals and artificially restricting licensees,” said Health GAP’s Asia Russell. “We call on governments to break Gilead’s monopoly, by issuing non-voluntary licenses, wherever Gilead’s patents present a barrier.” 

HIV community organizations in India, Argentina, Thailand and Vietnam – the Thai Network of People living with HIV (TNP+), DNP+, Fundación Grupo Efecto Positivo, and the Vietnam Network of People living with HIV (VNP+) – have already filed eight oppositions against Gilead’s lenacapavir patent applications.

Gilead promises ‘access price’

UNAIDS executive director Winnie Byanyima (2nd right) and Gilead Vice President Jared Baeten (2nd right) address a media briefing.

Addressing a media briefing on Wednesday, Gilead Vice President Jared Baeten said that lenacapavir will be available for generic production and promised that in the interim, his company would make high-volume orders for an “access price”.

The company noted in a press release on Wednesday that “lenacapavir for HIV prevention remains an investigational drug until approved by regulatory authorities”, and it is “too early to state the price of lenacapavir for HIV prevention”.  It is currently only licensed in the US for drug-resistant HIV.

“Gilead is committed to access pricing for high-incidence, resource-limited countries. The current price for the approved indication in the heavily treated HIV population will not be our reference,” it added.

“Gilead will ensure dedicated supply of lenacapavir for HIV prevention in the countries where the need is greatest until voluntary licensing partners are able to supply high-quality, low-cost versions of lenacapavir,” the company noted, adding that it is “developing a robust direct voluntary licensing program to expedite access to those versions of lenacapavir in high-incidence, resource-limited countries”. 

However, Baeten did not comment on whether his company would work through the Medicines Patent Pool to licence generics.

Image Credits: IAS.

Almost half of the world’s population suffers from a neurological condition, yet in low-income countries, most lack access to medicines needed for treatment.

Nearly half of the world’s population suffers from some form of neurological condition ranging from simple migraines to Alzheimers. And yet in low-income countries, more than 75% of people needing neurological treatment cannot access care, according to a new World Health Organization report released on Tuesday, World Brain Day.  

The treatment gap – the difference between the number of people with a condition and those receiving treatment for it – is the combined result of misconceptions about neurological diseases, low diagnostic capacity and limited access to medicines.

“Most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive,” said Dévora Kestel, Director of WHO’s Department of Mental Health, Brain Health and Substance Use in a press statement. 

Should that change, “the impact of neurological disorders can be significantly decreased and quality of life improved.”

Using epilepsy and Parkinson’s disease as tracer conditions, the new WHO report identifies bottlenecks in existing treatments, particularly access to care in remote and rural areas.  

Affordability, procurement and availability of specialists are among the main barriers of access to neurological treatment.

The report also advocates for more education about neurological disorders to reduce stigma. And it recommends that neurological treatments  be integrated more completely into the essential medicines lists (EMLs) of national authorities as well as WHO’s own recommended essential medicines listing.

Finally, local healthcare systems need to budget for procurement of such medications – while international donors and agencies consider how to make treatments more affordable – including through donor-supported funding. 

Treatment access, but also prevention programmes, “will take a whole of society approach, especially given that the whole of society is impacted either directly or indirectly by these diseases,” said Dr David Dodick, co-chair of World Brain Day, at a briefing Monday, just ahead of the WHO report launch.

Nearly half of the world’s population suffers from a neurological condition 

In 2021, almost half of the world’s population, or 3.4 billion individuals suffered from a neurological condition, including side effects from a stroke, Alzheimer’s disease, neonatal brain injury, or chronic migraines, according to the Institute for Health Metrics and Evaluation (IHME) data. 

But the burden is distributed unevenly, with over 80% of the deaths related to neurological conditions, as well as losses in healthy life years, occurring in low- and middle-income countries.

Burden of neurological disorders amount for a total of 443 million years of healthy life years lost globally.

Neurological conditions are a leading cause of healthy life years lost (disability-adjusted life years, or DALYs) in 2021, ahead of cardiovascular diseases. In 2021, that amounted to a total of 443 million healthy life years lost due to a  chronic  illness, disability, or premature death.

Over the last three decades, DALYs associated with neurological conditions rose by 18% – and that is likely to increase further as a result of aging populations as well as lifestyle and environmental risks.

