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SIGNIFICANCE OF THE UNDETECTABLE EQUALS UNTRANSMITTIBLE (U = U) CONCEPT/CAMPAIGN ON THE LIVES OF PEOPLE LIVING WITH HIV

 by: VICTOR EBOH ESQ                                                                                            (LEGAL/REPRODUCTIVE RIGHT OFFICER) LAWYERS ALERT

LAWYERS ALERT

1st day of December of every year is designated as WORLD AIDS DAY, an international day dedicated to raising awareness of the Aids pandemic caused by the spread of HIV infection and mourning those who have died of the disease.

 

There is no known cure for HIV/AIDS in the world today. However, treatment for

HIV, offers hope for people living with the virus. According to the UNAIDS Fact Sheet (2019), there are 37.9 million people living with HIV, globally.

Out of this number, 24.5 million people are accessing HIV treatment.

 

In Nigeria, UNAIDS (2018) estimated that 1.9 million people in Nigeria were living with HIV, however, in 2019 statistics indicate a 1.4% HIV prevalence rate among adults aged 15-49 years in Nigeria. Consistent and effective HIV treatment leads to improved health outcomes for people living with HIV.

Scientific evidence holds that people living with HIV who have an undetectable viral load cannot transmit HIV via unprotected sex to their partners. This is the basis for the undetectable equals untransmittable (U=U) concept.

 

CONCEPT OF UNTRANSMITTABLE (U = U)

 

The U=U Campaign was started by PREVENTION ACCESS, an organization in

the United States which seeks to raise awareness and ensure universal access to

treatment for people living with HIV. It is beneficial for people who are diagnosed

with HIV to start treatment early and adhere, by remaining on treatment. This

reduces the amount of HIV in the blood stream to an undetectable level. In simpler

terms, an undetectable HIV viral load means that the amount of HIV in the blood is

negligible.

 

The Centre for Disease Control, CDC (2019) holds that most people on

HIV treatment achieve an undetectable viral load within six (6) months of initiating

HIV treatment. This occurs as long as they consistently take the medication as

prescribed. After, the initial six (6) month period, adherence to HIV treatment is

advised to ensure that the HIV viral load stays undetectable. While the CDC (2019)

defines an undetectable viral load as having less than 200 copies of HIV per mililitre

of blood, the Canada AIDS Treatment Information Exchange, CATIE (2018) notes

that, HIV viral load is undetectable when it is less than 40 to 50 copies of HIV per

mililitre of blood.

 

The U=U concept is supported around the world by renowned organizations. The

World Health Organization, WHO (2019) cites an empirical study to the effect that,

the risk of HIV transmission through sex, where condoms are not used, in sero-discordant couples is effectively zero when HIV viral load is suppressed through

ART treatment. The WHO recommendation to initiate ART in all people living with HIV will contribute significantly to reducing HIV transmission.

 

From the foregoing, there is no risk of HIV transmission through unprotected sexual

intercourse from a person living with HIV to a negative partner as long as the former

is on HIV treatment and has achieved an undetectable viral load. This finding has far

reaching implications on the relationships and interactions between people living

with HIV and those who are HIV negative, especially surrounding stigma and

discrimination.

 

People living with HIV often suffer stigma from other members of the public when they know the HIV status of the former. Thus, scientific evidence such as U=U which supports the fact that people living with HIV who consistently adhere to HIV treatment, and become undetectable, cannot transmit HIV through unprotected sex, “strikes down” the reason for the stigma and discrimination against people living with HIV.

In addition, UNAIDS (2018) lends credence to the U=U concept with its submission

that, there is a strong scientific consensus that people living with HIV who are taking effective antiretroviral therapy and whose level of HIV is suppressed to undetectable levels, will not transmit HIV sexually.

