ART
ARVs
Africans' Involvement in HIV Research Needs to be Stepped Up
According to a 2020 survey, scholars from Africa and the Middle East generated just 21 61% of worldwide HIV/AIDS scienti c contributions. This can be ascribed to African nations' inadequate research skills and lack of empowerment to a considerable extent. Therefore, lower-producing and less-developed nations must be included in research initiatives¹. Africans are under represented in HIV related research. Individuals are unmotivated to participate in HIV research because of the social stigma associated with the illness, fear and uncertainty, and socioeconomic reasons such as insu cient funds. Furthermore, a lack of good understanding and adequate knowledge of the research process impedes HIV research in Africa². Homosexuals and transgender women confront signi cant societal stigma and legal restrictions in SSA, posing a signi cant danger to their involvement in HIV research. Some participants have also complained
about the loss of anonymity and sexual harassment by research workers³
HIV Research Should be Contextualized to Partcipants' Cultures
For a long time, culture has been inadvertently cited to explain disparities in HIV trends between SSA and the West. As a result, many cultural practices have been stripped of their meaning, sociological context, and historical placement, and have been converted into illness cofactors⁴. Today, the emphasis is gradually shifting toward adopting research approaches that recognize cultural contexts in order to elicit correct ndings on HIV in African communities. HIV is primarily a social illness, and the barriers to e ective prevention are mostly social and political in nature⁵. As a result, in order to develop e ective preventative methods, a signi cant fraction of HIV research in SSA must be contextualized to speci c cultures. However, this is a less charted path with limited resources to promote cross-cultural studies in African contexts. More tools must be developed/customized to be suited for diverse communities in SSA. Fortunately, African scholars are leading the way. Sematlane et al., for example, recently completed a cross cultural adaption and validation of a scale that evaluates chronic illness identi cation among South African people living with HIV⁶. This is admirable, but we still have a long way to go
Women and Girls are Disproportionately A ected by HIV
There is an increased gender disparity in HIV/AIDS prevalence in SSA compared to the global trend. According to the UNAIDS report, girls and women account for 58% of new HIV infections in 2020 in this region, while the global distribution was 18% (among girls aged between 15 to 24) and 24% (among 25-49 years old women) in the same period⁷.
HIV/AIDS prevalence di erences between men and women ranged from a low of 0.68% in Liberia (2005) to a high of 11.5 % in Swaziland (2006 7). Three distinct patterns were observed for the explanation of the gender disparity in 21 SSA countries. First, HIV/AIDS is concentrated among women in most countries due to the di erential e ect of risk factors on men and women Second, in Uganda and Ghana, 84% and 92% of the higher HIV/ AIDS prevalence for women was explained by the di erential distribution of risk factors by gender, respectively. Third, in Cameroon, Guinea, Malawi, and Swaziland both the di erential e ect and the di erential distribution of risk factors by gender explain the gender inequality in HIV/AIDS prevalence⁸. Besides the biological vulnerability of women, socio cultural and economic factors, are responsible for the higher number of infections among women⁹.
In research conducted in 30 SSA countries, 80.1 % of women with comprehensive knowledge of HIV/AIDS tend to negotiate better for safer sex than those without comprehensive knowledge (71.3%)¹⁰. Therefore, empowering women and provision of full and equal rights are central to making a change⁷
In 2007, it was estimated that around 3 million persons in the age range of 50 and above were infected with HIV¹¹. HIV prevalence has signi cantly increased among elderly people during the last decade compared to youth¹². This is most likely owing to the increased frequency of HIV testing in the elderly, which is often overlooked since they are at a lesser risk of contracting the illness. In the elderly, HIV can be contracted through sharing sharp items with an infected person, but sexual transmission is less likely. However, it is thought that age-related vaginal thinning and dryness may heighten the risk of HIV infection in older women¹³. Older people may also be less likely to use condoms during sex because they are less concerned about pregnancy¹³. HIV tends to induce premature immunosenescence in a ected individuals, which is the early aging and destruction of the CD4+ T cells of the immune system¹⁴ This invariably puts the elderly at even greater risk of morbidity and mortality as their immune system would naturally be weaker due to aging. Most HIV patients who are compliant with their HAART from the time of diagnosis and start of management at a younger age tend to live longer and happier lives even till old age. It is, therefore, essential that prevention, early diagnosis, and compliance to treatment of HIV infection are adhered to so as to cut the chain of transmission and eradicate the disease
HIV is the Most Potent Risk Factor for Tuberculosis factor for Mycobacterium tuberculosis infection and progression to active illness, increasing the probability of latent TB reactivation 20 fold. TB is also the most common cause of AIDS related death. Thus, M. tuberculosis and HIV act in synergy, accelerating the decline of immunological functions and leading to subsequent death if untreated¹⁵
Co infections with tuberculosis and HIV exert a signi cant strain on healthcare systems and present unique diagnostic and treatment hurdles. HIV infection is the most potent known risk
In 2008, there were an estimated 1.4 million new cases of tuberculosis (TB) among persons with HIV infection, and TB accounted for 26% of AIDS related deaths. The relative risk of TB among HIV infected persons, compared with that among HIV uninfected persons, ranges from 20- and
By the end of 2008, an estimated 33 2 million persons were infected with HIV, and in 2007, there were 2.7 million new HIV infections and 2 million HIV infection-related deaths. During the same end of the year, there were 1.37 million (15%) cases of TB and HIV coinfection, resulting in 456,000 deaths. Prevention of TB requires prevention interventions for both HIV infection and TB, including HIV counseling and testing, disclosure and partner testing, behavior modi cation, earlier antiretroviral therapy, and the "Three I's for HIV/TB": isoniazid preventive treatment, intensi ed case nding, and infection control for TB¹⁷.
The HIV/AIDS epidemic is a global problem, although SSA bears a disproportionately greater burden. HIV is transmitted through a variety of means, including unprotected sexual contact, and sharing needles or other drug injection equipment, with the latter route being most frequent among injection drug users¹⁸. IVDU are persons who self-inject recreational drugs, typically heroin, though cocaine, prescription opioids, and methamphetamine are also routinely injected. Drug abusers can be both injecting and non injecting; nonetheless, injecting drug usage has been identi ed as one of the key drivers of HIV risks with re emerging infections¹⁹. Non injecting drug use, such as alcohol intake, increases the risk of HIV transmission by a ecting judgment and leading to risky behaviors such as unprotected sex²⁰. There is a signi cant incidence of HIV among IV drug users, with an estimated 500,000 to 3 million people injecting drugs in SSA, and roughly one fth being HIV positive21. However, substance/drug misuse in Africa is inadequately documented.
Substance abuse, in addition to being a risk factor for HIV transmission, has other consequences among HIV/AIDS patients, including the likelihood of drug interactions with the ARVs the patient is taking. Also, injection drug usage, particularly heroin use, is frequently linked to poor ART adherence²².
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