Timely access to lifesaving antiretroviral medicines added more than 9 million life-years between 1995 and 2011. South Africa, in a remarkable feat, scaled up access to lifesaving medicines by 75% in two years. Better access to lifesaving medicines continue to reap immediate benefits: for every 1000 Africans with timely access to antiretroviral therapy, 228 deaths will be averted and 448 children will be spared a tough life of orphans.
Despite increasing evidence of consistent gains in the fight against HIV/AIDS, Africa remains the epicenter of the global epidemic, an unchanged situation for more than a decade. In 2011, Africa while accounting for less than 10 percent of the global populations represented at least two-thirds or more of various negative indices of HIV/AIDS. In 2011, Africa accounted for 69% of all individuals living with HIV/AIDS around the world, 92% of all pregnant women living with HIV and at least 90% of new infections among children.
In terms of sheer numbers, Africa remains a long way from the dream of an AIDS free generation. On the average, 23.5 million people live with HIV/AIDS in Africa. At least 1.8 million people contracted HIV in 2011 and 1.2 million died of AIDS. For the next several years, Africa will continue to record the annual HIV/AIDS million deadly double: one million new infections and one million deaths every year. Up to 5 million Africans unable to access antiretroviral medicines may die within two years without assistance.
Individuals accessing antiretroviral therapy in Africa remain significantly lower than newly infected individuals, reducing the effectiveness of the “treatment for prevention” strategy that reduces new infections by up to 96 percent. Even the US$100 to $350 annual cost of antiretroviral treatment is unsustainable in many poor African countries that depend significantly on external funding (50% or more) for national expenditures in the fight against HIV/AIDS. The flat international funding for HIV/AIDS in the last two years and the projected global funding gap of US$6 billion complicates the quest to provide comprehensive preventive and clinical care to millions at risk and/or living with HIV in Africa.
What to do?
First is for African governments and continental institutions to continue setting ambitious goals in the fight against HIV/AIDS. Continental leaders should never accept a scenario whereby one million mostly able-bodied men and women will either die of AIDS or contract HIV every year. No matter the progress made in the short term, the focus should be on how to deploy relevant public health goods that changed the epidemic in richer countries. In particular, nobody should die in Africa due to lack of access to antiretroviral therapy.
Second, treatment for prevention should be an important strategy moving forward. Providing antiretroviral prophylaxis on a wide scale is neither cheap nor without significant logistical hurdles. A primary focus should be on sero-discordant couples where one partner is living with HIV.
Third, strengthen HIV preventive programs to reach at-risk populations, utilizing formats that encourage change in personal behaviors. The message, the messenger and the target population should be on the same page. In particular, young men and women and individuals living with HIV/AIDS should be prime focal points of remedial efforts.
Fourth, producing first and second-line antiretroviral medicines in Africa should remain a top priority. Public and private sector partnerships will be critical in designing and setting up manufacturing facilities that meet international standards. The role of Africans in the Diaspora as technical and investment resources should be explored. South-South technical cooperation is also vital, especially on sharing lessons learned and working on joint projects. Twinning between universities in Africa and other parts of the world is also important in product pipeline development.
Finally, funding gaps are likely to persist until ongoing economic woes in the West subside. Some African countries as noted by the UNAIDS are gradually taking on greater financial responsibilities in the fight against HIV/AIDS. The key is to think creatively, explore alternative funding streams, involve the organized private sector, promote indigenous research efforts and mobilize relevant stakeholders.
Africa continues to make progress in the fight against HIV/AIDS. However, the epidemic remains a serious challenge. Only a determined, resolute stance by African leaders to fight HIV/AIDS to standstill can permanently swing the pendulum in favor of African people.
By Dr. Chinua Akukwe
Former Chair of the Technical Board of the Africa Center for Health and Human Security at the George Washington University, Washington, DC. He is the Chair of the Africa Working Group of the National Academy of Public Administration, Washington, DC. He is solely responsible for this article.