The United States’ Centre for Disease Control (CDC) first recognized Human Immunodeficiency Virus (HIV) in June 1981 after 5 agile homosexuals between the ages of 29 and 36 were treated for biopsy-confirmed Pneumocystis carinii pneumonia in 3 different hospitals in Los Angeles. (1) Five years later, in March 1986, the first case of HIV was reported in Ghana. (2) 1996 saw the advent of Highly Active Antiretroviral Therapy (HAART) a supposed miracle drug because for the 15 years before its production a diagnosis of HIV was a death sentence. (3) HAART reduced the mortality rate by about 50 to 80% within a decade of its introduction,(4)Life expectancy in areas like Brazil rose from 3.3 years in 1997 to 25.7 years in 2014, after two decades 9.5 million deaths had been stopped resulting in 1.05 trillion dollars global economic benefits. (5)A study in the UK revealed HIV positive patients could have a normal life expectancy if treated successfully with HAART. (12,13)
HAART was known for its “Lazarus effect” and was highly expensive, at about 10,000 to 15000 dollars per patient per year. (5)Therefore, only the rich could afford the medication. James Edwin Cameron of the Constitutional Court of South Africa, a human rights lawyer living with HIV made known that this glaring injustice was unacceptable. (14)This near miracle drug was a distant rumour in many low-to-middle-income countries(LMIC). (3)Moreover, the burden of the disease had significantly shifted to Sub- Saharan Africa where life expectancy had dropped about a decade since the emergence of HIV. (9) It was not until the creation of the President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR) in 2003 that LMIC began to experience significant improvement in morbidity and mortality amongst their diseased. (3,5,10,11)This initiative marked a new era for Sub- Saharan Africa where life expectancy has only now begun to reach its pre – HIV levels. (9)
According to The Joint United Nations Programme on HIV/AIDS (UNAIDS) fact sheet of 2020, 79.3 million people had been infected with HIV and 36.3 million of these people had lost their lives to AIDS-related illnesses. (12) In 2020, 37.7 million people were living with HIV worldwide, with two thirds in Sub- Saharan Africa. There were 1.5 million newly diagnosed HIV cases and 39% of them are in Sub -Saharan Africa. (12) HIV/AIDS when it was first discovered was noted to be more prevalent amongst men and homosexuals in the western world. However, as it spread to the rest of the world and Africa that demographic changed. It had a predilection for women with a ratio of 4:1 in 1986 in Ghana. (2,13) 53% of those currently living with HIV are women and children. (12,14) Over a third of the females living with HIV around the world experienced some form of abuse. There is a 1.5 times more chance of a female who has experienced some form of abuse to contract the disease according to the UNAIDS 2020 factsheet (12) Justice Cameron mentioned in his address at the AIIDS Society conference, HIV affects the marginalized on a larger scale than the rest of the population (15). A study done in the Eastern Region of Ghana revealed that males living with HIV received and demanded more support than women living with the disease. WLHIV were less likely to gain employment due to stigmatization and more likely to receive abuse. (15) This only proves that the stoning of Gugu Dlamini in 1998 when she announced her HIV status was a grim glimpse into the future for women living with HIV. (19) A study conducted in Spain to determine the socioeconomic impact of AIDS mortality inequalities before and after introduction HAART revealed that the mortality rate amongst those with low socioeconomic status was still higher than the rate amongst those with high socioeconomic status even though the drug was completely free for all. (17)
