COHESODEC Working in Collaboration with other National and International Organizations / Stakeholders End the AIDS Epidemic by 2030

COHESODEC is working towards stopping new HIV infections, ensuring that everyone living with HIV has access to HIV treatment, protecting and promoting human rights and producing data for decision-making.

HIV Prevention

COHESODEC Cameroon is aware that no single prevention method or approach can stop the HIV epidemic on its own. This is because several methods and interventions have proved highly effective in reducing the risk and protecting against, HIV infection, including male and female condoms, the use of antiretroviral medicines as pre-exposure prophylaxis (PrEP), voluntary male medical circumcision (VMMC), behavior change interventions to reduce the number of sexual partners, the use of clean needles and syringes, opiate substitution therapy (e.g. methadone) and the treatment of people living with HIV to reduce viral load and prevent onward transmission.

Despite the availability of this widening array of effective HIV prevention tools and methods and a massive scale-up of HIV treatment in recent years, new infections among adults globally have not decreased sufficiently. It is in this regard therefore that we are corroborating the efforts of the United Nations Political Declaration on Ending AIDS target to reduce new HIV infections to fewer percentages by 2020 and completely eradicating the epidemic by 2030.Two interconnected reasons seem to underpin the failure to implement effective programs at scale: reluctance to address sensitive issues related to young people’s sexual and reproductive needs and rights and inadequate investment in key populations and harm reduction compounded by a lack of systematic prevention implementation strategies.

COHESODEC seeks to boost national and local HIV prevention campaigns, accountability and Fast-Track the implementation of effective HIV prevention programs in the country by providing guidance on effective approaches to achieve the prevention targets of the 2016 Political Declaration which includes; ensuring access to combination prevention options, including condoms, PrEP, harm reduction and VMMC to at least 90% of people at risk by 2020, especially young women and girls in high-prevalence regions of the country and key populations, reaching 700,000 people at high risk with PrEP, reaching 2 million men with VMMC and making 200,000 condoms available in the country to help stem the epidemic.

COHESODEC Cameroon’s Management board has called for the establishment of a new national prevention coalition and a 2020 road map to fight the epidemic in the country. The objectives of the coalition are: to create a platform of HIV prevention policy-makers, program managers and civil society organizations to strengthen political commitment; define critical steps and milestones to ensure effective prevention programs to scale-up in a national prevention road map; and strengthen the accountability of all stakeholders as well as technical support for HIV prevention programs towards achieving the 2016 Political Declaration prevention targets and commitments so as to Save lives, leaving no one behind.

Community Mobilization

To end the AIDS epidemic, community responses to HIV must be integrated into national AIDS plans, from the planning and budgeting phases to the implementation, monitoring and evaluation phases.

The role of COHESODEC in community mobilization, advocacy, and participation in the coordination of AIDS responses and service delivery in the fight against HIV/AIDS cannot be overemphasized. Reason why we recognized that to meet the Fast-Track Targets, community responses to HIV/AIDS must be scaled-up by all and committed to at least 30% of services being community-led by 2030.

Community action translates into results and can achieve improved health outcomes, mobilize demand for services, reach people with services difficult to reach with formal health systems, support health systems strengthening, mobilize community leadership, change social attitudes and norms, and create an enabling environment that promotes equal access to treatment.

Community responses to HIV include:

  • Advocacy and participation of other civil society organizations in decision-making, monitoring and reporting on progress made in delivering HIV responses.
  • Direct participation in service delivery, including HIV-related health services, prevention, sexual and reproductive health and human rights-services.
  • Participatory community-based research.
  • Community financing.

COHESODEC encourages the integration of community responses into national plans through:

  • Facilitating the meaningful participation of civil society and local community leadership in national and international processes to ensure that policies and services are responsive to community needs.
  • Providing technical guidance to stakeholders and partners on planning and resourcing community responses through domestic and international resources.
  • Documenting and disseminating good policy and practice of community responses.

COHESODEC upholds the principle of the greater involvement of people living with HIV/AIDS and commits to have meaningful engagement of all communities vulnerable to HIV/AIDS.

Community responses to HIV/AIDS are essential to ending the AIDS epidemic, and they are a model on how to reach Sustainable Development Goal 16 (promote peaceful and inclusive societies).

