More men are infecting women with HIV— John Eliasu Mahama

[00:00:00]It's been a very busy uh news morning because the other issue we're going to be talking about has to do with HIV AIDS. But before then, there's uh we're getting some news that's coming through has to do with the former finance minister Keno Forata. Now the there's been a case where the OSB has been trying to get him um extradited to Ghana to make a case against him. Now court in the US, an immigration judge has ruled that um on that case whether Kenophoriata engaged in criminal wrongdoing tied to a state contract with SML. The judge um is saying that the OSB's case lacked persuasive proof or evidence of criminal wrongdoing. And uh it's it's open to interpretation. Essentially, it it uh makes it makes it a little bit more difficult for government's quest to want to bring down the former for former finance minister to Ghana so that he can face um prosecution or he can he can be be sent to court. So that's um one other issue that's just come up while we've been on the show.

[00:01:20]Now the HIV AIDS matter is also something that's threatening our existence and robbing us of uh our human resource which is why it's a very important uh conversation.

[00:01:37]Now I have been joined in in the studio this morning by um Johnasu Mahama who's the acting director policy and planning Ghana AIDS commission and Dr. Elizabeth Ajari who's the national aid control program. Good morning to you both and uh thank you for for making time.

[00:01:59]>> Good morning. Thank you for having us.

[00:02:02]>> Yes to be with us. Now, this is a very important conversation and um here's what I would the way I'd want us to approach it. So, the new stats having to do with 2025 HIV AIDS stats have been put out. I would want us to break down the statistics, not jump at the headlines. There's some headlines and some highlights that have come up, but I would want us to go through it and uh systematically get people to appreciate what we're dealing with right now.

[00:02:42]and the one of the headlines I'm getting from it is okay it's there's been a decline of some sort but I don't want us to look at it that way because if people get the impression that oh there's been some decline they feel that yes what's then what's it's what's why should we be worrying >> or there's no cause for alarm there's no cause for concern But beyond the decline, we're looking at the absolute figures and those figures are wild.

[00:03:21]So, we're looking at the number of people who have been infected right now as we speak and it's 300 and more than 300,000 people.

[00:03:36]Okay. So let's not look at the whatever decline is happening. We should look at the absolute figures.

[00:03:46]What's the actual figure? I want to start with you.

[00:03:49]>> Yes. Thank you very much Israel and thanks again for having us. Um I like the way you framed it because really it's a combination of the two issues that one we are making some progress.

[00:04:02]Yeah. But that progress is too slow and too little. So if we look at the targets that we set our for ourselves, we actually are not on on track. So that's the first message that there is progress but that progress is insufficient. And the second message also being that HIV still remains sorry it still remains a major public health challenge. Yes. So if we look at the data as you rightly mentioned in at the end of 2025 we had a cumulative figure of over 337,000 living with HIV. This is cumulative those who are living with it. Of course it doesn't include deaths and so on but actual survivors the estimated number at the end of 2025 is the 300 over 337,000.

[00:04:53]Now the data also showed us or we're also able to estimate the number of new infections that happened last year and that is where some gains have been made compared to the previous year but again to record over 13,000 new infections in fact very close to 14,000 because it's 13 951 13,951 new HIV infections in that one single year alone.

[00:05:23]>> So that still represents a very big number of new HIV infections happening and especially happening at a time when we know that we have effective proven interventions that can reduce these new HIV infections. So these are just part of the key statistics that were released yesterday. But I think what is also key about the new statistics is the fact that is disagregated by region and also up to the district level. So now it allows us to take a more precise approach in our targeting so that uh especially at a time where resources for HIV are reducing it's really important that we are able to use this differentiated approach so that in districts or regions where the prevalence is relatively higher we can target there much more than areas where is a bit lower. Of course, we don't want to keep our eyes off the ball and say that okay, this area is so low that there will be nothing because we've seen in the past where areas where we thought prevalence was low and we didn't pay sufficient attention over a few years then it begins to grow up in those areas. So there will be blanket or at least a minimum package of HIV interventions that are out there for everyone within the country. But in populations, population subgroups and locations where prevalence is higher, we are able to target there a bit more.

[00:06:54]>> Okay. Now the other thing I'd want us to uh look at you mentioned that there are proving interventions that that are working and I would want to come to you for you to discuss what are these proving interventions.

[00:07:08]Let's reiterate them for people to you know get to appreciate and we we we should emphasize or yes let's emphasize the preventive measures or interventions.