2020 marked the beginning of the ongoing COVID -19 pandemic. (18,19). The COVID -19 disease was seen to cause worse outcomes in those living with HIV yet at the middle of this year less than 3% of people in Africa had received the COVID -19 vaccine. (12) As the COVID-19 pandemic grasped the worlds focus in 2020, so did it grasp the focus from the devastating HIV epidemic. There was a 41% drop in HIV testing and a 37% reduction in referrals for diagnosis and treatment. (20) The COVID -19 pandemic brought in its wake economic crisis. Countries like Ghana and Nigeria redirected many of their domestic funds to fight the pandemic. (19,21) International funds from organizations such as the Global Fund and PEPFAR which primarily target persons living with HIV(PLWHIV) redirected their funds to help combat the pandemic. (22,23) UNAIDS and the World Health Organization(WHO) estimate that continual disruption could result in over 500,000 additional deaths in Sub-Saharan Africa between 2020 and 2021. (24) All reports show disruption in the HIV movement and the need for massive scale-up of funding to achieve set goals. However, the United Kingdom of Great Britain and Northern Ireland (UK ) has informed the UNAIDS of a reduced contribution from the 2020 GBP 15 million to 2.5 million this year. (25) On the other hand, PEPFRAR has recommitted to sustained control over the HIV epidemic by pouring more money into the Zimbabwe health system. (26)
We mark four(4) decades since the recognition of this disease with a theme set by the WHO -“End Inequalities, End AIDS, End Pandemics “ with an exceptional focus on reaching those left behind. (27) During the campaign launch in Ghana this year, the national initiative includes an antiretroviral site in most districts. It also includes the establishment of an HIV fund and standard operating procedures for the various population especially those at high risk. (28)
Right from the onset of the HIV epidemic, LMIC has been lagging behind the world in the help required to fight the disease adequately. (3) It has become evident from the trends that the burden of the diseases is now firmly seated in LMIC especially, African countries. (14) The HIV epidemic is very much still alive and claiming many lives. The less burdened countries should buckle down to help combat the disease in heavily burdened countries as we mark 40 years since its introduction.
The 40th anniversary of the HIV epidemic marked with its profound theme, calls us all to take self-inventories as colleagues, friends, employers of PLWHIV and reevaluate how we have treated these people whether consciously or unconsciously. Change begins with one person hence if we each endeavour to treat every individual equally regardless of social, economic, political, religious standing and most importantly health conditions, we all aim to reach equality for all.
Dr. Gilda Opoku, Kwame Nkrumah University of Science and Technology
- Dr Obed Ofori Nyarko, Kwame Nkrumah University of Science and Technology
- Dr. Saabea Owusu Konadu, Kwame Nkrumah University of Science and Technology
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14. ” Global and regional trends [Internet]. 2021. Available from: https://data.unicef.org/topic/hivaids/global-regional-trends/
15. Owusu AY. A gendered analysis of living with HIV/AIDS in the Eastern Region of Ghana. BMC Public Health. 2020;20(1).
16. AIDS activist stoned and stabbed to death by her neighbours | South African History Online.
17. Borrell C, Rodríguez-Sanz M, Pasarín MI, Brugal MT, García-de-Olalla P, Marí-Dell’Olmo M, et al. AIDS mortality before and after the introduction of highly active antiretroviral therapy: does it vary with socioeconomic group in a country with a National Health System? European Journal of Public Health. 2006;16(6):601–8.
18. Owusu M, Sylverken AA, Ankrah ST, El-Duah P, Ayisi-Boateng NK, Yeboah R, et al. Epidemiological profile of SARS-CoV-2 among selected regions in Ghana: A cross-sectional retrospective study. PLOS ONE. 2020;15(12):e0243711.
19. Oladele TT, Olakunde BO, Oladele EA, Ogbuoji O, Yamey G. The impact of COVID-19 on HIV financing in Nigeria: a call for proactive measures. BMJ Global Health. 2020;5(5):e002718.
20. Africa, Asia. New Global Fund Report Shows Massive Disruption to Health Care Caused by COVID-19 in Africa and Asia [Internet]. 2021. Available from: https://www.theglobalfund.org/en/news/2021-04-13-new-global-fund-rep
21. Abor PA, Abor JY. Implications of COVID-19 Pandemic for Health Financing System in Ghana. Journal of Health Management. 2021;22(4):559–69.
22. United States Uses $150,000 in PEPFAR Funding to Help with COVID-19 Prevention – U.S. Embassy in Zimbabwe.
24. Global HIV and AIDS statistics | Avert.