The Tale of Two Epidemics: HIV/AIDS in Ghana and Namibia

Abstract

Background: In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) introduced the 90-90-90 goals to eliminate the AIDS epidemic. Namibia was the first African country to meet these goals. Objective: To construct a comparative historical narrative of international and government responses to the HIV/AIDS epidemic in the two countries, to identify enabling and non-enabling factors key to mitigate the HIV/AIDS pandemic. Methods: We conducted a desk review of public documents, peer-reviewed articles, and media reports to evaluate actions taken by Namibia and Ghana’s governments, donors, and the public and compared disease prevalence and expenditure from all sources. Results: Namibia’s progress is due to several factors: the initial shocking escalation of infection rates, seen by donors as a priority; the generalizability of the epidemic generated, which resulted in overwhelming public support for HIV/AIDS programs; and a strong health system with substantial donor investment, allowing for aggressive and early ramp up of ART. Modest donor support relative to the magnitude of the epidemic, a weak health care system, and widespread household cost-sharing are among the factors that diminished support for universal access to HIV treatment in Ghana. Conclusion: Four factors played a key role in Namibia’s success: the nature of the HIV/AIDS epidemic, the government and international community's response to the epidemic, health system characteristics, and financing of HIV/AIDS services. Strengthening the health systems to support HIV/AIDS testing and care services, ensuring sustainable ART funding, empowering women, and investing in an efficient surveillance system to generate local data on HIV prevalence would assist in developing targeted programs and allocate resources to where they are needed most.

Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage

“…Though Ghana adopted the World Health Organization (WHO)’s “treat all” policy, which offers ART to all people living with HIV (PLWH) irrespective of their CD4+ T-cell count [ 21 ], in September 2016, the country fell short of achieving the UNAIDS “90–90–90” goals (where 90% of PLWH would know their status, 90% of those who know their status would be on antiretroviral therapy [ART], and 90% of those on ART would be virally suppressed, by 2020). As of 2018, an estimated 58% of Ghanaian PLWH knew their status, 78% of whom were on ART, and of whom 68% had suppressed viral load on ART [ 22 ].…”

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study

“…In support of this study, previous research claims that the recruitment of staff, as well as improving the provision of resources, would be a significant step in reducing the incidences of PU (Acosta-Hernández et al, 2023;Casal-Guisande et al, 2020;Cho et al, 2020), yet making this a reality is difficult in resource-limited settings (Oleribe et al, 2019;Yaya et al, 2020) Halasa-Rappel et al, 2021;Nyarko, 2023). Therefore, further research is thus needed to examine the impact of relying on donor funding in Namibia in relation to addressing lack of both physical and human resources.…”

“…Many developing countries, including Namibia, rely heavily on donations from well‐to‐do countries in the West (Yaya et al., 2020 ), thus addressing issues such as staff shortages is a challenge given the state's inadequate funding of the public health sector. Namibia currently relies on external funding from agencies such as the United Nations Programme on HIV/AIDS (USAIDS), the United Nations International Children's Emergency Fund (UNICEF), and the President's Emergency Plan for AIDS Relief (PEPFAR), and donations from global funds (Andayani et al., 2020 ; Halasa‐Rappel et al., 2021 ; Nyarko, 2023 ). Therefore, further research is thus needed to examine the impact of relying on donor funding in Namibia in relation to addressing lack of both physical and human resources.…”

Adaptation and feasibility of Many Men Many Voices (3MV), an HIV prevention intervention to reduce intersectional stigma and increase HIVST among YSMM residing in Ghanaian slums – A clustered pre-post pilot trial protocol.

“…Many feel unable to discuss HIV prevention or even purchase or carry condoms due to societal perceptions against premarital sex among young people in Ghana [27][28][29][30] . The US President's Emergency Plan for AIDS Relief (PEPFAR) and the Ghana AIDS Commission have acknowledged the necessity to focus on YSMM and other priority groups 20,23,31 . Moreover, global surveillance data highlights exceptionally high HIV incidence among YSMM in SSA and globally, due to unique barriers to HIV testing, including low-risk perception, active sexual engagement, and limited testing practices within this demographic 24,32,33 .…”

“…Consequently, YSMM in these communities may confront not only stigma related to HIV, sexuality, and gender expression but also the stigma attached to their place of residence, potentially leading to internalization of stigma that impacts their willingness to undergo HIV testing. The spotlight on slum areas aligns with the Ghana National AIDS Control Programme and PEPFAR's strategies, focusing on redirecting HIV behavioral interventions from a generalized approach to targeting high-risk geographical areas burdened with HIV prevalence 20,23,31 . Although limited, our formative work in Ghana shows that increased ISD and apprehensions regarding con dentiality and privacy in healthcare settings act as signi cant barriers to testing 1,[3][4][5]13,61 .…”