ABSTRACT
HIV continues to be a
major global public health issue. In 2020, an estimated 37.7 million people
were living with HIV (including 1.7 million children), with a global HIV
prevalence of 0.7% among adults. Around 16% of these people (6.1 million) do
not know that they have the virus. Since
the start of the epidemic, an estimated 79.3 million people have become
infected with HIV and 36.3 million people have died of AIDS-related illnesses.
In 2020, 680,000 people died of AIDS-related illnesses. This number has reduced
by around 64% since the peak of 1.9 million in 2004 and 1.3 million in 2010. The
vast majority of people living with HIV are located in low- and middle- income
countries. East and Southern Africa remain the region most affected by HIV in
the world, with 20.6 million people living with HIV and 670,000 new HIV infections
in 2020. The WHO African region remains most severely affected, with nearly 1
in every 25 adults (3.6%) living with HIV and accounting for more than
two-thirds of the people living with HIV worldwide.
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| A cross section of participants |
In an effort to curb this ugly global situation, the high prevalence rate of 2.7% in Cameroon, the high prevalence rate of 4% in the North-West Region and to improve data collection and reporting of HIV response activities at council level, the Regional Technical Group for the fight against HIV AIDS with the technical support of the Global Fund, has drilled some Focal Persons from over 30 councils in the NWR, on how to collect data pertaining to HIV, transmit reports as well as the response activities of their council, regarding this pandemic.
Presenting the objectives
of the brainstorming meeting to eliminate HIV by 2030, Dr. TAYONG Gladys, the
Coordinator, RTG HIV, North-West, reminded participants of their role to
collect and transmit HIV related data. The capacity building of Council HIV
Focal Points also had as objective, to provide information on the basics of HIV,
improve the knowledge and skills of participants on planning, monitoring and
evaluation of HIV response activities, improve the knowledge and skills on
formulation and calculation of indicators of HIV response activities.
The initial global response to HIV focused on prevention through behaviour change and research into a vaccine. However, it became clear that knowledge of transmission was not enough to stop the epidemic.
In the mid-2000s, the global response accelerated rapidly with universal access to treatment becoming a major priority. Recently, there have been calls to intensify global efforts with the UNAIDS Fast Track Strategy aiming to end the epidemic by 2030.
The worldwide epidemic of HIV continues to expand in many regions of the world and weakens the fabrics of our different society. different patterns predominate from generalized heterosexual epidemics to mixes of epidemics in which transmission among injection drug users, their sexual partners, commercial sex workers and their partners intersect.
Multilateral and bilateral
antiretroviral access campaigns such as the World Health Organization's 3 x 5
initiative, have resulted in broader access to live-saving therapy for infected
persons in low- and middle-income countries, but several million infected
people who are clinically eligible for antiretroviral therapy, remain untreated.
In the North-West Region and Cameroon at large, the public health challenge is to keep the uninfected and to treat and care for those who have already been infected, so as to meet the target of at least 95% of inhabitants of our municipalities living with HIV knowing their status, at least 95% of inhabitants go for their ART once tested positive and at least 95% of people living with HIV have viral suppression.
EDITOR’S
NOTE
Why should our municipalities address HIV and AIDS?
HIV and AIDS is one of the
biggest challenges we face in our various councils. The rate of infection is
rapidly increasing and more and more people are getting ill and dying from
AIDS. Of all the people living with HIV or AIDS, seven out of every ten live in
our municipalities. Our municipalities are vulnerable because of either their
enclave nature thus, they become more exposed to infections of all sorts.
The Government, together
with welfare and other organizations, has developed a response to the AIDS
crisis, but without a coherent and collective approach at local level, their
efforts will not achieve as much as it could. Municipalities should ensure that
all planning and projects take account of AIDS and its consequences. The
various Integrated Development Plans must deal with the issues around poverty
and development that assist in the rapid spread of HIV and AIDS. As employers, Councils
should also make sure that their own employees are adequately protected and
that they have workplace policies and programmes that spread awareness, provide
care and educate around prevention and non-discrimination.
But their role goes far
beyond adapting their own programmes and looking after their own personnel.