Over 80% of premature deaths from neurological conditions occurs in low- and middle-income countries – which have only 0.1 neurologist, on average, per 100,000 people. 

That is in comparison to 7.1 neurologists per 100,000 people in high-income countries, said Dodick.

On a more positive note, when diagnosis and treatment are available, then some 90% of strokes, 40% of dementia cases, and 30% of epilepsies are preventable. 

“We know what the modifiable risk factors are for some of the most prevalent and disabling neurological conditions, like stroke and Alzheimer’s disease, for example,” Dodick said.

Barriers to reaching global goals set out by WHA in 2022

The report identifies barriers limiting attainment of goals set by the World Health Assembly in 2022 to improve access to neurological care and treatment by 2031. 

The goals, laid out in the Intersectional global plan on epilepsy (IGAP), aim to have four out of five countries providing essential medicines and technologies to manage neurological disorders in primary health care settings within the coming decade. 

Disability-adjusted life years (DALYs) lost to neurological conditions: 80% of the global DALYs occur in low- and middle-income countries.

Even when treatment methods for neurological conditions are theoretically available, patients face many obstacles to accessing care. 

In African and Eastern Mediterranean regions, for instance, children with epilepsy are less likely to attend school because of the stigma surrounding the disorder. As the report shows, lack of knowledge about Parkinson’s and epilepsy, and exclusionary practices around people with those conditions, are common issues.

More regional manufacturing of medicines can bolster supply chains

The paucity of medicines available in pharmacies and clinics also was highlighted by country-level surveys included in the WHO report. 

In Ghana, for instance, out of 180 drug stores surveyed, levitiracetam, which is used to treat epilepsy, was available in only 50% of urban pharmacies and not at all in rural areas. Similarly, another epilepsy medicine, phenobarbital, was only available in roughly every second urban drug stores and in one in three rural pharmacies.

The report highlights the need for regional manufacturing of such medicines as well as more robust supply chains, overall, to ensure that such essential drugs are accessible. 

Consistent regulatory authorization of essential neurological medicines and ensuring their inclusion in national essential medicines lists, could also lead to more state financing support, improving treatment affordability.

Finally, the report also identifies the need for more specialised healthcare staff, particularly in rural areas, as well as more systematic data collection to improve surveillance. 

Neurological health access should be “inclusive and equitable”, also on the prevention level, said Prof. Tissa Wijeratne, Co-Chair, World Brain Day, during the webinar. “Access to preventative measures at community level, grassroot level, individual level, […] should be available to everybody across the world.”

Image Credits: WHO, IHME.

Bavarian troupe of gay traditional folk dancers provide entertainment at the opening of the International AIDS Conference.

MUNICH – German Chancellor Olaf Scholz reaffirmed his government’s commitment to the global campaign against AIDS, including the Global Fund, at the opening of the international AIDS Conference – and appealed to other global powers to do the same.

The Ukraine war is draining Germany’s resources, and on the far right, the substantial and growing influence of the anti-immigrant, anti-global Alternative for Germany (AfD) party is also influencing German spending and policies.

The budget of the government’s development ministry (BMZ), largely responsible for overseas development aid, was cut by 7% earlier this year sparking fears that Germany may retreat from its leading role in global health.

“As one of the largest donors, Germany contributes €1.3 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” Scholz told the packed conference, which is being attended by over 10,000 delegates.

“And we will continue to support it because programmes sponsored by the Global Fund have saved 59 million lives,” he added to applause.

“We also support UNAIDS and the World Health Organization and will continue to be a reliable partner. Together with France and Norway, Germany supports the WHO Replenishment Round as a co-host for the European Union. Because the WHO needs more support. It is the chain that holds different threads of global health together.

“I would like to call on other donors for stronger support,” Scholz added. 

German Chancellor Olaf Scholz speaking at the Opening Session.

PEPFAR jitters

As Russia’s war on Ukraine drains European resources, the possibility of a victory by Donald Trump in the US presidential campaign is triggering fears that a drastic reduction in the US President’s Emergency Plan for AIDS Relief (PEPFAR) could then follow. Through PEPFAR, the US has been the world’s largest single historical sponsor of antiretroviral medication in Africa, and other game-changing innovations in HIV/AIDS prevention and treatment since 2003.  

