By Mark Stirling and - -
PRETORIA, Jun 1 2005 (IPS)

In the worst-case scenario of a recent report by UNAIDS on the evolution of the AIDS epidemic in Africa by 2025, up to 83 million Africans could die of AIDS-related illnesses in the next twenty years, unless concrete action is taken today to scale up the response to the disease, writes Mark Stirling, director of the UNAIDS Regional Support Team for Eastern and Southern Africa. What is essential, the author writes in this article, is investment in both HIV prevention and treatment. We cannot sacrifice one at the expense of the other. As impressive as the recent gains in the fight against AIDS may sound, the bottom line remains that today only 8 percent of Africans who need treatment are getting it. If the commitment displayed by African governments and the international community in scaling-up treatment during the last six months of 2004 is any indication, in all likelihood the worst-case scenario is the least likely scenario. But this will only be so if we remember that the commitments to scaling up prevention and treatment today are the beginning of a life-long commitment to improving the health and well-being of all Africans, especially those vulnerable to, living with and affected by HIV and AIDS.

A recent report by UNAIDS outlines three scenarios on the evolution of the AIDS epidemic in Africa by 2025. In the worst-case scenario, up to 83 million Africans could die of AIDS-related illnesses in the next twenty years unless concrete action is taken today to scale up the response to AIDS. This means investing in both HIV prevention and treatment. We cannot sacrifice one at the expense of the other.

Africa has made great advances over the past year in scaling up treatment. A report by WHO and UNAIDS released in January this year illustrates that a number of countries have made advances in providing treatment. Thirteen countries have succeeded in providing treatment to more than 10 percent of those in need, and across the continent there are more than 700 anti-retroviral (ARV) service points in operation.

These gains have been made possible by the commitment of governments, who in partnership with civil society, the private sector, the activist community, and the international community are working hard to increase access to treatment.

The international community has scaled up its response through the Global Fund for AIDS, TB and malaria; the US President’s Emergency Plan for AIDS Relief (PEPFAR); and direct bilateral assistance programmes.

The prices of antiretroviral drugs have decreased considerably. Quality single dose generic ARVs are increasingly available, making treatment simpler than ever before.

As impressive as these gains may sound, the bottom line remains that today only 8 percent of Africans who need treatment are getting it. This fact signals the need to address a number of challenges to scale up treatment access and to improve the quality of life of all people living with HIV and AIDS.

Stigma and discrimination and the limited availability of counselling and testing services continue to prevent people from knowing their HIV status. At present it is estimated that only 10 percent of people have access to counselling and testing in Africa.

While the prices of ARVs have declined, this is only in relation to first line regimens. The cost of second line regimens is still prohibitively high. It must be underscored that the costs of ARVs are only one part of the treatment equation. Reducing the costs that surround access to treatment, such as the CD-4 cell count and viral load tests, which are important in monitoring and managing HIV and AIDS, is also necessary to ensure that people can access treatment. Continued efforts are needed to reduce the prices of ARVs and diagnostic tests.

Community involvement is absolutely key for the scale up and sustainability of treatment access programmes. There is a danger that technical interventions may be introduced without adequate community mobilization and participation. The challenge therefore is to rapidly increase support for community-based treatment, literacy, education, and leadership mobilization.

Much of the international attention over the last number of years has focused on the provision of treatment. Let us not forget that the majority of Africans today are not infected with HIV. The challenge is to ensure that they remain HIV-negative. The African Scenarios report reminds us that if we are to make any in-roads in managing the epidemic, we need to ensure that we bolster prevention and treatment simultaneously. Over twenty years into the epidemic, it is difficult to understand that there is still a huge unmet need for condoms — male and female. A study by the Futures Group indicated that in 2004 there was only 19 percent coverage of male condoms on the continent. The unmet need is confounded by religious and cultural attitudes, which deny the rights of people and particularly young people to be able to make choices about their sexual behaviour.

If the commitment displayed by African governments and the international community in scaling-up treatment during the last six months of 2004 is any indication, then we can say that in all likelihood the worst-case scenario is the least likely scenario. But this will only be so if we remember that the commitments to scaling up prevention and treatment today are the beginning of a life-long commitment to improving the health and well-being of all Africans, especially those vulnerable to, living with and affected by HIV and AIDS.(END/COPYRIGHT IPS)

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