[00:07:22]>> Okay. Um so thank you very much. So um the ABCD we've been talking about it for quite some time now and they are still very effective. So A abstinence of course if you do not have sex you are not likely to catch the HIV virus. Then the B be faithful to a faithful partner.

[00:07:40]>> Well if you don't if you're not having sex are there other ways you can >> there are other ways but um those other ways are what we call the um the vertical. So for mother to child transmission. So mother to child transmission means the mother had sex, she's pregnant, she was exposed or or she has the infection and then she passed it on to the child. So and what we've realized is that the highest u if you take the people who have the virus more is from the the um the sexual intercourse. And so that's where a lot of our attention is going to. Even though we also looking at the motherto- child transmission, in terms of blood transfusion, a lot of work goes into screening the blood and ensuring that the blood is very safe for use. And so that is not uh something that we uh >> worry about.

[00:08:30]>> Yeah. Exactly. And then the sharps, the needles and the um you know blades, exchanging needles and blades. we've uh there's a lot of IPC as in infection prevention control measures that we've put in place for that and so again that's also something that we are not so worried about but what we are worried about is the sex because you cannot control somebody's um sexual behavior so abstinence being the first almost 100% then uh be faithful to a faithful partner every time I say this people laugh because the be faithful to a faithful partner the faithful partner is not really emphasized yes So you have to be sure >> you can be faithful but if your if your partner is not faithful >> then it's cost 90. Yes. Exactly. So be faithful to a faithful partner. And then C condomize. Um and we've put in a lot of measures to make sure that condoms are available to at risk populations.

[00:09:26]And then D drugs. Um, and the drugs we're talking about are the preexposure prophylaxis medication, which we've made available to anyone that needs it, especially those in the high-risisk groups. Um, and then PEP, postexposure prophylaxis. So, the preexposure prophylaxis is you give the medication before you have a risky behavior. Um but the post exposure prophylaxis um it's been there for quite some time but it was more for health workers who have an accidental need needlestick injury or for rape victims um who we give the post exposure that means that you've been exposed to somebody who's potentially carrying the virus and then we give you medication to prevent the infection from um being established in the in the body.

[00:10:08]I'd want us to I want you to stay on this for a bit more or emphasize that because yes, we've heard about the we've been talking about condom condoms and and all of that, but this particular one I don't think it has gotten down that you know people appreciate it that much.

[00:10:25]So explain to us again the the prophylaxis that you're talking about.

[00:10:30]>> Okay. So let me start with the PEP which has been around for some time now which is the postexposure prophylaxis. Okay.

[00:10:37]So, anyone that has been exposed to a potential person who's carrying the virus, whether it's through needlestick injury or through rape or a sexual encounter, we give you the medication and that medication is for one month.

[00:10:52]>> So, you take that medication every day for one month to prevent the establishment of the infection.

[00:10:58]>> All right? Uh before you do that, we do some labs to ensure that you are fine to take the medication and you do not have the virus already. And you need to take this medication 72 hours maximum. At best 2 hours is the best window to take the medication. But we can move up to 72 hours. After 72 hours, it's it's not effective. So um within 72 hours, if you take it, chances that you will catch the virus um is quite low.

[00:11:25]>> All right. And then for the prep, which is the postexposure prophylax, sorry, the preexposure prophylaxis before you go and have a risky behavior, we give you the medication. And so with the prep, unlike the prep where you take it for one month and you are done, you stop taking it. With the prep, so long as the potential of getting infected is there, you will continue to take it even if it's for life. And initially when we started, we were giving it to discordant couples. And when I mean the squad couples, I mean one couple, one person is positive and the other is negative, but maybe they want to have a child and so they do not want to use a condom at that particular moment in time. So they would take the preexposure prophylaxis for the one who is negative, that person will take it and so if she has an encounter with the one who's positive, they would they're not likely um to she's not like he or she's not likely to get the infection. And for that there are different models for men, men who are born men. You can have um what my boss calls formula 211 which is you take the medication 2 days a day before the event then you take it a day like one tablet a day of the event and then you take one tablet a day after and if that is your only risky encounter you are done.

[00:12:39]>> All right. But with the women um you will take that every day um till you are done with the risky encounter. So for that it's a daily prep and then for the other one is eventdriven.

[00:12:53]>> Would that be useful for sex workers?