However, Chris Collins, CEO of Friends of the Global Fight, said at a pre-conference media briefing that “bipartisan commitment to the program remains solid in the United States.”  That, despite the fact that what he described as “misinformation” held up the five-year reauthorization of PEPFAR by the US Congress in 2024 – with Congress ultimately agreeing only to a one year authorisation, until 2025. 

Addressing the same briefing, PEPFAR’s head, Ambassador John Nkengasong, warned that “now is not the time to sit back; we must sustain the gains we have all worked so hard to make against this pandemic and accelerate our efforts to end it.”

Sharon Lewin, IAS President and International Chair, opening the session.

International AIDS Society president and chair of the conference Sharon Lewin warned against “regressive policies, attacks on human rights, the spread of misinformation, cuts to global health funding, and waning trust in international institutions”.

 “We’ve seen incredible breakthroughs at AIDS 2024, including a new case of long-term HIV remission and a promising twice-yearly injection [lenacapavir] to prevent HIV,” added Lewin.

“To end HIV as a threat to public health and individual well-being, we need an evidence-based HIV response and a political climate that respects science.”

Debt relief call

UNAIDS executive director Winnie Byanyima.

UNAIDS Executive Director Winnie Byanyima called for debt relief for low-income countries that are unable to meet their citizens’ needs – including HIV prevention and treatment – and service their debt.

“In Angola, Kenya, Malawi, Rwanda, Uganda and Zambia, debt servicing is more than 60% of all the government revenue that is collected. Sierra Leone spends 15 times more on public debt servicing than on the health of its people,” said Byanyima.

“The choking debate must be restructured and restricted now.”

Appeal to Gilead to allow generic production of ‘miracle drug’ lenacapavir

She also called on Gilead, the manufacturer of the “miracle drug” lenacapavir – the twice-yearly injection that protected 100% of women from HIV infection in a recent trial – to “make history” by licensing generic manufacturers to produce it more affordably through mechanisms such as the Medicines Patent Pool (MPP).

“Gilead has an opportunity to take us closer to ending AIDS as a public health threat,” Byanyima told AFP in an interview at UNAIDS’ headquarters in Geneva.

“Those people hiding from the law — gay men, trans women — who could come out just twice a year to get their injection and be safe,” she said. So could young women in Africa, fearing stigma and domestic violence.

Lenacapavir was approved for use in 2022 for HIV patients in the United States and the European Union. But its cost of around $40,000 a year in the US currently puts it out of reach for most low- and middle-income countries.

Ukrainian leader urges action 

Ukraine’s Andrew Klepikov received a standing ovation at the opening session.

The AIDS 2024 conference includes a special focus on eastern Europe and central Asia, a region with one of the fastest-growing HIV epidemics in the world. 

“While most other regions around the globe have managed to stabilise their HIV epidemics, in eastern Europe and central Asia, it is rapidly increasing,” Andriy Klepikov, AIDS 2024 Regional Co-Chair, told delegates to the event.

“Only half of people living in our region are on antiretroviral therapy, nowhere near the global target of 95%. At the root of the region’s epidemic are drug use, stigma and harmful policies – exacerbated by violent conflict.”

Klepikov asked delegates to imagine the sound of air raid sirens, which he described as the background soundtrack of daily life in Ukraine.

“I would like to sound a siren today about the [HIV and AIDS] danger in eastern Europe and central Asia,” he added.

“Progress will require major change and innovation, removing policy barriers and respecting the rights of the communities most affected by HIV.”

Impact of Uganda’s anti-LGBTQ law

Trans man Jay Mulucha, head of Fem Alliance Uganda, speaking to delegates at the 2024 International AIDS conference.

Trans man Jay Mulucha, head of Fem Alliance Uganda, gave a moving address about the impact of Uganda’s 2023 Anti-Homosexuality Act, which introduces harsh penalties for a range of same-sex activities.

He said that being HIV positive and trans meant that “we are always discriminated against when we go for treatment” and face “corrective rape”.

His organisation’s Uganda office had been closed down, as has the homeless shelter it provided for trans people, “meaning that we are unable to supply HIV and social services for our community.”

Mulucha said his life is constantly in danger and Uganda’s LGBTQ community remains “isolated and vulnerable” – despite recent international pressure on the government of Yoweri Kaguta Museveni, who has now been in power since 1986.

