Page 27 - Nursing Matters June 2021 Vol 12

current issues

Despite U=U having proven to improve personal health, sexual safety, intimacy and self-image;
reduce social stigma; and promote adherence and viral suppression, the U=U message has not been
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formally endorsed in South Africa and the U=U message has not been spread sufficiently to those
who need to hear it the most.

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2020. South Africa needs to better campaign is to decrease the number of is working which has a positive effect
address the second target of 95 percent people who transmit drug resistant HIV, in combating HIV stigma and shame,
by increasing linkage to care, given in the context of costly second-line ART. and barriers to ART initiation. It has
that only 71% have been reached to According to the current South African also played a role in motivating people
date. This is the country’s weak link and ART guidelines, these patients will not be to remain on treatment, thus enabling
deserves the necessary resources and tested for drug resistance prior to first-line sustained VL suppression. If South Africa
programming. treatment initiation. They will be initiated is to follow Vietnam’s lead, it can end the
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on a first-line regimen thus limiting viral HIV epidemic by 2030.
Potential challenges to sustained suppression success and negatively
viral load suppression affecting the third UNAIDS 90 target U=U footprints in Africa?
and potentially spreading the virus while
There are several challenges to viral load under monitoring. The U=U campaign is already present
in some African nations. In 2019,
(VL) suppression, including ignorance of Ethiopia began a viral load movement
HIV status, stigma and discrimination, The U=U global movement in which a delegate stated “Mindful of
poor adherence to ART, and drug the fact that HIV treatment with sustained
resistance. Pre-treatment drug resistance, The U=U movement has engaged more viral suppression is the most effective,
also termed acquired drug resistance, than 1000 organisations from 100 scientifically proven HIV prevention, as
is caused by ARV naïve people having countries with key populations on every Undetectable equals Untransmittable”.
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aquiring HIV from someone with a continent. The consensus statement In addition, Nigeria and Uganda
resistant viral strain. Bessong et al. 7 from researchers, health providers launched a U=U campaign in 2019. 10
maintain that the level of drug resistance and advocates includes the scientific
in the pre-treated population in South background for U=U and identifies Thomford et al. state that short of a
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Africa has increased over the years, gaps in scaling up the message. cure for HIV, U=U can substantially
although it is heterogeneous across and reduce the HIV burden and change
within provinces. The authors state that Vietnam officially endorsed the U=U the landscape of HIV epidemiology
“At least one study has documented a campaign via its national guidelines, on the continent. From a public health
pre-treated population with moderate with the Vietnam Authority for HIV/AIDS perspective, the U=U concept will
(> 5%) or high (> 15%) levels of drug Control (VAAC) mobilising a movement reduce stigma in PLHIV in sub-Saharan
resistance in eight of the nine Provinces”. to advocate for access to HIV services Africa and strengthen public opinion
Bessong et al. further mention that and to reduce HIV-related stigma and to accept that HIV infection is not a
optimal management of the drivers discrimination in men who have sex with death sentence. This will also promote
of drug resistance in the pre-treated men (MSM), transgender, and other key ART adherence by motivating PLHIV
population will be beneficial in ensuring populations most affected by HIV. Bach to achieve viral suppression within the
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shortest possible timeframe.
sustained viral suppression in at least Mai, one of Vietnam’s hospitals, was used
90% of those on ART, a key component as a pilot site for the U=U campaign. This Even though ART coverage is not
of the 90-90-90 strategy. site has provided HIV services for over where it is expected to be in the African
10 years, and is a centre of excellence in region, according to the UNAIDS report
As Bessong et al state, there is a need HIV treatment, with 98.4% of HIV patients published in 2019, an estimated 67%
for implementation of optimal measures achieving an undetectable viral load. of PLHIV were on treatment (up from
to promote adherence and enhance Vietnam is also the first PEPFAR country to 53% in 2015), representing 70% of
viral suppression in order for the country achieve viral suppression in over 95% of the 21.7 million people accessing ARVs
to curb the spread of the pre-treatment people on ART. 9 globally. This is the first step toward
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drug resistant virus. This translates to a achieving regional viral suppression but
need for South Africa to embrace the Vietnam’s success on the third UNAIDS robust adoption of the U=U campaign
U=U messaging. One of the aims of this 90-90-90 target shows us that U=U by country states is lacking.

HIV Nursing Matters | June 2021 | page 25