Gender

Achieving gender equality, advancing women’s empowerment and fulfilling the sexual and reproductive health and rights of women and girls are crucial to reaching the Sustainable Development Goals and achieving the targets set in the 2016 United Nations Political Declaration on Ending AIDS.

Four decades, the HIV response has heralded significant success. Yet, much more is needed, particularly in terms of ensuring that women and girls are not left behind. Pervasive gender inequality, patriarchy and discrimination undermine the progress in the HIV response. Young women and adolescent girls face a heightened vulnerability to HIV infection and every week 70 young women (aged 15–24) acquire HIV in Cameroon.

Gender-based violence is a global epidemic and one in three women worldwide has experienced physical and/or sexual violence by an intimate partner, or non-partner sexual violence, in her life. Studies have shown that, in some regions, women who experienced physical or sexual intimate partner violence were 1.5 times more likely to acquire HIV.  Among women living with HIV, intimate partner violence can lead to lower antiretroviral therapy use and adherence to HIV treatment, and higher viral loads.  

Access to education in local communities in Cameroon, including comprehensive sexuality education, and to sexual and reproductive health services is essential to supporting the autonomy of women and girls. When women are empowered in decision-making, they are more likely to negotiate safer sex, have higher HIV-related knowledge and use condoms. Additionally, the integration of sexual and reproductive health services with other health services improves access to, for example, tuberculosis and cervical cancer screening, prevention and treatment, and mitigates the impact of gender-based violence. 

COHESODEC together with its partners including women living with HIV can work towards meeting the needs of girls and women across all targets in the in all local communities across Cameroon and working towards ensuring that women and girls everywhere have their rights fulfilled and are empowered to protect themselves against HIV and that all women and girls living with HIV have immediate access to treatment and care.

HIV Treatment

Since the discovery of AIDS in 1981 and its cause, the HIV retrovirus, in 1983, dozens of new antiretroviral medicines to treat HIV have been developed. Different classes of antiretroviral medicines work against HIV in different ways and when combined are much more effective at controlling the virus and less likely to promote drug-resistance than when given singly. Combination treatment with at least three different antiretroviral medicines is now standard treatment for all people newly diagnosed with HIV. Combination antiretroviral therapy stops HIV from multiplying and can eradicate the virus from the blood. This allows a person’s immune system to recover, overcome infections and prevent the development of AIDS and other long-term effects of HIV infection.

COHESODEC researchers and national regulatory authorities, promoted unprecedented investment in AIDS research and accelerated access to new medicines. This enabled new medicines and combinations to get to patients faster than ever before. Pressure from the global AIDS movement also ensured that the prices of new medicines were rapidly brought down to make them affordable to almost every country in the world.

Currently, there are 19.5 million people globally on HIV treatment and over 600,000 living in Cameroon. A person living with HIV who starts antiretroviral therapy today will have the same life expectancy as an HIV-negative person of the same age. Antiretroviral therapy results in better outcomes when started early after HIV infection rather than delaying treatment until symptoms develop. Antiretroviral therapy prevents HIV-related illnesses and disability and saves lives. AIDS-related deaths have globally declined by 43% since 2003. Antiretroviral therapy also has a prevention benefit. The risk of HIV transmission to an HIV-negative sexual partner is reduced by 96% if the partner living with HIV is taking antiretroviral therapy.

Safer and more effective antiretroviral medicines and combinations are increasingly available and affordable for low- and middle-income countries. Current World Health Organization recommended standard first-line antiretroviral therapy for adults and adolescents consists of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus a non nucleoside reverse transcriptase inhibitor or an integrase inhibitor. Fixed-dose combinations and once-daily regimens are preferred. Second-line antiretroviral therapy in adults consists of two NRTIs plus a ritonavir-boosted protease inhibitor.

The effectiveness of HIV treatment is best monitored by measuring the amount of HIV in a person’s blood. If the virus cannot be detected they are said to have viral-load suppression—indicating that their HIV infection is unlikely to progress and they are at very low risk of transmitting the virus to their partner. Viral-load testing is recommended six months after starting antiretroviral therapy and annually thereafter to ensure that treatment is being taken and that drug-resistance has not developed.