“The sanctions and penalties being placed by the international community on the Ugandan government are working, but the lifting of these sanctions needs to be contingent not on changes in policy, but on evidence of changes in implementation,” said Mulucha. 

“You need to listen to the communities and hear what we are saying. We are still suffering and need your support more than ever. So the funding that is being denied to the government should be funnelled directly into LGBTIQ organizations and communities in Uganda.”

Image Credits: Steve Forrest / IAS, Steve Forrest / IAS, teve Forrest / IAS.

WHO’s Dr Prebo Barango at the NCD Alliance event at AIDS 2024

MUNICH – Despite a global commitment to cut deaths from non-communicable diseases (NCDs) by a third by 2030, virtually all countries are off-track  – and the NCD Alliance is appealing to allied organizations to help pressure governments to take action.

“NCDs cause three out of four deaths globally, and 80% of premature mortality from NCDs – deaths before the age of 70 – take place in low- and middle-income countries,” the World Health Organization’s (WHO) Dr Prebo Barango told an NCD Alliance satellite event shortly before the opening of the international AIDS conference in Munich.

“We also know that HIV mortality is worse in low and middle-income countries and that so there is a colliding epidemic of HIV and NCD,” added Barango.

Aside from the global goal to cut NCD deaths, which is one of the Social Development Goals (SDGs), global leaders made another commitment, NCD Alliance CEO Katie Dain said the meeting.

HIV High-Level Meeting

They committed at the 2021 United Nations High-Level Meeting on HIV and AIDS to ensure that “90% of people living with, and affected by, HIV have access to people-centred and context-specific, integrated services for HIV and other diseases, including NCDs and mental health by 2025,” said Dain.

“This, in many ways, is one of the real frontiers of the global HIV response, recognising that people living with HIV are living longer thanks to advancements in antiretroviral antiretroviral therapy,” she added.

But slow progress to achieve this 90% goal has prompted the NCD Alliance to issue a call for action to world leaders – and they have appealed to HIV organisations to sign the open letter.

The letter calls on all governments to “fulfil their commitments to tackle the NCD burden” by the time they attend the UN High-level Meeting on NCDs in September next year. They are calling for three key actions:  mobilising more investment, accelerating the implementation of policies to reduce NCDs and monitoring the progress made.

“NCDs such as diabetes, cancer, cardiovascular diseases, chronic respiratory conditions, neurological conditions, and mental ill health, are the leading cause of death and disability worldwide,” the letter notes.

“We urge governments to fulfil their responsibility to protect current and future generations from the risk factors that cause NCDs and provide healthcare for those who need it.”

Image Credits: Marcus Rose/ IAS.

UNAIDS executive director Winnie Byanyima and IAS chair Sharon Lewin at the launch of the UNAIDS report in Munich.

MUNICH – While new HIV infections in 2023 plummeted globally to the level that they were in the late 1980s, they have surged by 20% in Eastern Europe and Central Asia since 2010, according to UNAIDS.

There were 140,000 new HIV infections across Eastern Europe and Central Asia in 2023, with 93% of new cases occurring in Russia, Ukraine, Uzbekistan, and Kazakhstan, according to the UNAIDS global report released on Monday ahead of the International AIDS Conference in Munich, Germany.

Since 2010, there has been a 20% rise in new HIV infections and a 34% increase in AIDS-related in Eastern Europe and Central Asia – while over the same period, 59% fewer people acquired HIV in sub-Saharan Africa – traditionally the worst affected region in the world.

Restrictive legal environments obstructing progress

“Restrictive legal environments and stigma are obstructing progress in the region,” said Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia.

“Restrictive laws, along with aggressive policing and stigma, push people away from medical care. If people are pushed underground, the HIV response will not succeed.”

Only half of the 2.1 million people living with HIV in Eastern Europe and Central Asia are on treatment, and only 42% of those living with HIV have suppressed viral load – the lowest rate globally. People with suppressed viral loads don’t pass the virus on to others.

Almost all new infections (94%) are in what AIDS researchers term “key populations” – men who have sex with men, people who inject drugs, and sex workers – and their sexual partners. Yet only 12% of resources are dedicated to prevention programmes for key populations.

All 16 countries in the region criminalise sex work, 13 criminalise the non-disclosure, exposure, or transmission of HIV, and seven criminalise small amounts of drug possession for personal use.

