Why Tanzania Should Consider Alternative Approaches to HIV Prevention
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Loading... - Bridget Tarimo
- 15 May 2023
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Tanzania faces a crucial deadline in its efforts to combat the HIV/AIDS epidemic. With only seven years remaining to achieve the UNAIDS 95-95-95 targets and put an end to the crisis by 2030, it is imperative for the country to explore new avenues for prevention.
The UNAIDS targets aim to ensure that 95 percent of individuals living with HIV are diagnosed, 95 percent of those diagnosed receive antiretroviral therapy (ART), and 95 percent of those on ART achieve suppressed viral loads. To accelerate progress towards these goals, health experts and stakeholders suggest that Tanzania should adopt two additional preventive methods: the Dapivirine Vaginal Ring (DVR) and the long-acting injectable Cabotegravir (CAB-LA).
Currently, Tanzania's preventive measures include the use of condoms, voluntary male circumcision, and oral pre-exposure prophylaxis (PrEP), which was introduced in 2018. However, health stakeholders argue that incorporating DVR and CAB-LA, already implemented in countries like Zimbabwe, South Africa, Malawi, and Uganda, will be instrumental in reaching the 2030 target. These measures were discussed during a recent Journalist Engagement event organized by Mulika Tanzania, a youth-serving organization dedicated to empowering young people in development and decision-making processes.
Dr. Lilian Mwakyosi, the Executive Director of DARE Tanzania, an NGO focused on advocating for the health and well-being of adolescents, youth, girls, and women, highlights the importance of prioritizing informed choices for these demographics in order to end HIV/AIDS by 2030. She explains that DVR and CAB-LA, while demonstrating modest efficacy compared to existing methods, can still have a significant impact as part of a comprehensive prevention strategy. These interventions have the potential to prevent millions of HIV infections over time.
Catherine Madebe, a Programme Manager at Mulika Tanzania, emphasizes that DVR and CAB-LA expand the range of options available for HIV prevention. Unlike other measures such as condoms and oral PrEP, which require consistent use, the vaginal ring can be used for 28 days, and CAB-LA is effective for two months. Madebe asserts that by adopting these two methods, Tanzanians can choose the prevention approach that suits them best.
Francis Luwole, the Compass Tanzania Country Coordinator, advises that the decision to adopt CAB-LA and DVR should be based on a comprehensive assessment of Tanzania's HIV prevention needs and available resources. While clinical trials have shown the effectiveness of these interventions in reducing HIV transmission, their suitability and feasibility in the Tanzanian context need careful evaluation. Factors such as cost, availability, acceptability, and potential access barriers should be thoroughly considered before implementing these interventions.
Luwole further warns that by delaying the adoption of CAB-LA and DVR, Tanzania is missing an opportunity to expand its HIV prevention toolkit and reduce the burden of the disease. These interventions have proven effective, especially among high-risk populations, and not embracing them may limit the country's ability to reach and protect those most vulnerable to HIV.
Bahati Haule, a community expert at the National Council of People Living with HIV (NACOPHA), underscores the urgency for Tanzania to adopt these preventive measures. Despite being among the Sub-Saharan countries with the highest rates of new HIV infections, particularly among young people and women, Tanzania must recognize the need for change. Haule states that clinging to traditional cultural norms has resulted in unnecessary loss of life among the youth and women who continue to be infected. By adopting CAB-LA and DVR, Tanzania can offer additional prevention methods to these high-risk groups.
Understanding DVR: DVR is a flexible vaginal ring designed to protect women from HIV-1 infection by releasing an antiretroviral medication called Dapivirine. Dr. Mwakyosi explains that once inserted into the vagina, the ring settles at the cervix's entrance, effectively preventing HIV transmission.
The protective effect of the DVR lasts for 28 days, after which the woman must replace it with a new ring. Made of silicon, the ring can be easily shaped to the user's preference, although it is recommended to insert it in a figure-eight form, which transforms into an O shape inside the vagina. It is crucial not to remove the ring before the designated 28-day period, as doing so disrupts the prevention process.
Inserting and removing the ring can be done by the woman herself with minimal assistance, either from a healthcare professional or her partner. During intercourse, the ring is typically not felt by the partner unless explicitly informed. The wearer may feel its presence initially but will gradually get used to it.
Dr. Mwakyosi notes that the DVR, developed by the non-profit International Partnership for Microbicides, is a one-size-fits-all solution. It falls under the category of microbicides, which are HIV prevention products designed for vaginal application during sexual activity. The DVR empowers women by providing an additional option, particularly in situations where negotiation for other preventive measures, such as condom use, may be challenging. In cases of sexual assault, wearing the ring can potentially prevent HIV transmission. Ultimately, the DVR gives women the freedom to choose their preferred method of prevention.