[00:12:57]Yes, it's very useful for sex workers and it's very effective in them and as I said initially we're giving it to the at risk population which were the female sex workers u men who have sex with men and discordant couples um but we are trying to bring in country a new u medication which is an injectable and for that you take an injection and then for 6 months you are covered. So you take the injection every six months. Of course you take the tablet for a few days as you take the injection to make sure that the levels of the medication is high in your blood before um any encounter and then after that you are good for 6 months and then you take a shot again 6 months. But um I think when my boss Dr. uh TV was giving the um statistics in the last uh I think it was Monday he mentioned that we we are not doing it for everybody in the country because if you look at our data two out of 100 people are likely to be infected with HIV 98 are not and then if you also look at it as he said there are some places where the infection rate is higher than others so those are the places that we will target exactly so we are not going to give it to everybody you can't just walk in and say I want um prep but um we want to make sure that if you are at risk then you are given the chance to take those medications.

[00:14:19]>> But are they also available on the on the market? Can you just walk into a pharmacy and and want to purchase that?

[00:14:25]>> Unfortunately, no, not yet. So the injectable is yet to even come onto the market. It's something that we've planned that we are going to work towards to bring in country next year.

[00:14:36]But for the oral medication it's it's not yet um available in thearmacies to be purchased because these medications are procured by donor and government and they are given for free. So once it's it's being done for free it's not likely that you will have them in the market to be sold.

[00:14:58]What should be the the you know there were there was a time when we used to please ignore my words Siri Siri just being Siri or Siri just being silly now. Yeah. But there there used to be a time sometime in the past where we had this campaign, you know, that was supposed to scare people >> yes >> away from uh to avoid HIV. There are people who have suggested that maybe we should bring back that campaign. Um but there's also been the argument against that that used to work in the past, but it's not something that's that's going to work now. How do you feel we should approach the campaign now if we are avoiding or we if we don't want to go back to those the scaremongering tactic >> okay so you're right in the past I think the scare was mainly because there was nothing we could do about it so don't get it at all um but now we have the medications to ensure that anyone who is HIV positive lives a normal healthy productive life. In fact, we've gotten so good at it that now we are rather worried about the hypertension and the diabetics in the normal population as in the population living with HIV. So them dying from um AIDS is actually coming down as per the statistics that we have.

[00:16:34]>> Um so we don't want people to fear people living with HIV. They are normal.

[00:16:40]they are fine and once they on their medication they are not likely to transmit to someone especially if they are um you equals U which we is a slogan amongst us which means undetectable is untransmissible >> that means when you take your medication and the viral load goes below undetectable levels you are not likely to transmit it to someone else and so the first thing is that you shouldn't fear anyone that is living with HIV just ensure that the person is taking their medications the way they should and they are good to go. However, because of stigma, we realize that those days where you see the scary and you know skinny person and all that, it's brought a lot of stigma to our clients and so they tend to hide their status and once you're hiding your status, you will not go for medication cuz you're afraid that somebody would see you. In fact, um I was in a clinic once and a lady walked in and her blood pressure was over 200 and 100 and I asked her why. She's like she's just seen her sister-in-law somewhere there and literally she was hiding as she was getting out of the consulting room to make sure that the person cuz they are that afraid to be discovered cuz they'll be stigmatized against which you shouldn't >> but that does not mean that you shouldn't know your status. That does not mean that you should know because if you do not know your status, it's going to show up. I always say that HIV is like pregnancy. You can deny you're pregnant 100 million times but once you are 9 months the baby will come out and everybody will see that you are pregnant.

[00:18:16]>> So if you do not check your status, if you do not know your status in 5 years, 10 years to come it will start showing and when it shows everybody will see that you do have the virus. But we do not want to get there. We want to catch you at the early stage, give you the medication, make sure that you're virally suppressed so that you can live your normal life, healthy life and go about the business that you are and you are not likely to spread and so then there will not be new infections that's coming into the society.

[00:18:45]>> Okay. Now I would want us to look go back to the stats.

[00:18:48]>> Okay. And um yes we we don't have to you know you know do the scare mongering but I would want to ask you what are some of the most you know the very alarming stats that you found.

[00:19:02]>> Okay. All right. Let me mention that the stars also showed another important progress that we made. So for example for the year 2025 we can tell from the >> waiting for you to tell me something alarming but you're telling me about progress.

[00:19:19]We don't want to scare them, but we should get them to know that I mean the >> let's let's not get people fooled into thinking that things are fine because things are not fine.