Only 43% of gay men, 52% of people who inject drugs, and 58% of sex workers get HIV prevention services. 

“The criminalisation of small amounts of drug possession for personal use, of sex work, and of HIV transmission and exposure, are driving the people most in need underground and out of reach of HIV services,” according to UNAIDS.

Nearly half the people surveyed who inject drugs in Kyrgyzstan and 32% of people living with HIV in Tajikistan reported avoiding medical care due to stigma and discrimination. 

“Supporting the leadership of communities is essential for reaching marginalised people and providing vital outreach services. Without community leadership and the integration of community services into the health system, reaching these groups is too difficult,” said Elena Rastokina, lead of the ‘Answer-Kazakhstan’ Association, which represents women with HIV.

HIV activists Ganna Dorbach and Elena Rostokina

“The shrinking of civic space and attacks on human rights threaten our response to HIV, which is based on community-led or civil society-provided services. Addressing these interconnected issues is essential for a sustainable response to the AIDS epidemic in our region,” said Ganna Dovbach, executive director of the Eurasian Harm Reduction Association.

Several governments in the region are trying to eliminate the space for civil society which would make it almost impossible to reach key populations, Dovbach told a media briefing in Munich on Monday.

Georgia, for example, is in the process of making all civil society organisations that get more than 20% of their funds form abroad to register as “foreign agents”.

‘Without respecting human rights, we cannot defeat AIDS’

Andriy Klepikov, AIDS 2024 Regional Co-Chair.

Speaking at a press briefing Monday at the opening of the 2024 conference, Andriy Klepikov, AIDS 2024 Regional Co-Chair, charged that Russia’s influence in the region is having ripple effects on stigmatization of LGBTQI populations and people who inject drugs – leaving them further than ever outside the circle of treatment.

“Eastern Europe and Central Asia have the least number, percentage, of people on treatment. Only 50%. This is a very worrisome signal,” he observed.

He called on other European governments and civil society groups to amplify calls to defend the rights of marginalized communities.   

“We have the Russian war against Ukraine. But actually what we have observed is a kind of hybrid war ….against evidence based science. We see that ideology stereotypes prevails over evidence based interventions,” he asserted.

“How many people are on opioid substitution therapy in Russia where 1 million people use drugs how many ? No one, not a single one. A WHO-recommended evidence based intervention is prohibited. How many people have access to clean needles and syringes? … Almost no one.”

“But why am I calling this a hybrid war? Look at what is happening in Central Asia where Uzbekistan, more recently Kyrgyzstan, and more recently in Georgia, where LGTBQI  populations are getting brutalized and criminalized. 

“In Russia, they say there are no transgenders. How you can treat people which not exist? 

“It’s very important to apply innnovations.. but without respecting human rights, we cannot defeat AIDS.”

 

However, Armenia is moving in a more positive direction, said the country’s health minister, Anahit Avanesyan.

“For us, an important change of pathway for the patients is to make more services affordable in primary health care. This means self testing. It means making ARV treatment affordable in the regions, not only in the capital,” said Avanesyan.

Armenian Health Minister Anahit Avanesyan and Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia.

However, Russia’s war on Ukraine has strained her country’s resources as it deals with an influx of refugees equal to around 3% of the country’s population.

Dr Hans Kluge, World Health Organization (WHO) regional director for Europe, called for the normalisation of testing for HIV and sexually transmitted infections to address the problem.

“I’m very, very concerned about the situation in my region, particularly in the sub-region, which we call Eastern Europe and Central Asia, where we saw an increase in new HIV infections,”  Kluge told Health Policy Watch. WHO Europe covers 50 countries including the EU, Russia and the Balkans.

“This is a big paradox because we have everything. We have a preventive treatment which works. We have rapid diagnostic tools. We have an effective treatment, one pill a day. The issue is not so much medical, but societal in the sense that stigma and discrimination.”

He called for a massive scale up of HIV testing and the “decriminalisation of a number of policies” 

New HIV infections have increased by a staggering 116% in the Middle East and North Africa, albeit off a very low base, and by 9% Latin America since 2010. However, both regions have reduced AIDS deaths during that time.

Many of the AIDS deaths in Eastern Europe are being fuelled by a high prevalence of multidrug-resistant (MDR) TB. 