 

This evidence from UNAIDS (2018) is borne from twenty (20) years of research

which demonstrates that effective treatment of HIV reduces the risk of HIV

transmission. Due to this fact, the U=U concept validates previous concepts such as

Treatment as Prevention (TasP). The reasoning is logical. If HIV treatment reduces

the risk of HIV transmission, then it simply means that HIV treatment is an effective

strategy at preventing the transmission of HIV from one person to another. However,

it is important to reiterate the conditions necessary for which transmission of HIV

will not occur. The person living with HIV, has to adhere to HIV treatment and consistently maintain an undetectable HIV viral load.

In Nigeria, (and indeed most countries of the world) HIV treatment services are free and viral load tests are conducted once every six (6) months. There is a persistent need to ensure that user fees are not charged to encourage access and uptake of HIV treatment.

Strict adherence to HIV treatment is advised for people living with the virus. This is

necessary because consistent HIV treatment ensures that the virus remains

undetectable over a long period and reduces the risk of transmission via unprotected

sex to zero (0). Thus, people with effective HIV treatment cannot transmit the

virus  through unprotected sex. This has far reaching implications on public health

and should re-configure popular perception about HIV especially the way people

living with HIV are treated in society.

 

Evidence for further validation of the U=U concept is provided by findings from

other empirical studies. Three (3) large studies (undertaken between 2007 and 2016)

were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al

(2016), and Grulich et al (2015). In each of these studies, the researchers investigated

sexual transmission of HIV among thousands of couples. With each of these couples,

one partner was living with HIV and the other was not, i.e. sero-discordant.

Findings from these studies show that there was not a single case of HIV transmission from the partner living with HIV (who had achieved undetectable levels of HIV) to their HIV negative partner. (Source: Rural Renewal & community Health Development Initiative)

 

Conversations as well as public enlightenment about the U=U concept are necessary

In the society to combat the stigma and discrimination which people living with HIV

face, especially regarding inter-personal relationships, family and even in the work

place. With the empirical evidence presented on U=U, people living with HIV

should not be barred from marriages and romantic relationships with others who are

HIV negative. They pose no risk because they cannot transmit the HIV virus through

unprotected sex. Sero-discordant couples have the potential of raising children

without the risk of transmitting HIV. Also, marital disharmony owing to HIV

diagnosis of one partner should not arise.

 

CONCLUSION

 

The concept of U=U offers hope to people living with HIV because HIV treatment

affords dignity, inclusion and acceptance in society. With effective public

enlightenment via relevant communication channels, notions of HIV/AIDS as a

deadly epidemic can be replaced with the U=U concept which demonstrates how

HIV transmission can be stopped. The hope and benefits from maintaining

undetectable levels of HIV will encourage people living with HIV to access HIV treatment services because it is a means to an end. Families, relatives and partners will be more accepting and supportive to persons living with HIV because they are no longer threatened by HIV transmission and treatment holds greater promise for better health outcomes.

Furthermore, countries and legal systems which impose travel bans as well as

criminalize people living with HIV on account of disclosure and so called “intended

HIV transmission,” need to revise these laws via necessary steps in the judicial

process. The scientific evidence from existing research is sufficient basis for judicial

reform in this respect. Also, the police, vigilante and other security agencies require

education and enlightenment on the U=U concept in order to guide the

administration of justice when complaints and disputes regarding HIV transmission

are brought before them.

References:

1. Three (3) large studies (undertaken between 2007 and 2016)

were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al

(2016), and Grulich et al (2015)

2. UNAIDS (2018) is borne from twenty (20) years of research

which demonstrates that effective treatment of HIV reduces the risk of HIV

transmission.

3. The World Health Organization, WHO (2019)

4. Canada AIDS Treatment Information Exchange, CATIE (2018)

5.  The Centre for Disease Control, CDC (2019)

CAVEAT

Lawyers Alert hereby puts our readers on notice that this article is based on the writers opinion and do not necessarily represent the views of the organization except otherwise stated.

 

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BENUE STATE HIV NON DISCRIMINATION LAW; PREGNANT WOMEN, CHILDREN AND THE UNBORN CHILD, HEALTH CARE AND EDUCATION.