Municipalities are ideally placed to play the coordinating and facilitating
role that is needed to make sure that partnerships are built to bring
prevention and care programmes to every community affected by AIDS. A local municipality is the sphere of
government closest to the people and local councillors are the politicians
directly elected to serve local communities. The impact of AIDS is increasing
and will continue to do so over the next few years.
It is for this reason that
Municipalities need a coherent strategy that brings together leaders of all
sectors of the community, service providers and welfare organizations to halt
the spread of HIV and to provide care for people living with HIV and AIDS and
their families.
Individuals, families and communities are badly affected by the
epidemic. The burden of care falls on the families and children of those who
are ill. Often they have already lost a breadwinner and the meagre resources
they have left are not enough to provide care for the ill person and food for
the family.
Children who are orphaned are often deprived not only of parental
care, but also of financial support. Many of them leave school and have no hope
of ever getting a decent education or job. These children who grow up without
any support or guidance from adults may become our biggest problem in the
future.
Most of the people who are
dying are between the ages of 20 and 45, an age when most people are workers
and parents. This has serious
consequences for our economy and the development of the municipality.
AIDS can affect anyone.
But it is clear that it is spreading faster to people who live in poverty and
lack access to education, basic health services, nutrition and clean water.
Young people and women are the most vulnerable. Women are often powerless to
insist on safe sex and easily become infected by HIV positive partners. When
people have other diseases like sexually transmitted diseases, TB or malaria
they are also more likely to contract and die from AIDS.
Although AIDS has become
very common, it is still surrounded by silence. People are ashamed to speak
about being infected and many see it as a scandal when it happens in their
families. People living with HIV or AIDS are exposed to daily prejudices born
out of ignorance and fear. We cannot tackle this epidemic unless we can break
the silence and remove the stigma that surrounds it. As elected representatives
in communities, councillors have to provide leadership on how to deal with
AIDS.
The fight against AIDS in
our various municipalities has to happen on two main fronts - prevention and
care. To prevent the spread of HIV and AIDS, Council’s Focal Persons for Health
have to educate people on how to prevent infections. FPs also have to change
the social attitudes that make women vulnerable because they cannot refuse
unsafe sex from a partner and the attitudes among men that lead to woman abuse
and rape. Poverty alleviation and development are also important programmes
that will limit the spread of HIV and AIDS.
To deal with the results
of the disease and the social problems it creates, we have to make sure that
people living with HIV and AIDS get care, antiretroviral, nutrition and
emotional support to help them live longer and healthier lives. We also have to
make sure that those who are dying are properly looked after. For the children
who are left orphaned, we have to find ways of looking after them so that they
do not become hopeless and turn to crime or live on the streets because of
poverty.
AIDS can affect the
progress that has been made in our various municipalities and the life our
councils towards building a better life for our people. The government cannot
fight this battle alone. They can provide health and welfare services,
development programmes and information. But municipalities, together with organizations
on the ground, have to provide the type of leadership and direction that will
lead to real change in people’s attitudes and behaviour. Municipalities are
also ideally placed to identify the needs of people in their area and to
co-ordinate a coherent response to those needs. Local municipalities can engage
with civil society, other government departments, as well as schools, churches to
make sure that everyone works together to combat the spread of HIV and AIDS and
to care for those affected by the disease.
Mayors and councillors
should act as role models for communities and be an example to people. They should
take the lead in promoting openness and ending the silence that surrounds AIDS.
They should also work closely with people living with HIV and AIDS and through their
actions, show that they accept and care for those affected. As political
leaders, they should use their influence and popularity to mobilize the
community and involve volunteers in projects that provide care for people who
are ill and orphans.
Finding out that you are
HIV positive can be a big shock in itself and can lead to further emotional and
physical suffering. There is a lot of ignorance and prejudice about HIV and
AIDS and it is often seen as a “death sentence”. Most people are
terrified when they are first diagnosed. Some respond by feeling that their
lives are over and become very depressed. Many people cannot accept the
diagnosis and deny that they are positive to their families and to themselves.
Others react with anger and refuse to be responsible and practice safe sex.
Many people feel ashamed of their HIV status and think that they will be
rejected by their partners and family, or that their communities will isolate
them if they are open about being HIV positive.