A study of TB/HIV coinfection using data from clinics in Belarus, Georgia, Latvia, Poland, Romania and Russia found that 19% of people newly diagnosed with TB had MDR TB and there was a 14% rate of TB recurrence. Over half the people with recurrent TB died.

Funding gap

A widening funding gap is holding back the HIV response. Approximately $19.8 billion was available in 2023 for HIV programmes in low- and middle-income countries (LMICs), almost  $9.5 billion short of the amount needed in 2025. 

Total resources available for HIV, adjusted for inflation, are at their lowest level in over a decade. The regions with the biggest funding gaps – eastern Europe and central Asia and the Middle East and North Africa – are making the least headway against their HIV epidemics.

“Countries in sub-Saharan Africa rely heavily on external funding for their HIV prevention programmes, whereas in eastern Europe and central Asia and Latin America, most of the funds spent on those programmes come from domestic coffers,” according to the report.

“World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” said UNAIDS Executive Director, Winnie Byanyima.

“Leaders can save millions of lives, prevent millions of new HIV infections, and ensure that everyone living with HIV can live healthy, full lives.”

UNAIDS estimates the funding gap for Eastern Europe and Central Asia  to be 54%, 85% for the Middle East and North Africa; 65% in Asia and the Pacific and 16% in western and central Africa.

Around 59% of funding for HIV comes from countries’ own domestic budgets, but both international and domestic HIV funding are under stress, the report notes.

“Adjusted for inflation, domestic HIV funding declined in 2023 for the fourth year in a row, and international resources were almost 20% lower than at their peak in 2013. Financing support from bilateral donors has dwindled dramatically.”

Germany’s Dr Sabine Dittmer and Dr Nittaya Phanuphak, Executive Director of the Institute of HIV Research and Innovation in Thailand.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and the US government development assistance for HIV are the key bulwarks against further regressions. However, many countries in Europe and Central Asia do not qualify for Global Fund or Gavi assistance because of their middle-income status.

Money is Europe is tight because of Russia’s war against Ukraine. German State Secretary to the Federal Minister of Health Dr Sabine Dittmar said that her country was committed to funding UNAIDS at the same level and that her health budget had not been cut, although the budget for the development ministry had been cut.

Progress in sub-Saharan Africa

Despite the setback in Eastern Europe and Central Asia, worldwide almost 31 million people were receiving lifesaving antiretroviral therapy (ART) in 2023.

The 39% decline in new HIV infections globally is due “primarily to progress achieved in sub-Saharan Africa”, according to the report. 

Between 2010 and 2023, there was a 59% reduction in new infections per annum in eastern and southern Africa and a 46% reduction in western and central Africa.

In sub-Saharan Africa, life expectancy has jumped from 56.3 years in 2010 to 61.1 years in 2023.

“For the first time in the history of the HIV pandemic, more new infections are occurring outside sub-Saharan Africa than in sub-Saharan Africa,” the report notes.

South Africa runs one of the biggest treatment campaigns in the world. Almost one-fifth (19%) of all people on ART worldwide are in South Africa. In 2023, the country’s HIV programme was providing treatment to 5.9 million people, about 77% of all people living with HIV in the country. 

Over 90% of the people receiving treatment in South Africa in 2023 had a suppressed viral load. 

“This massive treatment programme has led to a rebound in average all-person life expectancy, from 53.6 years in 2004, when the treatment rollout began, to 65.9 years in 2023,”notes UNAIDS.

However, HIV incidence in girls and young women aged 15–24 years is “extraordinarily high in parts of sub-Saharan Africa”, according to the report.

“Prevention programmes and efforts to reduce gender inequalities, violence against women and harmful gender norms are not having a big enough impact,” it notes.

People living with HIV and NCDs tell their stories at the last International AIDS Conference.

MUNICH – People living with HIV and non-communicable diseases (NCDs) often have to see different health providers for each condition, wait too long for their NCDs to be diagnosed and take medication that can interact with one another.

In addition, most were unaware that their HIV status increased their risk of some NCDs – and some health workers did not know how to manage their conditions. This is according to a collection of interviews with people living with HIV and NCDs launched in advance of the AIDS 2024 conference.

A Case for Integration: A Collection of Lived Experiences of People Living with NCDs and HIV has been published as part of the NCD Alliance’s “Our Views, Our Voices” initiative, dedicated to promoting the meaningful involvement of people living with NCDs in the NCD response.