HIV treatment works best when taken as prescribed. Missing doses and stopping and re-starting treatment can lead to drug resistance, which can allow HIV to multiply and progress to disease. People living with HIV on treatment need to be provided with the support that they need to overcome the challenges to taking treatment regularly and robust systems to monitor drug resistance must be in place.

COHESODEC works with Programs, with youths as beneficiaries of the HIV response. This youth program was initiated on three cornerstone principles with a robust, cross-cutting focus on advocacy: policy, participation and partnership. The Youth Program was launched in 2016 and was based on the Crowd Out AIDS recommendations developed in collaboration with more than 5000 young people. It advocates for evidence-informed policy through increased strategic information and fosters a decentralized, organic youth-led movement in the AIDS response. This Youth Program strengthens young people’s leadership skills and their ability to operate in a framework that advances evidence-informed HIV responses. 

Human rights

A human rights-based approach is essential to ending AIDS as a public health threat. Rights-based approaches which we embark upon create an enabling environment for successful HIV responses and affirm the dignity of people living with, or vulnerable to, HIV.

With the adoption of the Sustainable Development Goals, United Nations Members States committed to leave no one behind and to end the HIV, tuberculosis and malaria epidemics by 2030. Leaving no one behind requires addressing stigma, discrimination, and other legal, human rights, social and gender-related barriers that make people vulnerable to HIV and hinder their access to HIV prevention, treatment, care and support services.

The AIDS response has demonstrated the importance and feasibility of overcoming legal, human rights and gender-related barriers to HIV services. Through advocacy and litigation, civil society and people living with HIV have been instrumental to advancing human rights in the response to the epidemic. In many communities across Cameroon, their demands have led the government, parliamentarians, donors and partners such as the United Nations to support law reforms, policy change and human rights programs in this regard.

COHESODEC ensures that national human rights standards and commitments translate into action and programs at the country level by supporting stakeholders to build alliances with our Programs and beyond and to respond effectively to human rights challenges in the context of the AIDS response.

Yet these efforts and investments to advance human rights remain largely insufficient in Cameroon. Human rights challenges, including stigma and discrimination, inequality and violence against women and girls, denial of sexual and reproductive health and rights, misuse of criminal law and punitive approaches and mandatory testing remain among the main barriers to effective HIV responses. These challenges particularly affect people living with HIV and key populations. 

Key Populations

COHESODEC and other stakeholders consider gay men and other men who have sex with men, sex workers, trans-gender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.

The global 2016–2021 HIV/AIDS Strategy calls for bold action to Fast-Track the AIDS response across the world. It incorporates a human rights-based approach to development and aims to leave no one behind in the AIDS response. The strategy recognizes sexual and reproductive health and rights issues, calls for comprehensive sexuality education and the removal of punitive laws, policies and practices that block an effective AIDS response, including travel restrictions and mandatory testing, and those related to HIV transmission, same-sex sexual relations, sex work and drug use.

In 2016, outside of sub-Saharan Africa including Cameroon, key populations and their sexual partners accounted for 80% of new HIV infections. Even in Cameroon, key populations accounted for 25% of new HIV infections in 2016.  

The HIV epidemic requires a cross-sector, multi-stakeholder response. The Sustainable Development Goals (SDGs) are part of a complex, ambitious and transformative agenda. It’s realization will require moving beyond business as usual and embracing innovative new partnerships across all sectors of society.

For the AIDS response, partnerships need to embrace the areas of health, development, injustice, inequality, poverty and conflict. HIV has a high cost to society and is a barrier to economic growth. HIV matters to business

Risk

Companies working in countries heavily affected by HIV see improvements in productivity, morale and staff turnover when they take an active, visible role in the AIDS response.

Reputation

Being part of an effective multi-sector AIDS response generates goodwill and demonstrates a company’s commitment to strong corporate citizenship and to the well-being of its employees, customers and communities. 

Opportunities

Forward-thinking businesses forging ahead with sustainable and inclusive business models can radically reshape markets and the future direction of policy. 

Communities

Aligning with communities and meeting their basic needs and protecting human rights will enable companies to forge a new and improved social contract.

