SRAN attends the 2019 ICASA conference

The Sex Rights Africa Network team under the AIDS Foundation of South Africa attended the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) at the Kigali Convention Centre, Rwanda at the beginning of December 2019.

The Team joined other Sex Rights Africa Network members and nearly 9000 other delegates from 152 countries in learning about many aspects of sexual health on the African continent. SRAN also hosted a panel discussion on Improving Sexual and Reproductive Health and Rights in South Africa.

Trainers Lab launched it’s e-learning week at the conference with a course focusing on stigma. If you haven’t yet, register as a trainer/organisation, or take one of the courses available!


See below for summaries of the plenary sessions (from the ICASA website)

PLENARY SESSION DAY 1

Time: 8.45 – 10.15
Reporter: INGRID UWASE

Towards Developing a Globally Effective HIV Vaccine: Prof. Corey highlighted how HIV is still the most important global health issue; and why the world needs to invest in new technologies and tools to fight control the epidemic. There are still a significant number of new HIV infections each year, including mother to child transmission of HIV. The existing methods will not help us achieve the global HIV goals. This is why some scientists are working tirelessly to introduce new disruptive prevention solutions such vaccines.

Prof Corey discussed the two vaccines that are undergoing clinical trials. He admitted it has not been an easy task. One of the two vaccines is that developed from the RV144 (31% efficacy) vaccine and the other is the Johnson and Johnson HIV vaccine program. He described how each vaccine works and the implication for HIV diagnosis once a HIV vaccine is developed. HIV vaccine development has helped with the development of research capacity in Africa in the last 7 years, especially with infrastructure development. While there has been significant scientific progress with HIV control, there is still a lot more to accomplish if we are to get to an AIDS Free Generation.

African Heads of State towards AIDS Free Africa: What does it take! The talk was taken by Honorable Mukabalisa Donatille. The Executive Director of UNAIDS, Winnie Byanyima, introduced the talk acknowledging the mileage the HIV field has gained through the efforts of science. However, the translation of science to implementation is significantly limited by sustainable leadership: without the efforts of the government nothing much would be achieved. Honorable Mukabalisa Donatille, the Speaker of the Rwandan Parliament, elaborated more on the importance of leadership and governance in promoting health, discussing the successful Rwandan model. Rwanda credits its successful progress towards AIDS elimination to the successful collaboration between international donors, civil society organizations, communities, faith based organizations, and youth organizations. Currently, the prevalence of new HIV infection in Rwanda is down to 0.08%. The goal is zero new infection. Also, 98% of pregnant women have access to treatment thus successfully preventing mother to child transmission of HIV. This Rwandan parliament has played a key role in making this progress possible. It has enacted laws that promote access to contraception, advocacy for SRH related programs, incriminating child abuse, and putting young people and adolescents at the core of the national HIV response. She concluded by emphasizing why promoting social justice and collaboration will help make the needed difference for the HIV response.

Health financing: community and private sector engagement for increased domestic funding. Ms Rosemary Mburu made the presentation. She highlighted that seven key things that were critically needed for successful health financing. She reminded the audience that the country leaders in Africa had made many commitments towards ensuring domestic financing for health. These include the Abuja Declaration (2001), AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria (2012), Abuja +12 declaration (2013), commitments at periodic High Level Meeting on HIV/Political Declaration on HIV, the Africa Score card on domestic financing for health, and the Africa Leadership Meeting (ALM) on Investing in Health (2019). These commitments have led to steady increase in health resourcing in the continent. Despite this, the gap remains huge. Millions of Africans fall into poverty due to health payments. Sadly, 20% to 40% of all health resources are wasted. In addition, to the financial barriers, communities of key populations, young people and adolescents and other populations vulnerable to HIV are not been adequately reached with the needed services. Private sector financial and technical engagement is poor yet they can support governments to enable every dollar they spend reach further and work more efficiently. She ended on Call to action for courageous political leadership. Leadership that stop greedy pharmaceuticals that put profits before lives. And crucially, TO DO THE RIGHT THINGS FOR THE PEOPLE.

Closing remarks: The Deputy Executive Director of Global Fund identified the need to step up domestic financing of HIV response through strategic governments plans to achieve Universal Health Coverage. Universal Health Coverage isn’t a cheap option but it’s a fantastic option. We need to do better by spending on the right things such as primary care, public health and building mechanism to reduce corruption. However, Government can’t do it without collaboration with Civil Societies Organizations while the private sector should create job opportunities for people so that they can be able to pay taxes.