[00:19:31]>> Well, so I think it's both sides of the same coin, >> correct?

[00:19:34]>> So there are over 12,000 ACE related deaths that happened last year, but at the same time there were over 13,000 deaths averted. So um that's just looking at the statistic around ACE related deaths.

[00:19:51]>> The deaths were averted because of the treatment and the effectiveness of the treatment and as Dr. Jerry mentioned if people present early if they detect that they have HIV early then it helps with the treatment outcomes and one of the ways is when people get to know their HIV statistics.

[00:20:08]>> Okay.

[00:20:08]>> But one of the major challenges we still have now is the male testing. We realize that the males are not presenting early enough. They wait until they are really sick because of all the cultural and health seeeking behavior which tend to be very poor among the male population compared to the women and and so on. And so that's one of the key mistakes.

[00:20:29]>> What you mean is generally men don't >> men are indigenous species.

[00:20:33]>> We we we don't really you know care about our health. Well, I think there's that perception that men are supposed to be strong and so even when they are not feeling well, they would want to, you know, keep postponing and will not want to frequent health facilities. But then generally it is also believed that >> if you compare um the way women >> take care of their health or you know listen to their bodies >> and uh are concerned about their head and you compare that to the way men do theirs men don't do too well.

[00:21:07]>> Exactly.

[00:21:07]>> Right. And but also at the same time if we look at male to female transmission of HIV it tends to be very high compared to women to men transmission.

[00:21:18]>> So the men more men are infecting women.

[00:21:22]>> Exactly. And so it's really important that we have more men taking up the HIV services from prevention treatment and so on. So that if you are positive you are put on treatment very early. And now as she mentioned because of the availability of treatment and um unlike 20 30 years ago when what to do was not so clear now there's effective treatment and it's much simpler to take. 20 years ago you have to take several pills a day.

[00:21:50]>> Today is just one pill a day. It's much easier. It's like taking your hypertension pills a pill a day. Very easy to take. But one of the other things that keeps people away is the issue of stigma. And that relates to the earlier question you asked about the scare messaging and the scare approach that was used at the beginning and even the combative terms that were used. You know I don't want to repeat some of those terms but really that help in perpetuating the stigma and that is still hunting us up to today that you know because of stigma people not go to health facility and stigma is really very high. uh Ghana statistical service data really tell us that over 70% of Ghanaians have nonaccecepting attitudes towards people living with HIV and so that scares people away from coming to uptake services. There are a lot of interventions we are undertaking in that area through training and so on at various sectors. Um but really um the point is HIV is still a major problem.

[00:22:51]is still causing over 13,000 close to 14,000 new infections and for each infection is the treatment burden is still causing over 12,000 deaths. So it remains a major public health threat but there is hope with all the preventive interventions that are mentioned and the treatment that's >> and I also get to I I'm getting the point you're making about >> instead of you know scaring people >> we probably should be showing more examples of people of positivity of people who are living with HIV and are doing very well.

[00:23:28]>> Yeah. That brings in the issue of influencers, you know, social media influencers. Are we identifying some of these people to encourage them to share their stories? I've seen a couple a couple of um at least there's one lady.

[00:23:43]>> She comes out on social media and she's talking about the fact that she's not Ghanaian though, >> but she's talking about the fact that yeah, she's she's living with HIV and she looks very well. I mean there there's no way you can tell that this person um is is living with with with AIDS. So I I believe that that's a place that we should be that's a space we should be looking at. Is that something that you uh >> No, I think um we've had a few people that have really done so well for the HIV response in coming out to say we are HIV positive and uh for a high stigma environment such as ours, it takes a lot the psychological burden even in terms of um people being ejected from their homes, suffering at the workplaces, in schools, their children facing these repercussions within such a context it can be really difficult. But we've had in the past a religious leader who came out to say I have HIV I'm living with HIV and they are able to share how they able to do so to encourage others to test and know their status. You know we've had a a breastfeeding mother. So generally the point is we've had a few ambassadors that we've worked with that represented various aspects of the HIV response or living in the community. So the religious person was one a pregnant woman who you know successfully had kids that did not get HIV. She was having HIV but really showing the effectiveness of the mother to child preventive measures.

