As the global HIV/AIDS epidemic continues its steady march, infecting and killing millions of people, Africa remains the epicenter of its destructive path. The UNAIDS estimates that at least 22.4 million Africans live with HIV/AIDS. Africa accounts for 67% of all individuals living with HIV/AIDS globally and 75% of all deaths. More than 90% of all AIDS orphans live in Africa and more than 9 out of every 10 children (less than 15 years of age) living with HIV/AIDS are Africans. For every two Africans that commence antiretroviral therapy, another five contract HIV.

The current global economic crisis has significantly impacted African countries capacity to respond to the epidemic according to a recent report by UNAIDS and the World Bank. Many countries in Africa as a direct result of the ongoing global recession are struggling to meet the needs of their citizens in the areas of health services, education, agriculture and social services. Africa requires a revitalized joint continental and international effort to strengthen AIDS response in the continent. In this article, I discuss the need for a revitalized, durable and energized international coalition against HIV/AIDS in Africa. An international coalition against HIV/AIDS in Africa is extremely important as the triple threat of global recession, the continent’s endemic poverty, and external donor fatigue appear poised to roll back hard won gains in AIDS remedial efforts in the continent

Challenges

Implementation of continental initiatives in Africa remains a working progress. Despite a plethora of continental resolutions and platforms, implementation is the elephant in the room, with major difficulties in raising money, coordinating continental resolutions in member countries, mobilizing technical resources in the continent and working across national and regional boundaries.

1. High level of endemic poverty in the continent. More than one third of Africans live on less than US$2 dollars a day. The ongoing global economic crisis is putting more Africans onto poverty rolls, according to a recent report by the World Bank. Africa-based HIV/AIDS programs are yet to be tightly integrated with poverty alleviation efforts in many African countries. 
2. The twin epidemics of poorly managed health systems and dilapidated health infrastructure.
3. The reality that in the next few decades, the fight against AIDS will be dependent on external donor support. All external donor support eventually comes to an end. As long as international development efforts are subject to domestic politics and shifting strategic priorities in donor countries, it would be difficult to plan a long term fight against AIDS in resource challenged environments around the world.

Opportunities

The enhanced global response to HIV/AIDS, especially since 2001, has given rise to opportunities.  The maturation of UNAIDS as the premier technical and advocacy organization for global AIDS response is a major plus in organizing a durable coalition. The election of its first African executive director, Michel Sidibe also confers extra gravitas on the capacity of UNAIDS to work with African leaders and policy makers.

The emergence of the Global Fund against HIV/AIDS, Tuberculosis and Malaria (GFATM) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in the last few years creates an incredible opportunity to combine huge resources and consolidate program efforts in geographical areas devastated by the epidemic. GFATM and PEPFAR are now responsible for putting 3,000 individuals on antiretroviral therapy everyday around the world, according to the UNAIDS.  A major task of a revitalized international AIDS coalition in Africa will be to work closely with GFATM and PEPFAR so that the two entities can combine their program support on the ground in Africa to better support AIDS hard-hit African countries. These countries need integrated external program support in the provision of preventive, treatment and social support services.

The determination of African governments and continental institutions to fight AIDS is another opportunity. African governments have dramatically improved their policy attention on HIV/AIDS. The African Union (AU), the African Continental Bank (ADB), the World Health Organization Africa Region (WHO AFRO), and the United Nations Economic Commission for Africa (UNECA) are actively engaged in continental efforts to contain the epidemic. These continental institutions are focused on achieving universal access to HIV/AIDS, Tuberculosis and Malaria control and treatment programs. The coalition can work with all partners focused on the universal access principles, including foundations and the organized private sector.

The global attention on attaining Millennium Development Goals (MDGs) by 2015 in the poorest countries is another opportunity. Since reducing the impact of HIV/AIDS is one of the eight MDGs, a continental coalition can have access to shared technical, financial and logistics resources available for the attainment of MDGs by 2015.  Luckily, the support for MDGs for now is largely devoid of ideological or politically partisan battles known in AIDS remedial efforts.

Building a Durable AIDS Coalition for Africa

The key to building a successful, durable coalition is to think outside the box and to avoid duplication of activities on the ground in Africa. A revitalized international coalition must operate on the valid assumption that leadership must come from Africa.  International members of the envisaged coalition can only supplement long term commitment from African leaders and stakeholders. 

A serious international AIDS Coalition for Africa should become operational after three important confidence building steps. First, African continental institutions, African governments, the organized private sector, professional organizations and members of the civil society should meet to harmonize existing positions and adopt a comprehensive continental platform on HIV Prevention and AIDS Treatment Strategy.  This continental platform and strategy should be the major imprimatur of the fight against the epidemic in Africa. 

Second, based on a harmonized African position, bilateral and multilateral institutions, international business conglomerates active in Africa and international foundations should meet to adopt a common position on AIDS in Africa aligned to the platform and strategy adopted by African governments and stakeholders.  Third, a meeting between African partners and international partners should take place to adopt coordinated programming efforts on the ground in the continent and to establish applicable benchmarks for success.

The ultimate goal of the international AIDS coalition for Africa should be to target specific financial, technical and logistical resources on specific needs in specific geographical locations in the continent. The impact of the envisaged coalition will be measured by how specific resources are directed to specific needs in the continent, and, on how specific needs are met in designated target populations.

The envisaged International AIDS Coalition for Africa, to become successful, should address the following issues:

A) The role of poverty in facilitating both HIV transmission in Africa  and the lack of access to antiretroviral therapy;
B) The need to tackle inefficient health systems and dilapidated infrastructure that stymie AIDS relief efforts;
C) The need to end gender inequities and other human rights violations in Africa that stifle a comprehensive response to AIDS;
D) The need to proactively and comprehensively involve young men and women in the fight against AIDS since they lack resources to fight back against the epidemic, This effort will end the current token involvement of the youth in HIV/AIDS remedial efforts in the continent;
E) The need to plan long term for the sustainability of AIDS funded programs in the continent since external donor support will eventually come to an end; and,
F) The need to address governance challenges that bedevil international development efforts in the continent. Governance challenges such as corruption and maladministration have significant negative implications in the fight against HIV/AIDS in target populations.

Conclusion

Africa remains the epicenter of the global HIV/AIDS epidemic.  In the end, the global fight against AIDS will be won or lost in Africa. The time is now ripe for a revitalized, out-of-the box, durable international coalition against AIDS in Africa to galvanize continental and international efforts.  Africa will lead this coalition. External partners will follow the lead of Africans. With African and international partners better organized and their relief efforts harmonized and coordinated on the ground in Africa, it is possible to stop AIDS in the continent.

By Chinua Akukwe

Chinua Akukwe is the Chairman of the Technical Advisory Board, Africa Center for Health and Human Security, George Washington University Medical Center, Washington, DC. He is also the Executive Chairman of the Africa Union Africa Diaspora Health Initiative, Washington, DC. He has written extensively on health and development issues in Africa, including four books.