About the possibility of controlling an HIV epidemic hotspot

This article was first released in the 18th volume of the Humanitarian Alternatives magazine.

Designed to reduce the incidence of HIV/AIDS in a Kenyan district, a Médecins Sans Frontières project successfully exceeded the “90-90-90” target set by UNAIDS. A look back on the results that the authors of this article - Pierre Mendiharat, Deputy director of operations at MSF France and Léon Salumu Luzinga, Program manager at MSF France, interviewed by Elba Rahmouni - believe are encouraging but by no means a guarantee that the epidemic will be over by 2030.

Despite strong international mobilisation over the last decades that has enabled significant advances in the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the disease continues to kill on a massive scale, as is the case in Kenya, in the rural district of Ndhiwa in the county of Homa Bay.Kenya has been composed of forty-seven counties, each divided into districts, since the decentralisation of power introduced by the new constitution adopted in 2010. The ancient province of Nyanza, situated on the shore of Lake Victoria in the southwest of Kenya, includes the county of Homa Bay, itself divided into eight districts, including the district of Ndhiwa.Although there is still no definite treatment or vaccine, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set itself the ambitious goal of ending the HIV/AIDS epidemic by 2030, in particular through the implementation of the strategy known as the “90-90-90” target (or “treatment cascade”): 90% of all people living with HIV should know their HIV status, 90% of all people with diagnosed HIV infection should receive sustained antiretroviral therapy (ART) and 90% of all people receiving ART should have viral suppression. These bold claims were put to the test in a five-year programme launched in 2014 by Doctors Without Borders (Médecins sans frontières – MSF) and Kenya’s Ministry of Health in the district of Ndhiwa. Previously, the Ndhiwa HIV Impact in Population Survey 1 (NHIPS 1) conducted by Épicentre (MSF’s epidemiology centre) in 2012 had brought to light HIV incidence and prevalence figures amongst the highest in the world. Six years later, a new Épicentre study, NHIPS 2 Médecins Sans Frontières, VIH : l’amélioration de la prise en charge a fait chuter la proportion des personnes infectées dans l’un des foyers les plus touchés au monde, 24 novembre 2020, https://www.msf.fr/communiques-presse/vih-l-amelioration-de-la-prise-en-charge-a-fait-chuter-la-proportion-des-personnes-infectees-dans-l-un-des-foyers-les-plus, demonstrated that the “90-90-90” target had been exceeded. With incidence in significant decline, yet still elevated, can this truly be considered a success?

READ THE ARTICLE