We need the business community

Companies can offer business solutions to the AIDS response through:

  • Workplace programs.
  • Policy and advocacy.
  • Innovation and program solutions.
  • Strategic philanthropy.
  • Cause-related marketing.
  • Employee giving program.

Despite remarkable achievements in reducing the number of new HIV infections and increasing access to effective treatment, governments and humanitarian aid institutions struggle to address HIV care needs in emergency and humanitarian contexts and in fragile states. People in those areas face serious problems, with reduced or complete loss of access to HIV prevention, treatment, care and support services. Without significant additional effort, especially with respect to HIV in humanitarian and emergency settings as well as in fragile communities in Cameroon and around the world, the Fast-Track Targets will not be reached.

Social Protection

Social protection schemes reduce gender and income inequalities and social exclusion, all of which increase the risk of contracting HIV. They also make it easier for people to access HIV and other health services and can cushion the social and economic impact of HIV on households and individuals. Social protection diminishes the risk of HIV infection, increases adherence to HIV and tuberculosis treatment and fosters resilience.

COHESODEC’ work on social protection focuses on:

  1. Advocating with the government and other stakeholders on expanding and increasing the HIV sensitivity of social protection programs.
  2. Supporting the generation and application of evidence and strategic information on HIV and social protection towards achieving the Fast-Track Targets.
  3. Tracking progress in attaining the Fast-Track commitment, particularly the commitment on social protection, which seeks to strengthen national social and child protection systems to ensure that, by 2020, 75% of people living with, at risk of and affected by HIV benefit from HIV-sensitive social protection.
  4. Coordinating and guiding stakeholders and partners working on social protection for a coherent engagement in the AIDS response.

Social protection is more than cash and social transfers such as food and vouchers. It encompasses economic support, social health insurance, employment assistance and social care to reduce poverty, inequality, exclusions and barriers to accessing social and medical services. 

Tuberculosis

Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis. TB infection occurs when a person breathes in droplets produced when someone with active TB disease coughs or sneezes. These droplets can remain infectious in the air for several hours in damp enclosed spaces with little ventilation or direct sunlight, such as overcrowded informal housing or prisons. TB infection does not always result in active TB disease; most healthy people are able to kill or contain the TB bacteria. A person who has TB infection, but no disease, cannot transmit TB. Only someone with active TB of the lung is infectious. Overall, a relatively small proportion (5–15%) of the estimated 2–3 billion people infected with TB in the world will actually develop TB disease during their lifetime. However, if a person’s immune system becomes weakened, the TB bacteria are much more likely to multiply, spread and cause active disease. TB disease typically affects the lungs (pulmonary TB), but can also affect any other part of the body (extra-pulmonary TB). HIV infection is the strongest risk factor for TB infection progressing to TB disease. Other risk factors include malnutrition, diabetes, drug use, excessive alcohol use, silicosis, cancer or cancer treatment and old age.

TB is the leading cause of death among people living with HIV, causing more than one third of all AIDS-related deaths in 2015. Almost 60% of the estimated global HIV-related TB cases are not diagnosed and not treated.

New molecular diagnostic tests for TB are increasingly available, which are faster and more accurate than the traditional microscopy tests. They can also detect drug-resistant forms of TB. The lipoarabinomannan (LAM) urine dipstick test can help diagnose TB among people living with HIV with advanced HIV disease (CD4 count <100 cells/mm3). Despite these advances, TB can remain difficult to diagnose in people living with HIV and in children. Clinical algorithms, including X-rays, can be used to determine when presumptive TB treatment is indicated in the absence of a positive TB test.

Without treatment TB is rapidly fatal in a person living with HIV. Treatment of drug-sensitive TB is six months of daily treatment with four antibiotics. It is well-tolerated, effective, and relatively low cost (about US$ 100–1000 total cost) and can be safely combined with antiretroviral therapy.

Drug-resistant TB treatment is more complicated and expensive, requiring three to six second-line anti-tuberculosis medicines for up to two years, often including painful daily injections. The outcome of treatment is worse than for drug-sensitive disease, owing to side-effects, including permanent hearing loss, and interactions between medicines. People living with HIV are twice as likely to die during TB treatment compared with TB patients who are HIV-negative.

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