 

PLENARY SESSION DAY 2

Time: 8.45 – 10.15

Reporter: INGRID UWASE

Operationalizing the implementation of innovative biomedical prevention (PrEP, microbicides, and long acting ARVs) – Prof. Linda-Gail Bekker
Prof Bekker, discussed the history of PrEP research and development, challenges associated with its access, the successes to date and future direction. She referred to PrEP as a chemical condom that has been able to saves 3 million people at risk of HIV from acquiring infection since its approval for use in 2012. This is one prevention options available that needs to be incorporated in all prevention program for HIV. It is clear the world will miss its 2020 HIV target with regards to closing the prevention gap. PrEP is a critical tool to help make the difference to the global response as it shows a 90% reduction in the risk of individuals who use it, from contracting HIV infection. Promote stronger community led leadership for ending AIDs in Africa. – Massogui THIANDOUM
Participants were informed about the ‘why’ and ‘how’ of civil societies engagement in national response. The speaker highlighted about the 30 years civil society organizations have been in the fore front of the fight against HIV. These movements have been through strong religious organizations commitment, and civil society actors have helped in raising for PLWHIV. Civil Society actors advocacy have been fundamental in providing access to generic ARVs. Community programs in different African countries are leading the path against HIV, where they have initiated innovative approach in reaching key populations, eradicating stigma, and collecting evidence that are used in advocacy. Those programs, include the Programme LILO in Namibia, and the establishment of legal clinics and legal aid agencies to support key population in Mauritius, and many others. The key take home message is that ending HIV is possible, but will not be achieved without communities. Integrating HIV care with emerging infections, comorbidities, and NCDs – Prof. Wafaa El – Sadr
Non-communicable diseases may likely overtake communicable diseases, neonatal, and nutritional disease combined to become the leading cause of mortality in sub-Saharan Africa by 2030. People living with HIV are at the same risk to NCDs as people who are HIV negative. However, People living with HIV may be more at risk due to HIV infection and or the use of antirerovirals. There is a necessity to integrate non-communicable diseases management in all HIV programs. An effective method is the use of the Public Health 2.0 approach, and active engagement of the services users. Trials conducted, like the in Kenya, has shown that integrated multi-disease screening, increased acceptability and uptake of HIV testing in rural communities. The home message is that successful NCD/HIV integration will require countries to identify and focus on non-communicable disease that makes the highest impact on health, using approaches that can allow non-clinicians to provide services, and empower recipients of care for self-management. It is important to scale up NCD/HIV integration now in order to control these two syndemics.

 

PLENARY SESSION DAY 3

Time: 08.30 – 10.30

Reporters: Annet Kampororo and Ange Umutoni

WHAT WILL IT TAKE TO ACHIEVE EMTCT AND 90-90-90 GOALS FOR CHILDREN IN AFRICA –DR DOROTHY MBORI-NGACHA.
It is important to super fast-track targets for pregnancy woman. This should help reduce the number of children newly infected annually to less than 40,000, reduce the rate of mother to child transmission to 5% or less among breastfeeding woman and to 20% less among non- breastfeeding women. It is also important to reach and sustain 95% of pregnant women living with HIV on lifelong HIV treatment.

Countries are meeting targets for the elimination of mother to child transmission of HIV. Those that have reached <90% of pregnant women living with HIV are Burkina Faso, Botswana, Namibia, Malawi, Ethiopia, Libya, Benin, Tanzania. Those who have reached the 70.89% include ESwatini, Lesotho, Cameron, Kenya, Burundi, South Africa, Togo, Gabon, and Ghana. Also, those that have reached 50.69% include Chad, Guinea Bissau, South Sudan, Guinea, DRC, Senegal, and Equatorial Guinea.

Testing during pregnancy is sub-optimal. The testing rate is low in rural areas, among the poorest woman, among those with limited knowledge of HIV, Barriers to access and testing include poor integration, health care providers related issues, communication challenges with male partners, fear of disclosure, and HIV-related stigma. PMTCT retention rates are below the retention rates of the general population in care. Retention compromised by HIV status denial, stigma, fear of disclosure, lack of social support and lack of transport fare. Discontinuation of treatment high in small health delivery sites and in facilities with high staff turnover.

Community engagement improves outcomes. Recent evidence suggests that retention of pregnant women in care improves when couple tests together. There is also improve male outcome when the partner engages them through the antenatal platform.

Remaining gap and those left behind: Adolescent, women living in extreme poverty, women in the most remote area where access is poor, women who are migrants, women who are marginalized in society because they belong to key population or their partners are.

STRONGER POSITIONING OF WOMEN LEADERSHIP IN AFRICA FOR THE HIV RESPONSE – TSEHPO RICKI KIGOSITAU
Tsehpo works with Accountability International whose vision is a world where there is accountability for the life’s human rights and wellbeing of all person, across all spheres of society. Its mission is to serve as a as a watchdog and to a amplify the diverse voice of marginalized communities The problem: Girls continue to be married and forced out schooling. Intimate partner violence and sexual and gender-based violence continues to be the rise. New HIV infection on the rise amongst young women and adolescent girl. Accountability within the HIV response quite poor including reduced funding and global shifting priorities. The status of nurses and auxiliary health care staff needs our attention.

Who have we left behind: Lesbian women who have sex with women, women, women who lives in rule areas and those in conflict and militarized area. Others are transgender women, refugees and asylum seekers, women who use or inject drug.

What are some of the solution: Improve the status of health care, pay women in the HIV and health field equally and more generously, invest in communication led initiatives and intervention that are women lead.