[00:25:16]And we also had someone who suffered because the person was in the security services and when the person was just being recruited when they realized she had HIV you know her appointment was terminated because they didn't want someone living with HIV to be so you know they are all um these dimensions that we've previously represented working with ambassadors but generally >> it's something that we should be doing much more or we wish we could be doing more but it is difficult also and it takes a lot to prepare people to be able to live with these repercussions. You know, I've been working in the HIV space for over 20 years now, but it's not very common to be sitting with people in meetings here in Ghana and they will say, "Oh, it's time for me to take my ARVs. Let me step out and do so." But I you go to, you know, places in southern Africa, Eastern Africa, and the people would readily say, "Oh, it's time for me to take my medication." Then they would excuse themselves from the group. It's not so common here. So you you mentioned the person who was in the security services or was going to be join joining the security services that which brings up the issue about the recruits >> which recently we found out there were you know some recruits significant um you know percentage of people who had wanted to be recruited who didn't get the the chance to be recruited because of their status. Now, I know advocates have come out to say that that was wrong >> and and that um that shouldn't happen.

[00:26:47]And I I tend to agree with with with them when you also say that if we're trying to project positivity and getting people to appreciate that you can actually live and work with a with a virus, we should give those people an opportunity to go in there and work and, you know, take their medication and and live their lives. So >> I know that came up. I don't know how far um you've gone in trying to >> get that reooked at. I I don't think based on that they would say they're bringing back the people, but what's the conversation about that?

[00:27:30]>> Thank you for mentioning this because um it's really an issue that we are actively engaging with the security services on this. Um and I think the former defense minister came to mention that there's a policy in the military not to recruit persons living with HIV.

[00:27:44]if you already have HIV while serving they would not take you on mission on deployment and so on. Um but and this has been a policy that has been around for a while. Most countries in the world introduced such policies when there were no ARVs but now countries are beginning to change their laws. Kenya in 2024 reversed that policy. South Africa has reversed that policy. Ghana has not done so yet. Even though in our case we have a very progressive provision in the Ghana Ace Commission act in the section 32 where it makes a case that um recruitment should be based on medical fitness and not on the sole uh HIV status alone because unlike back then when having HIV automatically meant you are going to your immunity would go down and so on. Today you can have HIV and you will still be healthy. you can still be productive. You know, you'll still be able to function like anyone else. And so there's a need to shift so that you don't just have the blanket prohibition of everyone who has HIV, but it should be a casebyase basis based on the individuals, the status of their health.

[00:28:59]So we are having that engagement with the security services especially because these are government agencies. If government does not show the example by recruiting people, we have youth unemployment in this country. Who should >> if government doesn't do so then private sector and others are emboldening to also break that law and this is a clear law of the land. So those engagements are going on and the other thing related to stigma was the way in which that information was kept out. You did medical screening for several issues but they only put out a number for HIV.

[00:29:34]We don't know how many people got hippatitis or any other condition. Why single out HIV to put out that number.

[00:29:41]So again, these are some of the issues we raise on that.

[00:29:44]>> Okay. I I'd want we we do not have, you know, a lot of time. So I'd want us to go back to what are some of the things that you would want the people to know Dr. about staying healthy, you know, preventing um or avoiding a situation where they they're getting infected.

[00:30:11]>> Okay. So, um first and foremost, you have to understand there's a difference between HIV and AIDS. HIV is a virus and what the virus does is it destroys the immune system. That in itself will not kill you. But when your immune system is destroyed, then other infections that come in, there is nothing that fights that infection. And so then you get what we call the AIDS. So when your immune system is destroyed, when you get an infection, I don't know if you've ever had a cold or you were feeling some tingling in your throat, the next day you are fine. You didn't take medication. It's your immune system that fought that infection. So you didn't have anything to do with it. But now if your immune system is down then even a common cold becomes dangerous to the person. And so we have to distinguish somebody who's living with HIV from somebody who has AIDS. If you are living with HIV and you've taken your medication enough for the virus to become undetectable in your blood, you are like a normal person going about their business. The only problem is that some of the virus ends up going into places that we call the sanctuary sites.

[00:31:25]And those places the medication can't get there. But when they get into those sanctuary sites, they become dominant.

