By M. Dennise Nimpson
Fellow, AAMIN Health and Human Rights Journalism Fellowship
Liberia: Stakeholders in the HIV response in Liberia say the surest way to end AIDS by 2030 as a public health threat is to combine efforts in encouraging treatment adherence for persons living with HIV to accomplish the Undetectable and Untransmittable (U=U) level.
U=U means people living with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the blood—by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others.
Liberia has a generalized HIV epidemic with reproductive aged population showing HIV prevalence of 2.1%, according to the 2013 Liberia Demographic and Health Survey (LDHS), although UNAIDS 2021 Spectrum estimates put indicates 1.1%, with an estimated HIV population of 35,000 with significant variations in HIV prevalence existing between and within regions and counties.
The LDHS revealed that HIV prevalence is higher in urban areas (2.6%) than in rural areas (0.8%). The South-Central Region has the highest prevalence of 2.8% among the five regions, with Montserrado, Margibi, and Grand Bassa counties having the highest HIV prevalence among the 15 counties, accounting for about 70% of the burden of disease in the country.
Also, an Integrated Bio-Behavioural Surveillance Survey (IBBSS) conducted in 2018 revealed a high HIV prevalence among predominately male key population sub-groups, which include men who have sex with men (MSM), People Who Inject Drugs (PWIDs) and female sex workers among others.
According to the survey, MSM account for 37.9% of HIV infection rate, 9.6% for People Who Inject Drugs (PWIDs) and 16.7% for female sex workers.
The IBBSS report revealed that “except for miners, the HIV prevalence in all key populations has risen by a minimum of 70% for FSW and a maximum increase of 252% for Uniformed Service Personnel and 270% for PWID. The HIV prevalence for MSM and transport workers has doubled from their values in 2013”.
Highlighting the effectiveness of the U=U as one of the strategies to end AIDS in Liberia, the Program Manager of the National AIDS and STIs Control Program (NACP), Dr. Julia Toomey-Garbo said the approach is progressively aiding the country’s program toward the achievement of the 95-95-95 target.
Dr. Toomey-Garbo said, “The strategy…..where we are, we started doing our viral load suppression but we had a good number.”
“We have a very good number of persons living with HIV (PLHIV) who have undetectable viral load because they have been on their treatment for a long time and adhering to their treatment, so based on that… they are undetectable. Therefore, they will be unable to transmit the virus, Dr. Toomey-Garbo said.”
According to Dr. Toomey-Garbo, the need to continue the method should be done through publicity to include outreach that will create the needed awareness to sensitize those living with HIV who are not knowledgeable of such to gain hope and utilize the U=U approach.
“We have developed messages to be aired on radio and to erect billboards, telling people that it is important to adhere to their treatment, that once they are undetectable the virus will be untransmittable,” she said.
“So, the government needs to do more, commit domestic funding to the response so that even if we can’t reach zero, we should be able to reach epidemic control.” Madam Garbo indicated.
The NACP program Manager expressed optimism that once there is continuous awareness to include effective community engagements with the involvement of Civil Society Organizations, ensuring the adherence to treatment, the 2030 projection will be achievable.
“We know that this approach can make us reach epidemic control because once I have an undetectable viral load, I am unable to transmit the virus to another individual. So if we push this approach using community engagement and the CSO partners to be able to create demand, create peer-peer awareness that encourages adhere to treatment….. we can reach our desire target by 2030.” Dr. assures.
One of those directly involved with the U=U program in Liberia is madam Josephine Godoe, Executive Director of the Liberia Network of persons living with HIV (LibNeP+), she confirms the importance of ensuring a reduced HIV infection.
“My husband and I have been together for more than ten years and he’s not positive because I am virally suppressed. Once I am suppressed for him to contract HIV from me is going to be very difficult,” Josephine said.
In an interview with a team of Anti-AIDS Media Network specialized health and human rights reporters in Monrovia, madam Godoe said, “If the population can understand that U equals U cannot allow your positive partner to transmit to the negative partner, I think we will be able to reach far.”
Madam Godoe who spoke with so much boldness, emphasized the need for more awareness to present U equals U as a remedy to achieving 2030.
Also speaking, the President of LibNeP+, Wokie Cole said lack of understanding is responsible for stigma and discrimination against persons living with HIV in the country.
“I want people to understand that HIV is no longer a death sentence, and that is the benefit of U equals U,” Wokie added.
“How will we reach there by 2030 when even the 90-90-90 they are talking about we haven’t reached there and they come up with 95-95-95? People still need to get on treatment…we have not reach there,” Wokie wonders.