“We will not be able to control the HIV/AIDS epidemic if we forget about the most vulnerable groups”

The Zimbabwean immunologist Linda Gail Bekker She is a leader in the fight against HIV/AIDS in Africa. Defend the access of the most vulnerable to all health and social services to deal the final blow to the coronavirus pandemic. HIV and AIDS. He has seen with a certain sense of deja vu how the same mistakes have been repeated with the coronavirus, due to the appearance of fake news or the uneven distribution of vaccines and treatments. She was president of the International AIDS Society (IAS) until 2018, when he received the Desmond Tutu Prize for research in HIV prevention and human rights. He recently participated in the “Milestones in Basic and Clinical Research in HIV” meeting organized by the pharmaceutical company Gilead.

The 24th International AIDS Conference, held this week in Canada, was divided into these main areas: presenting evidence, learning about Covid-19 and HIV, or promoting the next generation. Why are these points so relevant?

Public health responses are best evidence-based, with research to ensure they are feasible and scalable. We must always learn from current experiences and science is repetitive; you have to rely on past experience. Moreover, we are in a long-term process and we therefore need the younger generation to be mobilized, guided and encouraged to take the reins in a fluid and sustainable way.

People have not fully understood the U=U concept: if a person is HIV positive but has a suppressed viral load, HIV cannot be transmitted

Bringing HIV prevention to the most disadvantaged populations is one of the objectives she has pursued the most. Do you think this is one of the burdens that prevents controlling the epidemic?

There is no doubt that we will not control this epidemic if we leave the most vulnerable groups without services and access. The key to ending the epidemic is to leave no one behind.

Another challenge is to bring all the medical advances closer to the population threatened with exclusion. How to remedy this problem still present more than 40 years later?

For sure. The populations hardest hit by HIV and most at risk of contracting HIV are those who most often have the most difficult access to health care and services. These populations have been called “key populations”. They are considered essential because unless we figure out how to reach them and bring them these services, the epidemic will continue to get worse. These populations are often the most marginalized and are often criminalized and persecuted. For example, young people who inject drugs, sex workers, transgender people or who are incarcerated.

“Breaking the Silence” was the theme of the XIII Durban Conference, the first to be held in Africa. 22 years later, how much do you think the HIV/AIDS situation has changed in Africa, and in particular in Zimbabwe, your country?

We now have one of the largest HIV treatment programs in the world…it’s huge! Our life expectancy has increased and we see far fewer people dying of AIDS. We have not made much progress in primary prevention, stigma and addressing the epidemic among women and girls and the most vulnerable young people. We have reduced vertical transmission, which is very important, but we still have too many babies born with HIV because we have not reached all women to prevent vertical transmission, especially during breastfeeding.

Why is it so important to protect the rights of all people affected by the epidemic?

Protecting the human rights to health, safety and basic access to services is fundamental to the response to HIV. When people feel they have no rights, they end up hiding and away from care, prevention and health services. It just allows the epidemic to continue

When people feel that they have no rights, that they are violated, they end up hiding and far from care, prevention and health services

Are you optimistic about future infection control?

I am optimistic by nature! Over the past 40 years, we have made tremendous advances in science and innovation in virus understanding, treatment, prevention and diagnosis. Although we don’t yet have a vaccine or a scalable cure, we do have some great tools that, if properly implemented, could make great strides in disease control. For example, HIV in children…we have all the tools to stop vertical transmission, but there are still 150,000 children born with HIV every year and another 150,000 who become infected. These 300,000 children will need treatment for the rest of their lives. It is our responsibility!

You are an expert in HIV prevention, what is the best tool to prevent new infections in Africa?

Every day we have more options beyond using condoms. The introduction of antivirals to prevent infection has been very good. This includes post-exposure prophylaxis (PEP) [medicamentos que se toman después de una relación de riesgo] and pre-exposure prophylaxis (PrEP) [medicamentos que se toman para prevenir la infección].

And while first-generation PrEP with daily pills may not be ideal or feasible for everyone, we will soon have a vaginal liner for women and an injectable that can be dosed less frequently and is a game changer. It is hoped that with multiple options, people are more likely to find a method that works for them at every stage of their life. This will lead to the elimination of transmission of the AIDS virus.

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