Kenyan Domitilah Anyango Okeymo, 50, lives with HIV and hypertension. When she moved to a rural part of the country, she was told she had to go to two different clinics for her two conditions.

“Here, they have an HIV clinic, but I have to go to another facility for hypertension and then explain everything there again. It is not comfortable having to explain to different people and disclose my status each time. So, I check my blood pressure myself,” said Okeymo.

Serah Mbovi Makau, 58, has HIV, hypertension and diabetes.  Diagnosed with HIV back in 1996, Kenyan Makau shunned health care for 10 years until TB and other opportunistic infections forced her to seek help.

She first took TB treatment, then antiretroviral (ARVs) medicine in 2006.

‘All was fine until 2018 when I discovered that I was hypertensive. I went to a regular clinic, where they tested my blood pressure and, realising that it was high, they put me on medication,” said Makau.

“Now I had another medication, which I had to take daily, another appointment and another clinician I had to see. Taking both medications was not easy. The timings of the medication didn’t match. I also felt that each clinician had their own interest – HIV only or hypertension only.”

Makau wishes that her conditions “can be treated and monitored in one clinic, with one clinician, and one appointment”. 

“I want to be treated holistically, and to be given information about these conditions and my medications so that I am empowered to manage them,” she added.

People living with HIV have a much higher risk of getting certain NCDs

Mental health struggles

Many people living with HIV struggle with mental health, yet most are unaware that their HIV status makes them more vulnerable. 

Zambian Luthando was infected with HIV at birth but only found out at the age of 14 when she and her friends decided to have HIV tests.

“When the results came, my friends were given their status there and then. But the counsellor told me that they needed my mother to be present.”

When she returned with her mother, the counsellor told her that she was HIV positive. The and asked if she was sexually active.

“I didn’t know about mother-to-child transmission. At this time my mother disclosed her status to me and my older sister,” said Luthando.

Once she had completed high school, “the reality of my status hit me”, says Luthando, who is now 25. 

“Even if I seemed okay on the outside, inside I wasn’t okay. I would break down and cry, I didn’t talk to my mum some days and I became rude in our conversations. It took connections with people for me to make a change and come to terms with my status,” she says, adding that a support group and counsellor helped her.

“I would like to see all clinics give information to patients, in their languages, about mental health support. I also want to see healthcare providers asking their patients more questions about how they are coping and what their needs are. They should be trained to offer this support and information on mental health,” she stresses.

Lack of diagnosis

A number of people with HIV also reported that their other conditions were not promptly diagnosed by healthcare workers at HIV clinics.

Indian Mona Balani, 48, lives with HIV and hypertension, but feels that her health promblems have often been overlooked because health workers assume that they are all related to HIV.

“Every time I’ve sought treatment for health issues other than HIV, discrimination has been my constant companion,” recounts Balani.

“Stigma and discrimination contributed to further delay in diagnosing my extra-pulmonary TB in the abdomen, pushing me close to death,” she said.

“Beyond my own story, other people living with co-morbid conditions in my community also face similar challenges, including the fact that most of the NCDs are left undiagnosed, untreated or inadequately treated due to stigma and discrimination associated with HIV and TB,” Balani added.

“With my experience, I would like to emphasise the need for HIV-NCD service delivery integration.”

Her story is echoed by that of Ashleigh Bezuidenhout, who lives in South Africa.

“For three years, between 2018 and 2021, I suffered severe stomach cramps and constipation. Each time I told my [HIV] doctor, I was just given laxative medication and sent home,” says Bezuidenhout.

“The focus was on treating us for HIV and not on our overall health. It broke me all the time leaving the clinic or hospital and always being told that there was nothing serious, when each X-ray or scan showed lumps on my ovaries and all I got was numerous types of pain meds which helped just for a short time.”

Finally, in February 2021, she went to hospital after her HIV clinic had once again fobbed her off with laxatives.

“A scan detected a mass and the doctors had to put a draining tube through my nose to help relieve the swelling and pain in my stomach,” says Bezuidenhout.

“I needed an emergency operation which took place a few days later. They removed a big mass the size of an orange, 12 small tumours and 30cm of my small colon which was badly infected. I tested positive for cancer of the colon, and ended up with a stomah bag, which I still have today. My world shattered when I was given this diagnosis and told I needed to have chemotherapy.”