It takes courage to face
this disease and a lot of support is needed to fight it. People with HIV and
AIDS can live long and productive lives if they get emotional support,
strengthen their immune systems, get proper medical treatment and take good
care of their health.
The vast majority of
people who are HIV positive do not know it. The people who do not know may be
spreading the disease by having unprotected sex. Many of them only realize they
are HIV positive when they develop AIDS and get seriously ill.
Families and children
The burden of care falls mostly on the families and children of those who are ill. Often they have already lost a breadwinner and the meagre resources they have left are not enough to provide care for the ill person and food for the family. Families also suffer the daily stress of looking after someone who is ill and, in many cases, facing death. Many children, especially older female children, have to leave school to look after ill parents.
Children who are orphaned
are often deprived of parental care and financial support. More and more
orphans are living in child headed families where no-one is earning an income.
Many of them leave school and have no hope of ever getting a decent education
or job. These children who grow up without any support or guidance from adults
may become our biggest problem in the future. They are more likely to become
street children or turn to sex work or crime as a way of surviving.
Older female relatives,
mostly grandmothers, are the most likely to take in orphans. Many of them
survive on pensions and already live in dire poverty. When their children die
and they become responsible for grandchildren, they get a huge extra financial
burden and at the same time they lose the financial support they may have
received from their children.
Poverty and the economy
People who carry the heaviest burden as a result of HIV and AIDS are the poor. AIDS increases poverty and families are the first to feel the economic effects of HIV and AIDS. Families lose income if an earner is sick. Often another one of the family members stays at home to look after the sick person and further income is lost. Families also have increased costs as they have to spend money on caring for the sick or paying for funerals.
Municipal impact
It is very likely that AIDS will have the following direct impact on our municipalities:
- There will be fewer people living in the area in 10 years than earlier projections.
- People will not live for as long as projected (around 43 years instead of 60 years)
- Infant mortality will increase because of mother to child transmission as well as a higher death rate among orphans who lack parental care.
- There will be an increase in the need for health care.
- There will be an increase in the need for poverty alleviation.
- Existing inequalities between rich and poor areas will become worse.
- The number of orphans will grow dramatically.
- The make-up of your population in terms of age distribution will change.
- The number of old people who need care will increase since many of them will lose the adult children who may have been helping to support them.
- Economic growth will shrink since less disposable income is available for spending.
- Poor households will be less able to pay for services, rents and rates.
- Productivity in the economy will be affected by increased absenteeism.
- It will cost more to recruit, train and provide benefits for employees because of loss of skilled staff.
- It is likely that there will be an increase in bad debts.
- Municipal employees could be affected on a large scale and this could affect their ability to deliver key services.
- Expenditure meant for development may have to be spent on health and welfare.
Breaking the silence around HIV and AIDS
There are myths around HIV
and AIDS and they lead to people seeing it as a scandal that should be kept
secret. Many people see those with HIV and AIDS as people who are somehow to
blame because they were promiscuous or homosexual. AIDS is seen by some people
as a plague that you can catch just from being with someone who is HIV
positive. In some communities people with HIV and AIDS have been chased out or
attacked. This underlines the great
importance of widespread community education efforts because the ignorance and
prejudice around HIV and AIDS can be almost as destructive as the disease
itself. In some areas of our
Municipalities, AIDS activists have adopted the slogan “Fight
AIDS - not people with AIDS.”
In countries where the
infection rate has gone down, this only happened after so many people became
ill that no-one could pretend it was not happening. Everyone started fearing
that they would be next. We cannot
afford to wait that long and must find ways of bringing HIV and AIDS into the
open.
The challenge for us is to
make people fear getting the disease without them turning against those who are
already HIV positive. This means that we have to make it easier for people to
be open, to go for tests and to seek care. We have to treat it as an illness
and not a scandal that has to be kept secret. We must work to ensure respect
for and observance of rights and freedoms for people with HIV and AIDS, as well
as the avoidance of HIV and AIDS-related discrimination and stigma.
We have to create an environment
where communities become more caring towards people living with HIV and AIDS
and orphans and we all take responsibility for education around prevention.
Although HIV and AIDS is a terrible disease that can destroy families and
communities, we should never forget that it is also a preventable disease. We
can protect ourselves against it.
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