[00:31:32]They are not moving. They are not growing. They're just there. It's when you stop taking the medication, then they come back into the bloodstream and then they multiply. And when they do that, I I I say that there was this advert that says men, you know, was a coil advert and the mosquitoes were coming in. When they come back into the blood, it's like free. They're just going to multiply excessively. and you get worse off than if you hadn't taken the medication at all. So those who are currently living with HIV and you are taking your medications, please continue to take your medication. We are praying that a day will come we will have the medication that goes into the sanctuary sites and removes them and once that is done then we have the cure. But for now we do not have the cure. What we have is the treatment. So the treatment would make sure that the ones in the bloodstream is removed but the sanctuary sites is the problem. So you will live a normal life. Now if unfortunately you get into the AIDS stage it's other diseases like tuberculosis like um pneumonia like skin rashes diarrhea which cannot be stopped you know >> at which point do you progress from or deteriorate from HIV to AIDS >> okay so when you so the the white blood cells which is what's protecting us it's everywhere in the body from the brain brain to the stomach to the lungs everywhere to the skin everywhere. Now when you get the virus and the virus starts destroying the white blood cells the body will try to pro protect itself.

[00:33:10]So initially it would try and produce more white blood cells to try and fight the infection but of course the virus would get the upper hand. One virus in 24 hours can multiply to 24 billion viruses. So once it does that it would just starts destroying the the immune system and then the body will try and preserve what's its importance. So it will start by taking the white blood cells from your skin to try and preserve the brain to try and preserve the heart to try and preserve the lungs the vital organs. And so that's when the person now starts getting these rashes, starts getting you know the face you know there are these um uh fungi infections um chicken pox that is excessive not the chicken pox that in a week's time it clears away but this one is just excessive or if you've had chicken pox before you get what we call the anansi the shingles okay so that's the skin one that that's what we call the stage two then now if the white blood cells just keeps getting destroyed then the the body would now remove the white blood cells from the stomach, the lungs and then try and protect the brain. So then that's when the person will now start getting the pneumonia, the TB and uh the the diarrhea that is chronic.

[00:34:29]>> So that's when you have eight.

[00:34:31]>> So when you get to stage three, that's when the eight starts. And then once it's the white blood cells are totally gone then it removes it from the brain and that's when they get the uh the the cerebral menitis and the toxopplasmosis and they become unconscious and sometimes they become delusional and all that. So that's a stage four. So stage three, stage four is the age stage and we don't want people to get there cuz you can imagine if you get a stroke or cerebal toxoplasmosis. Even when we've we've treated it and you are better, you may still have some deficits. You may have a stroke, you can't move an arm, you can't move a leg. Um you may have some cognitive issues. Um so we do not want you to get there. M >> if you have chronic diarrhea we may solve it but then you would still be very very skinny and it will be difficult to get your nutrition back to where it is but it's not impossible but we just don't want you to get to the aid stage. So anyone that is living with HIV try as much as possible to take your medication so you do not get to the a stage.

[00:35:34]>> Okay. So John, what do the statistics >> say about you had earlier mentioned that a lot more men are infecting women, but what do the statistics say about some behavioral patterns that we're having coming up in in recent in recent times where we call it a hookup culture.

[00:35:59]>> What what are the stats saying about that? Okay. So maybe just two things related to that. One is that um multiple concurrent relationships so the social sexual networks remains one of the major ways in which the infection is perpetuated. Already Dr. Jerry mentioned that most in fact we estimate that about 85% of the infections is through the sexual relationships and most of it is one person being in multiple relationships. So that sort of sexual network and as you mentioned the hookups and so on but linked to that actually there are so the two statistics one is what we call the risky sex which is this multiple relationships hookup behavior and so on and the evidence actually Ghana statistical service measures that they measure the risky sex and they measure the condom use and for us we want to compare the two because it's really important to see is risky sex increasing or reducing if we look at the data over 20 year period. It actually shows that risky sex is increasing. On the other hand, condom use is declining and that is a very bad combination for us because at least if the two were increasing at the same time, then you would know that well when they practice risky behavior they protect themselves.

[00:37:22]But to do so and see condom use declining is really not a good um >> Dr. J, should it come to a point where we say um we're deemphasizing condom use? Because if you go out there and you're speaking to to men, you're doing a general vox pop, you hear a lot of men tell you that that's for condom use. And even though there are female condoms too, there are females who also don't find the the condom use that effective. So I would want to think that maybe it's about time we deemphasize the you know condom use and maybe push a lot more of the prophylaxis that uh you you've been talking about.

[00:38:11]>> Well as we said there are different populations and the risky sex the approach should not just be one way. So even in our management of the prevention bit of it, we we are not just emphasizing on use condom alone. We are sometimes you use a condom and you use the prep.

[00:38:32]>> Sometimes you use um the prep and then you abstain. You know there are different approaches that we have to managing as as um John said sometimes it's just about tailoring the the the specific need of what the person needs.

