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“Equalize” Our Path to Ending HIV/Aids in Eritrea

The theme for this World AIDS Day is “Equalize” and it is a call to action, challenging us to recommit to practical solutions needed to address inequalities holding back the end of AIDS.

Data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has fallen behind, resources have shrunk, and millions of lives are at risk as a result. Inequalities still persist globally even for the most basic services like testing, treatment, access to condoms, and certainly for new technologies. Unfortunately, young women remain disproportionately affected by HIV.

We have only eight years left before the 2030 goal of ending AIDS as a global health threat. Eight years may seem far away but, considering the many challenges faced as a global community, it is very short, and we have a lot of work to do.

Having said all of this, I am most h a p p y and even proud to say that Eritrea has registered considerable efforts over the years to combat the scourge of HIV/AIDS.

There is a very strong political commitment and leadership on the matter, which is complemented by a very dedicated healthcare workforce. The country relies on a multi-sector approach that capitalizes on the strengths and value adds of each sector and partner.

HIV transmission in Eritrea has shifted from a generalized to a concentrated epidemic characterized by mostly female sex workers (FSW), long-distance truck drivers (LDTD), and inmates. However, due to a well-managed national HIV response, the prevalence and incidence rates of the virus have declined. The HIV prevalence declined from 1.4 percent in 2001 to 0.5 % in 2020. The HIV incidence dropped from 0.43 per 1000 people to 0.11 between 2005 and 2019. The Spectrum 2020 estimation further indicated that HIV-related mortality had declined from 1,400 deaths in 2005 to 310 in 2019.

The Spectrum 2020 estimation revealed the status of the UNAIDS 90:90:90 Fast-Track targets progress at 86%, 92% and 89% respectively.

The area that I am most privileged to have been a part of is the country’s path toward the elimination of mother-to-child transmission, also known as eMTCT.

Global efforts have transformed the pediatric HIV epidemic, and evidence indicates that the responsibility for a successful eMTCT program is shared between families, communities, health services providers, national authorities, and regional partners.

The adoption of highly effective, evidence-based simplified interventions based on lifelong the risk of HIV infection has been reduced from ~30% to 5% (or 2% for non-breastfeeding HIV-positive mothers). This called for the establishment of criteria and processes for validation of eMTCT of HIV, syphilis and HBV infections (triple elimination initiative) with input from all World Health Organization (WHO) regions. The criteria allow validation to be carried out using a credible, systematic approach that facilitates recognition of countries that have successfully eliminated and sustained eMTCT of infections. In 2021, WHO updated the global guidance on criteria and processes for validation to include eMTCT of HBV. The global guidance outlines the impact and process targets and indicators that countries have to achieve before they apply for the validation of eMTCT.

I am very happy to note that Eritrea, given the significant work exerted in this area thus far, is on track to become one of the first African countries to achieve eMTCT.

The country has achieved consistently high coverage of ANC (above 95%) and HIV testing in pregnant women (above 95%) between 2019 and 2021. The HIV treatment coverage in HIV-positive women was also above 95% in the same reporting period. The population case rate due to vertical transmission per 100 000 live births and the HIV MTCT rate has been zero (0) between 2019 and 2021 in the country which breastfeeding. The number of HIV-exposed infants who tested positive at 18 months (Final Infant Diagnosis) born from HIV-positive women has been decreasing from 1 in 2019 to 1 in 2020 and zero in 2021. This is a remarkable achievement.

Recently, the country established and oriented a National Validation Committee (NVC) to provide oversight in preparing for the validation process. Furthermore, four thematic technical working groups (data, programs, laboratory and gender equality, human rights and community engagement) have also been established and are operational reporting to the NVC. The NVC played a critical role in the pre-validation assessment.

The strengths, opportunities, gaps and challenges in the Eritrean PMTCT program have been identified. The assessment has shown a significant improvement towards eMTCT of HIV and syphilis. The country has also revised the PMTCT program to integrate provision of HBV through the ANC platform.

The pre-validation assessment indicates that the country can verify data quality, systems and services relevant for the eMTCT of HIV and syphilis at service delivery sites, subnational and national level. This can be done through reviewing patients’ cards and clinic registries for completeness data availability, completeness, and timeliness.

Of course, some challenges still remain, and the country has committed to address them and invest in the implementation of the recommendations proposed by the recently conducted Pre-Validation Assessment of Elimination of Mother-To-Child Transmission of HIV, Syphilis and HBV, which form the roadmap for the validation process. Furthermore, all development partners have committed to work with the Ministry of Health to close the gaps identified.

Together, it is possible to end AIDS by 2030.

Therese Poirier

Country Director

UNAIDS, Eritrea

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