Day: December 1, 2022

Cameroonian health workers and people with HIV marched for World AIDS Day on December 1, calling for access to treatment for patients in conflict areas.

About half a million Cameroonians have HIV, and at least 1,000 live in troubled western regions and the border with Nigeria. The protesters urged Cameroon’s military, separatists, and militants to allow all HIV patients access to needed treatment.

Marie Chantal Awoulbe, who belongs to the Cameroon Network of Adolescents and Positive Youths, which encourages those with AIDS to get regular treatment, took part in the protest and World AIDS Day activities at Chantal Biya International Research Centre in Yaounde. The center carries out research on AIDS, and supports programs to treat and support vulnerable people with HIV.

Awoulbe said her network is asking both armed groups and government troops to stop deaths among people with AIDS where there are armed conflicts by allowing the patients access to regular treatment.

Cameroon’s public health ministry says similar protests and activities to encourage free screening took place in 70 hospitals, with at least 30 hospital workers and people with AIDS taking part at each of the hospitals.

The Cameroon government accuses separatists in the country’s west of attacking hospitals and abducting health care workers. Activists also accuse government troops of attacking and arresting hospital staff suspected of treating civilians the military believes are either fighters or sympathize with separatists.

In April, medical aid group Doctors Without Borders suspended work in Cameroon’s troubled Southwest region to protest the rearrest of four of its staff members. Authorities accused the staffers of cooperating with regional separatists, but the organization denied it.

Medical staff members say intimidation and abduction of health workers, and ceaseless battles between government troops and separatist fighters make it impossible for medical supplies to reach the troubled English-speaking regions.

Twenty-eight-year-old Betrand Lemfon said he and several dozen people with AIDS moved from Jakiri, an English-speaking northwestern town, to Bafoussam, a French-speaking commercial city. He said he and others with the disease were afraid of dying in Jakiri because they did not have access to regular treatment.

“There are a lot of persons out there who are in need of medications, so if we could have the opportunity and chance for medications to always reach every interior part of the North-West region, South-West region who are hit by the crisis, it will help the adolescents, young persons and children living with HIV to take their ARVs [antiretroviral medicines] and stay healthy,” he said.

Lemfon spoke via the messaging app WhatsApp from Bafoussam.

Cameroon’s military says it will protect all health workers and civilians in the troubled regions.

The government says the number of people with the disease in Cameroon has decreased from about 970,000 in 2010 to 500,000 in 2021.

Health officials say the decline is due to increasing awareness of the disease and its consequences. The government says sexual behavior is changing, with the number of people using condoms or abstaining from sex increasing.

Honorine Tatah, a government official in charge of AIDS control in Cameroon, said unlike in 2020 when there was resistance due to lack of awareness, many more civilians now accept systematic screening for HIV.

“During antenatal care, a woman is screened for a number of diseases including hepatitis B, HIV and if you are tested positive, you are eligible for treatment and that treatment will reduce the chances of a child getting infected with HIV. The treatment is free of charge,” Tatah said.

World AIDS Day was the first international day for global health, starting in 1988. It allows people all over the world to join in the battle against HIV, to support those with HIV, and to remember those who have died from an AIDS-related illness.
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A new, long-lasting drug could be a game-changer for preventing HIV infections, experts say.

Advocates are hopeful that those who need it most in low- and middle-income countries will not have to wait for it as long as they have for previous HIV drugs. But questions remain about access and price.

The drug is called cabotegravir and is delivered as a shot once every other month. In clinical trials, it did a better job at preventing infection than another option — a pill taken once a day.

The bimonthly injection seems to be an easier treatment regimen to stick to than daily pills, according to Mitchell Warren, executive director of AVAC, an HIV prevention advocacy organization.

“If you can take a pill every day, that’s great. But if you can’t, we see a lot of people who start [taking the pills] who don’t continue,” he said.

Aside from the inconvenience, there can be a stigma attached to taking the pills, Warren said. The drugs for prevention, called pre-exposure prophylaxis, or PrEP, are the same as the drugs used to treat HIV infection.

“If you’re a young person and your parents find your pill bottle, they say, ‘Why are you taking this pill? Are you HIV infected?’ And the young person may say, ‘No, I’m protecting myself,'” Warren said. “And they say, ‘Well, why are you having sex?'”

Long-lasting drugs like cabotegravir or another new product, a once-a-month vaginal ring, offer patients more choices, he added.

About 1.5 million people were newly infected with HIV in 2021, according to the World Health Organization, about 60% of them in Africa.

Uganda and Zimbabwe approved cabotegravir for PrEP earlier this year. They are the first countries in sub-Saharan Africa to do so.

These approvals come less than a year after the U.S. Food and Drug Administration authorized it.

That’s progress, Warren said. FDA approved PrEP pills in 2012, but “it took three years before any African regulatory agency approved it. So, we’ve already seen a condensing of that timeline.”

Cabotegravir costs $22,000 per year in the United States. ViiV Healthcare, the company that makes the drug, has not officially announced what it will cost in low- and middle-income countries, but it is expected to be much lower. Some aid groups have indicated that ViiV will offer the drug at $250 per year.

“The problem is that actually that won’t be really affordable for countries who need to roll it out and scale up,” said Jessica Burry, a pharmacist with humanitarian group Doctors without Borders.

PrEP pills cost about $54 per year, Warren said.

“The hope is that early in 2023, we can see a price point that is much closer to that 54 [dollars] than to the 250 [dollars],” he said. “Hopefully, in the $100 range per year.”

ViiV said it is working with the U.N.-backed Medicines Patent Pool to allow generic manufacturers to produce cabotegravir at a lower price for low- and middle-income countries.

ViiV said cabotegravir is more complicated to manufacture than most HIV drugs. No generic manufacturers have been selected yet. Once they are, it will take about three to five years before a generic version is on the market.

The company has filed for regulatory approval in 11 countries so far. Burry says there should be more.

“If they’re going to be the only supplier for the next four or five years until generics are available, then they really need to step up to the plate and actually file, register and get that drug available,” she said.

Demand for the drug is unclear. PrEP pills have been slow to catch on.

About 845,000 people in more than 50 countries took them in 2020, but the United Nations was aiming for 3 million by that time.

“We don’t have a ton of PrEP users, so if you’re ViiV, you’re looking at a very small market,” Warren said.

Warren said providers and advocates need to help grow that market. They need to do a better job connecting people at risk with programs that offer PrEP, he added.

“Some of the early PrEP programs began with us thinking that if you just bought the product, people would magically show up,” he said.

Warren hopes to change that as part of a coalition that includes ViiV, the Bill and Melinda Gates Foundation, the World Health Organization and others.

“There’s a huge effort in this coalition to bring in civil society from day one, and the communities that this product is meant to help and support,” he said.

The slow uptake means PrEP has not yet shown that it can make much of a real-world impact, Warren noted. He hopes to see research programs launch next year to find the best ways to reach the communities most at risk and lower infection rates.

“If we can’t show that in the next three years, then we don’t necessarily need all these generic manufacturers, because there will not be a market for this product,” he said.
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