[00:38:48]So I was going to talk about um the I talked about the two people that what we they need to do take the medication but the 98 what they need to understand is that look it just takes one moment for you to get the infection lately I saw a video of a lady who was saying that she was going to spread it because somebody is gave it to her so she's upset and she's going it just takes one moment and you read on social media they met on Facebook they were chatting then they he got he he called her to his place gave her transport she went she slept over she came back and then is not hearing again it's >> you have to take responsibility for your own actions >> I'm bringing I'm bringing I raised this matter too because yes we have people because of the hookup culture you may be targeting sex workers >> but when it comes to the hookup culture the people are not defined >> y They are all over the place.

[00:39:48]>> Exactly.

[00:39:48]>> So maybe we want to, you know, put out an appeal out there that >> if you happen to be in the hookup >> Y, >> you know, space, >> come to us.

[00:40:00]>> Yeah.

[00:40:00]>> And um we can make the ARVs or the medications that you're talking about, we can make them available to you.

[00:40:07]Exactly. So that you can, you know, you can stay safe. So yes, you may be targeting the sex workers, but I feel we should be looking at this, you know, this other population that are not defined, but are also in >> in our space, we've defined them. So when when you come when we say target, it's not just, you know, when you come and say I'm a female sex worker. No, there's a um a list of questions that we ask you unfortunately because we have to determine your level of risk.

[00:40:35]>> Okay? So when you come in and even if you you do not define yourself as a hookup person but you come in and per what we gather your risk is quite high we will give you the medication. In fact anyone who WHO says that anyone that comes in and says I feel I'm at risk.

[00:40:52]>> Okay you should give the person the medication but as I said it's quite limited. So if we have the opportunity to give everybody, we will give everybody but um as much as possible we'll try and make sure that those who really need it are the ones that we give the medications to.

[00:41:08]>> Okay. So I would have wished that we had a bit more time or a lot more time because this is a very very crucial issue which we need to be talking about but we don't. But to end I would want to you know make this appeal put this this appeal out there. Yes, there lots of young people, especially young ladies who are deciding that um yes, they're going to do hookup as uh their way of of getting by. Yes, it's dangerous.

[00:41:43]Ideally, you should be using condoms and it goes to the men as well who are engaging these women. But you find yourself in a in a really risky space.

[00:41:56]Fortunately, the Ghana AIDS Commission is available and they're saying that if you find yourself in that space, you can come to them, approach them.

[00:42:05]>> How do they get to reach out to you? Are they calling or >> any health facility?

[00:42:12]>> You can go to any health facility.

[00:42:13]>> Exactly. and uh tell them you know I need and I'm sure there's a way when you get to the health facility you're not mixed up with just about everybody it's secluded in a certain way we try to offer as much as possible privacy for us to have that conversation it may be a difficult conversation but we'll have it and then offer the service to you >> okay so you go there and go to any health facility and um get these medications that are available that you can take before and you can take after so that if you happen to have engaged in some risky sex and you're not sure in fact whether you're sure or not I think you should just you should just go for it so that we avoid a situation whether you're going to you're going to end up um with um with a with a disease but thank you um Dr. Elizabeth Hijari who's with the National AIDS Control Program and uh John Elasu Mahama who's the acting director policy and planning at the Ghana AIDS Commission for joining us for this conversation. I really really do appreciate it.

[00:43:22]>> Thank you for having us.

[00:43:23]>> Yes. Thank you. Thank you so much. And uh we it's a conversation I believe we should we should get to um another time.

[00:43:31]But there's one other um issue that we can we can we can uh go to. I was hoping that we could get to um do but yes it has to do with the um OSP and Ken of Foretta matter. We're hoping to get a bit more detail but turns out that we've run out of time. So I'm just going to share with you what it was that I shared with you earlier. So on the case of whether former finance minister Keno Forata engaged in criminal wrongdoing tied to a state contract with SML, an immigration judge in the US from where Ghana is seeking to extradite the former minister says he cannot be denied the request to change his immigration status because the OSP's case lacked persuasive proof or evidence of criminal wrongdoing. So, that's the that's the news that we have um right now and uh I'm sure there's going to be a lot more detail coming up.

[00:44:42]You just have to stay tuned in to uh the rest of our our programs and for the news which comes up at midday. Just stay tuned in and we'll be sharing we'll be sharing the details the details with