Health officials in sub-Saharan Africa are finally focusing on non-communicable diseases (NCDs) such as cancer, diabetes and chronic lung disease, having spent much of the past decade concentrating on HIV/AIDS and malaria.
The growth of NCDs in developing countries has gone almost unnoticed, having been largely perceived as a problem affecting affluent countries. But NCDs have overtaken infectious diseases as the leading cause of death worldwide, with nearly 80 percent of these deaths occurring in low- and middle-income countries, according to the World Health Organization (WHO).
The UN High-level Meeting on NCDs on 19-20 September sought to identify concrete actions to tackle the issue. The last time the UN held such a meeting on a disease was 10 years ago for HIV/AIDS and the similarities do not end there.
Countries grappling with HIV prevalence are now faced with rising epidemics of chronic diseases. UNAIDS has warned that diabetes cases, for example, will rise by 50 percent globally and by 100 percent in sub-Saharan Africa between 2010 and 2030.
As more HIV-positive people access antiretrovirals and live longer, their risks of contracting illnesses such as diabetes and heart disease are growing. In South Africa, the fourth most common cause of death in people living with HIV is hypertension, while diabetes comes in at number six.
According to Miriam Rabkin, director for health systems strategies at Columbia University's International Center for AIDS Care and Treatment Programs (ICAP), HIV and NCDs are often seen as completely separate challenges.
"In fact, HIV and NCD departments are often siloed and separated at every level of the health system, from the health facility to the Ministry of Health, up to the WHO. But from a health systems perspective, HIV, a chronic communicable disease, and NCDs, chronic non-communicable diseases, actually have a great deal in common and it is important for us to learn from each other," she told IRIN/PlusNews.
"In many countries, HIV programmes are actually the first large-scale chronic disease programme, and can be a great resource... it's important to avoid 'reinventing the wheel'," Rabkin noted.
The responses to HIV and NCDs can take similar approaches, including appointment and medication reminders, transport support, and counselling to support adherence and ongoing behaviour change.
In 2010, Columbia University and the Ethiopian Diabetes Association conducted a study looking at whether the tools and approaches used for HIV could be applied to the care of adults with diabetes. "It was a small study, but we did show that the quality of care for diabetes improved quite rapidly over a period of six months," said Rabkin.
However, Catherine Hankins, scientific adviser for UNAIDS, suggested more could be done to integrate the treatment of chronic diseases into the health sector. "Pregnant women who get gestational diabetes - what happens to them? You may have an antenatal system that has worked really well now for HIV. You know to put them on antiretroviral treatment, but then maybe there is no referral set-up for diabetes because there is no diabetes care," Hankins told IRIN/PlusNews on the sidelines of the recent AIDS Vaccine conference.
Countries are slowly beginning to combine HIV services with chronic disease care. According to Shanthi Mendis, coordinator of WHO's Chronic Disease Prevention and Management, HIV services and cervical cancer screening have been integrated in some settings. Kenya's Ministry of Health and the Kenya Cardiac Association have begun to screen people tested for HIV for hypertension, and to refer them to the appropriate care and treatment services.
Funding, or lack thereof, however, remains a problem for both HIV/AIDS and NCDs - more so for chronic diseases that lack the high-profile activist campaigns and celebrities found in the AIDS sector.
The US Centre for Global Development estimates that less than 3 percent (US$503 million) of the almost $22 billion spent in 2007 on global development assistance for health was spent on NCDs.
"We can be efficient and creative; we can avoid redundancies and build on the lessons of HIV scale-up. But the idea that because we have invested so heavily in HIV we can somehow treat NCDs for free is a dangerous illusion," Rabkin cautioned.
Mendis admitted that social and community mobilization for chronic diseases will "require more advocacy and will take more time", unlike AIDS, which had had a "devastating impact" on families and societies and galvanized communities quicker. "NCDs impact on families but... the impact is more prolonged... People with HIV provide a powerful image of sickness. NCDs, on the other hand, are silent killers and most of the time do not even cause symptoms."