The NCD Alliance has developed 15 Transformative Solutions, which are recommendations for contextually appropriate, person-centred information about NCDs and their risk factors for people living with HIV. 

 

Administering oral polio vaccine – Gaza’s vaccination rates have plummeted since war began.

Variant type 2 poliovirus (VDPV) has been isolated from six environmental (sewage) samples in the Gaza Strip – collected from two different collection sites in the southern city of Khan Younis as well as Deir al Balah, further north,  WHO confirmed Friday.

The variant poliovirus strains detected in all six wastewater samples, collected in late June,  are genetically linked to each other, said the WHO-hosted Global Polio Eradication Initiative (GPEI), in a news release.

“It is important to note that virus has been isolated from the environment only at this time; no associated paralytic cases have been detected,” the GPEI statement noted. Even so, it added that, “WHO considers there to be a high risk of spread of this strain within Gaza, and internationally, particularly given the impact the current situation continues to have on public health services.”

The oral polio vaccine (OPV) that has brought the wild poliovirus to the brink of eradication provides better immunity in the gut, which is where polio replicates. But the vaccine virus is also excreted in the stool. And in communities with low-quality sanitation, this means that it can be spread from person to person and actually help protect the community.

However, in communities with low immunization rates, as the virus is spread from one unvaccinated child to another over the course of 12-18 months, it also can mutate and take on a form that can cause paralysis just like the wild poliovirus. This mutated poliovirus can then spread amongst undervaccinated children in the same communities – as cases of vaccine-derived poliovirus (VDPV).

Immunization rates have declined sharply in Gaza – while clean water is scarce and garbage piles up

Gazans struggle to obtain basic supplies of food and water amidst mounting piles of garbage and debris.

Routine immunization rates in the occupied Palestinian territory (oPt), including Gaza and the West Bank, were estimated at 99% before the start of the conflict on 7 October 2023, when Hamas forces invaded some two dozen Israeli communities, killing 1200 people mostly civilians and taking 240 people hostage.  By end 2023, vaccination rates had declined sharply to 89%, according to the latest WHO-UNICEF routine immunization estimates. But the data does not separately address Gaza, which has suffered widespread destruction of its health infrastructure, along with over 38,000 deaths and nearly 90,000 injuries over the course of the nine month war.

Inside Gaza, currently only 16 out of 36 hospitals are partially functional and 45 out of 105 primary health care facilities are operational, contributing to reduced immunization rates. In addition, garbage has piled up, drinking water sources have been damaged or destroyed by the war, and sewage water is pervasive across the enclave in the wake of the breakdown in the enclave’s sewage treatment plant.  And that is in addition to pervasive malnutrition and undernutrition – increasing infectious diseases of all kinds, including but not limited, to polio.

Virus crosses borders – and conflict zones

Responding to the alert, Gaza’s Hamas-controlled Ministry of Health called for “an immediate halt to the Israeli aggression, providing usable water, repairing sewage lines, and ending population crowding in places of displacement.”

Israel’s Ministry of Health also confirmed the presence of the virus in samples it had taken from Gaza. The samples “raise concerns about the presence of the virus in this region,” the Ministry said.

Vaccine-derived polio virus has also plagued Israeli communities in recent years, where it has been circulating widely in sewage for some time, occasionally striking in under-vaccinated communities. In March 2022, a four-year-old girl from Jerusalem was diagnosed with the paralytic disease – the first case in the country since 1989.  Her case was also determined to be a vaccine-derived form of the virus.  In March 2023, four more children in northern Israel were diagnosed with the asymptomatic cases of the virus – they, too, counted among the estimated 150,000 Israeli children who are unvaccinated – mostly living in ultra-Orthodox Jewish communities.

“Unfortunately, it is no surprise that there is polio in Gaza sewage,” Professor Nadav Davidovitch, director of the School of Public Health at Ben Gurion University, was quoted as saying in Israeli media.

“Concerted effort is needed to see that everyone is vaccinated in Gaza, including Israeli soldiers, hostages, and especially the babies born in Gaza,” he said. “We must have regional collaboration in order to stop the spread of the disease.”

Image Credits: Global Polio Eradication Initiative, UNRWA .