By James Apeh

In Nigeria more than 5 million women give birth yearly. One out of every twenty is HIV positive. The chance of an infected woman giving the infection to her child is about 30%. In Nigeria about 60,000 children are born HIV positive every year. Most will not survive beyond their 5th birthday. Coupled with this is the high rate of ignorance about mother-to-child transmission of HIV and its prevention in the country. The Benue state government recently passed the people living with HIV AIDs (Anti Stigmatization and Discrimination) law 2014. The law provides for the protection of the rights of people living with HIV AIDs. How has the law made provisions for the protection of women children and the unborn child? Specifically what obligation has the law created on the government in the provision of healthcare and education to this vulnerable group i.e. women and children and the unborn child in the society.

Section 9 of the law provides:

 The following persons shall be subjected to routine HIV/AIDs testing for purposes of prevention of HIV/AIDs transmission

(a) Pregnant women

The implication of this section is that an obligation has been created on the government of Benue state to provide HIV testing service for pregnant women in the state.

Section (10) provides:

A health unit providing common health care services, ante-natal care family planning service or special or general treatment, shall offer HIV/AIDs testing services to persons

The implication of this section is that every government health unit offering common health care service, antenatal care services, family planning services or special or general treatment should be able to also offer HIV/AIDs testing services, thus the government is obligated to provide necessary facilities or equipments to these health units to offer HIV/AIDs testing services.

Section 11(i) provides:

A pregnant woman who is tested and found to be HIV/AIDs positive under section 4 shall be entitled to appropriate treatment, care and support and routine medication to prevent HIV to the child.

By this provision, a HIV positive pregnant woman is entitled to free treatment and medication to prevent the transmission of HIV to the unborn child. Also the child in this case is entitled to be protected form being infected from HIV AIDs where possible.

Section 11(ii) provides:

A child who is of an HIV positive mother shall be given immediate appropriate treatment care, support and routine medication.

The implication of this provision is that it is the right of a child of a HIV positive mother to be given appropriate treatment and support. The government is by this obligated to provide necessary health care to a child of a HIV positive mother.

Section 12(i) provides:

A child who is born of a mother who is HIV positive shall be tested for HIV as soon as it is medically practicable.

The implication here is that the government is obligated to provide HIV testing service to a child born of a HIV mother.

Section 12(ii) provides:

A child who tests positive to HIV under subsection (i) of this section shall be given HIV/AIDs treatment, care and support

This provision creates an obligation on the government to provide health care services to a child found to test positive to HIV.

Section 35(i) provides that

Government shall provide the necessary support systems and structures for people living with HIV/AIDs to seek redress

This provision obligates the Benue state government to provide among other facilities legal representation for PLWHA to seek redress for violation of their rights created by this law.

Section 35(ii) (e) provides

 The government shall devise measures to

(e) Develop and promote awareness, rights and duties imposed on persons under this law.

The government by this provision is obligated to educate the populace including pregnant women on their rights under this law.

Section 34 provides

Any person who has been stigmatized and discriminated against may sue for damages and other civil claims or remedy in the court of competent jurisdiction or high court of the state

The law by the above provision confers on the state high court with the jurisdiction to try cases where the rights of pregnant women and children have been violated.

In conclusion the law has addressed some important issues in its effort to protect the mother and child from HIV transmission. It has provided a legal frame work for the compulsory testing of pregnant women, provided a legal framework for the use of  HIV Counseling and Testing (HCT) services especially within maternal health care units, provided a legal framework for HIV positive women to be properly counseled, Provided a legal framework for the testing of children of HIV positive mother and the care of such children. The law has also provided a framework for the education of mothers and the general population about prevention of mother to child transmission of HIV and  it has provided a legal framework for the provision of legal and healthcare services for PLWHIV including HIV positive mothers.

 James Tor Apeh is a Legal Officer with Lawyers Alert

 
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Posted by on February 18, 2015 in HIV/AIDS & HUMAN RIGHTS

 

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