At a moment when the 2020 deadline is practically ended, the most recent figures obtained from the National AIDS Control Committee (NACC) indicate that Cameroon records a score of 94-69-79 on the 90-90-90 targets set by UNAIDS. Thus, while the country can boast of having reached and even exceeded the first objective, which was that 90% of the people living with HIV know their HIV status, much still needs to be done for the other two goals one of which is to ensure that 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and the other is to ensure 90% of all people receiving antiretroviral therapy will have viral suppression.
For Fogué Foguito, executive director of the NGO Positive Generation, who advocates for access to health care in Cameroon, this mixed performance can be explained by structural and strategic factors.
“Structurally,” he says, “the existing facilities were not prepared to take on this 90-90-90 concept. Because the technical equipment is not suitable”. “Without external assistance, do we have the structural and technical means to put 90% of HIV-positive people on treatment? Do we have the required human and technical resources to ensure that 90% of people on ARV treatment have viral suppression? How many machines do we have for viral load testing? And at what cost?” He questions to better express his thoughts.
By the way, Fogué Foguito points out that this structural flaw is not unique to Cameroon, but can be found in most African countries; hence, the overall failure of the 90-90-90 target.
With regard to the strategic shortcomings, according to this researcher, UNAIDS currently operates like a “tube box”.
“UNAIDS launched the 90-90-90 cascade without any real preparation, with the thinking that countries will adopt and implement it. And now they have already launched another cascade which is 95-95-95. You can’t move the goals posts all the time when you haven’t even been able to reach the first one”, he insists.
Jeannette Naken, a mother living with HIV/AIDS in Douala, points an accusing finger at the stigma that persists in the Cameroonian society despite multiple awareness-raising campaigns. A situation which, in her view, makes it difficult for many infected or sick people to accept their status. “Even today,” she says, “there are families in which HIV/AIDS remains a taboo subject. As a result, we see people who test positive, but they can’t come to terms with their status. Likewise, when you try to explain to people the need to stop by the mobile screening units to get tested for free in just a few minutes, some people are reluctant”.
According to Yap Boum II, a lecturer at the Faculty of Medicine of the University of Yaoundé I and a researcher at Epicentre with Médecins sans Frontières (Doctors without borders), the 90-90-90 target was somewhat “ambitious”. This is why few countries have been able to achieve it.
Avenues of solution
Therefore, he suggests some avenues of solution that could help Cameroon improve on its performance towards achieving the new objective which is 95-95-95 by 2030. “Screening has been carried out during events, in public places, in schools, this is a first step,” he says. But the challenge is that we must change our philosophy and go even further to take the diagnosis to the community and not the community to the diagnosis”. Concretely, he believes that we must get to a point where it is not the people who go to the screening centers and places, but rather the screening centers and places that go to the people in a kind of door-to-door screening campaign, with a large participation of community health workers. “We see many street vendors moving door-to-door in villages and cities to offer their products. I think we should envisage the same approach to HIV testing,” says the lecturer.
And naturally, Yap Boum II welcomes the deployment of new tools, such as “self-testing”, which, in his view, gives everyone the opportunity to test themselves at home using “relatively simple” procedures.
As far as the management of the disease is concerned, Fogué Foguito believes that the objectives of the fight against HIV-AIDS can only be successfully achieved through the implementation of universal health coverage (UHC). In his opinion, while UHC is not a panacea, “it constitutes a significant lever for achieving a number of major objectives in the health sector, including the fight against HIV/AIDS; insofar as UHC makes it possible to pool expenditures”. However, he emphasizes that it is necessary to first of all ensure that the health system itself is adapted to these challenges and that the strategies implemented are tested before they are scaled up, and that they take into account the local realities of each country.
On the issue of adapting health systems, Yap Boum II insists on the urgent need to put an end to the stigma that exists in the management of patients. “ When they go to the hospital, HIV-positive patientsmust queue up on the line of patients living with HIV/AIDS. Here again, there is a strong stigma that discourages some people who would have liked to go on treatment,” he points out. Consequently, this researcher believes that with the development of telemedicine, the authorities and other health sector actors have the opportunity to find a way for patients to receive their drugs in a more confidential way, without neighbours, friends and family knowing that they are HIV-positive.
Finally, Jeannette Naken draws attention to the “very strict” nature of the daily intake of HIV/AIDS medication, which could explain the failure of the last two “90s”. “It would be desirable,” she argues, “to find a way to reduce the frequency of the intake of antiretroviral drugs. Because it’s really not easy to take them every day without skipping. It’s not easy at all.
For its part, the NACC, that did not answer our questions, states in a document that the Government has taken measures to address “several barriers such as geographical accessibility, the quality of services, and socio-economic and cultural barriers identified as obstacles to achieving the 95-95-95 objectives by 2030, in particular, the third 95”.