HIV burden among youth a ticking time bomb

Dr John Nkengasong, Ambassador at large for the United States Global HIV/AIDS Coordinator, US President’s Emergency Plan for AIDS Relief (Pepfar) and the outgoing director of Africa CDC has witnessed Aids, Ebola and now Covid-19. He spoke to Angela Oketch, warning countries of the dangers of complacency and the need to allocate more resources to the pandemics

You hold a sensitive office as the US Global HIV coordinator, what should the continent, and to be specific, Kenya, expect from you?

This office will ensure that we join forces o bring HIV/Aids to an end by 2030 — this is very possible.  We have come from far. About 20 years ago, HIV was considered a scourge and its messaging was scary. I was in Côte d’Ivoire and we could literally see HIV killing people. While the threat is still there because young people out here do not know the risk, the stigma is slowly fading away.  In Kenya, there has been a steady decline in new HIV cases among young girls and adolescents; but there is a lot that needs to be done. We need to focus on them.

My goal is to work closely with the political and technical leadership of the continent to close the gaps. Our common target is to make HIV/Aids less of a threat to the continent and to Kenyans.

You are coming in at a time when Africa is leading in HIV prevalence and new cases, what is your assessment of Kenya’s hits and misses in the fight against HIV?

Kenya has done a remarkable job in the fight against HIV/Aids over the years and I am very happy that in Nairobi, which is one of the most populated counties, the HIV prevalence has reduced from 24 per cent to 5.1 per cent.  However, the fight gets harder because we are at the last mile. When you fight infectious disease and get to the last mile, it gets tougher and we have seen this with other diseases including Polio, Covid-19 and HIV.

In order to sustain the response, the government needs to continue investing more in sustainability so that we can get to the end of the fight. Pepfar will work closely with the government and ensure that we push for more funding.

Is Kenya on the right track towards eradicating HIV by 2030?

I am very optimistic that Kenya will achieve this. It is part of the United Nations and the goals were set by all the countries.

We all agreed to meet the target of 95: 95: 95 by 2030.

This means that 95 per cent of Kenyans infected know their status, 95 of them are placed on treatment  while 95 per cent are virally suppressed.

Kenya is almost achieving the goals; with 92 per cent of the infected knowing their status, 93 per cent on treatment and 87 per cent virally suppressed, we still need to see progress in the third goal.  Kenya is not very far but it’s my hope that I will build the right partnership with the government of Kenya so that we truly use the country as a model. This is because the country is ranked top five with high HIV numbers (South Africa, Nigeria, Uganda and Mozambique).

With the right political will and commitment, it can be done and we can reduce the numbers.

During your visit to Kenya, you met President William Ruto at State House, what are some of the issues that you discussed?

Issues of sustainability of HIV response made the top of our discussion. He acknowledged Pepfar’s impact on the country and he is fully aware that to meet the goals, HIV requires the government’s response and leadership.  We also discussed how the government needs to ensure that there is no disruption in commodity security and services. The President is committed to this and will ensure no disruption in future.

What do you think countries should do to reduce new HIV infections in young adults and adolescents?

The numbers are worrying across the continent because these young people do not know about HIV and they are not fully aware of the consequences because they have not seen them.

In our next Pepfar strategy, we will put in measures to look into this particular cohort.

Funding has been a contentious issue and Pepfar has been gradually reducing HIV funding in Kenya hence many services have been disrupted. Kenya now needs to fund its own services, why do you think this is happening now and in the event that Pepfar withdraws fully, do you think Kenya will be in a position to allocate funding for HIV?   

Pepfar’s decrease is natural because with the reduction of the HIV burden in Kenya and if the funding today is exactly what it was 20 years ago, then it would mean that something is wrong.

If the country is reducing the HIV prevalence, then it means that it is making progress, the country is winning the battle and will subsequently win the war.

Kenya receives 379 million dollars from Pepfar. This is a large amount compared to other countries in the region. It is not like we have fully withdrawn, we have just adjusted the funding.

We also have to consider that Pepfar has been flat-funded for many years and the budget is reducing.

You started your career in HIV vaccine development 37 years ago, how has the journey been? Is there a possibility of a HIV vaccine?

I am a virologist and immunologist and I concentrated my earlier career on finding HIV vaccine/cure. When I saw that this was not possible, I dropped it and started concentrating on other things.

I have worked on HIV/Aids, Monkeypox, and Ebola so there is no outbreak out there that I have not been privileged to be part of the response. I truly don’t know whether it will be possible to come up with a HIV vaccine but I am optimistic.  Covid-19 has taught us that science has advanced a lot and there has been remarkable progress in technology. Who knows what will happen in the coming years?

HIV is a very tricky virus, it does not expose itself the way Covid-19 does and because of the weakness of Covid, scientists are able to develop a vaccine very quickly, however, HIV hides from the immune system and it is not very easy to get a vaccine.

The fight against HIV will won only if we have a vaccine in place and we have been able to control the virus to a level that we can live with it.

Development in prevention tools is very promising. 

Bigger pharmaceuticals have been accused of benefiting from the HIV epidemic globally, how are you planning to deal with this given your position?

I have always argued that for us as a continent to be successful and win the fight, we need a partnership with the private sector. The private sector relies on good public health from us and science in order to develop the vaccines. It is not charity work to develop new medication, they have to make a profit, we understand. The question is always the margin of the profit and access to the population and we have to be sure that each time there is a new drug, the patients benefit from it.

This is the discussion that we need to continue having so that when there is a new drug, people get access and also the companies make a profit.

What are some of the challenges you encountered at Africa Centers for Disease Control during Covid-19?

This was one of the toughest fights in public health that I have ever faced in my whole life because we were dealing with an unknown virus and my people on the continent needed us to act.

They had no access to commodities, no protective personal equipment, no vaccine and no testing, and countries were hoarding some of the vaccine. It was not easy.  It was like going from one fire to the next with barely any time to catch your breath. This is exactly what was happening when HIV started way back. I am happy about the help of other partners and the fact that we are able to source some of the items for the continent.  

The HIV sector receives billions of dollars every year, however, there have been allegations of misappropriation of funds. As a new entrant in the hot seat, how will you ensure that every coin given to the sector gets to the needy?

(Very good question) When I came into this office, we worked together with the Pepfar family to agree on principles that will guide us when implementing HIV activities. They include respect and humility, equity, transparency and governance, impact and sustainability.  These five core values will be guiding us.  We have to ensure that the available funds are used in the most judicious manner to ensure we reach everyone in need of our services.

Parting shot?

Kenya is a strategic country in the fight against HIV/Aids. As I leave the country, I have a positive impression that the commitment expressed by President William Ruto in terms of primary health care and commitment to resolving issues relating to HIV commodities is critical. We will achieve this. It is doable.

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