Women investing in women: Proliferate intervention and initiative of women, bringing more women into our boardroom to enhance accountable governance. Transform qualitative representation of women in executive and management leadership in our organization

ACCESSING SERVICES FOR PEOPLE LIVING WITH DISABILITIES – PROF SENI KOUANDA
West Africa has a generalized co-existing with a concentrated epidemic. The response has been limited by the ignorance resulting from the lack to contextualized data thereby challenging the efforts at reaching the 90-90-90 target in region. Emerging new data from a study on humanity and inclusion looking as HIV and disability in West Africa, had the objective of strengthening strategic information for the effective inclusion of people with disabilities in the response to HIV/AIDS in West Africa. It was a cross sectional study on behavioral and biological, carried out in West Africa countries including Nigeria. Disabled people aged 15-69 years were recruited for the study. The result showed that accessibility and use of HIV services by people with disability was less than 14%. Less than 30% of people with disabilities had had a HIV testing in their lifetime. Access to and affordability to care for individuals with disabilities living with HIV can be a challenge as health care facilities are difficult to access, and health care unaffordable for the impoverished disabled. In conclusion, people with disabilities are vulnerable to HIV in West Africa. The HIV response need to play catch up game with people living with disabilities so they are not left behind by 2030.

 

CLOSING CEREMONY

Time: 10:45 – 11: 20
Reporter: Ingrid UWASE

The closing ceremony started by the show of a short video highlighting how ICASA 2019 Rwanda went. Colonel (DR) Alain AZONDEKON, the Chief Rapporteur presented the main conclusions and recommendations. He highlighted that political leaders have to promote health rights as human rights, address gender inequality, and to respect vulnerable populations during the designing and implementation of health policies. The government has to mobilize domestic resources to finance health budget in their respective countries. It was recommended the new and innovative health solutions needs to be developed, policies and guidelines needs to be more inclusive, scientists needs to pay more attention to what communities suggest. Mental health is a big issue that needs to addressed as part of the package for HIV care and people living with disabilities needs more information and knowledge to enable them make the right decisions.

Madam Jeanne Gapiya Niyonzima, represented the community. For her, community means people who are infected and affected by HIV, sex workers, MSM, drug users, and prisoners who are at a high risk of contracting HIV infected. She thanked His Excellency President Paul Kagame for his advocacy efforts while serving as the Chair of the African Union so that African governments can invest 15% of their revenues in health. She thanked Her Excellency, Madam Jeannette Kagame, for her investment in the control of HIV in Rwanda and Africa in general. She noted that political leadership is crucial to accelerate the HIV response. Yet, partnerships with civil society organizations, faith based organizations, donors, youth is important to end the HIV epidemic. Despite the recognised critical role of the community, community members still face discrimination and stigma for who they and how they live. Communities are requesting for complementarity and not competition. They have proven throughout history to be able to make a difference. She highlighted that it is unacceptable to be treated as second zone, counting dead people, the silence of government on death from diseases related to HIV, and poor systems to support the community response. The audience were reminded not to leave behind Middle East and North Africa.

Mr. Mabingue NGOM, the Regional Director of UNFPA, appreciated how organisation of ICASA. He noted it provided a unique platform for leaders, activists, young people, communities, scientists to interact on how to end the HIV epidemic in Africa. He appreciated how sessions recognized the leadership role of the youth in the fight against HIV. The response to the HIV/AIDS in Rwanda is an example of how political leadership impact in the achievement of goals. Therefore, it is fundamental to strengthen the role of political leadership. It is also necessity to ensure that every African child get access to Comprehensive Sexual Education. Laws need to be reformed, and make laws that value family planning. It is time to end the epidemic as Rwanda energized and inspired us to go back and do better.

Prof. John IDOKO, ICASA President, stated that ICASA 2019 had close to nine thousand participants from 152 countries in attendance. During ICASA we learnt new ways of prevention, how to integrate HIV response with other diseases response, we also learnt about the power of communities and the importance of mobilizing domestic resources. Never to forget the Abuja commitment. Next ICASA will take place in 2021 and more details will be communicated on the ICASA Official Website.

Dr. Diane Gashumba, Rwandan Minister of Health, gave the closing remarks. As the government of Rwanda they were thrilled to host ICASA 2019 as it had given them a chance to share the Rwandan story and experience. It was also a great opportunity to learn from the 152 countries that were represented. She emphasized that health should be seen as an investment progress is to be made with the HIV response. It is extremely crucial to live safe and healthy lives. Leaders committed to investment more in health, with commitment to the wellbeing of adolescents and girls in particular. She recognized that challenges remain on how to improve mental health management. She thanked everyone who attended, donors who made realization of ICASA, UNAIDS, WHO,ICASA volunteers and many others who helped. We are stronger together she noted. She encouraged everyone to keep the important discussions going and put lessons learnt into practice. She welcomed those who travelled into Rwanda to accept Hthe President’s invitation to extend their stay as long as they want. Rwanda was made happy and felt appreciated.