Govt must act now on AIDS, warns UN envoy

Angola will have to make an epic effort in both preventing and treating HIV/AIDS related illnesses if it is to escape the dismal fate of many of its neighbours, a senior UN official told PlusNews. Stephen Lewis, Kofi Annan's special envoy for HIV/AIDS in Africa, spoke to PlusNews after spending a week in the southwest African country which, ironically, thanks to its 27-year civil war, has the lowest infection rate in the region. "Angola is at the moment on the knife's edge - Angola will either plunge into the abyss of the devastation of the pandemic, or Angola will undertake a Herculean prevention effort and keep the prevalence rate low," Lewis told IRIN. The most recent data on the country, a 2004 survey by the Centres for Disease Control (CDC), showed a prevalence rate of just 2.8 percent, far less severe than many had expected. With the return of many of the country's four million refugees and internally displaced after the end of the conflict, many aid workers and health experts had feared the figure would be higher. But while the country's average is relatively low compared to neighbouring Botswana (37 percent), Zambia (17 percent) and Namibia (21 percent), in certain parts of Angola, especially along the borders, the HIV/AIDS prevalence rate has begun to creep up. "I would not take issue with the CDC study, but there is anecdotal evidence as you move around the country which suggests that there are pockets ... [where the HIV/AIDS prevalence rate is] much higher," Lewis said. The southern province of Cunene, bordering Namibia, has a prevalence rate of about 9 percent. After touring the region, Lewis noted that 12 to 15 percent of the women visiting antenatal clinics were HIV positive, as were 18 percent of those attending the testing and counselling centre during the last several months. Between August and December last year, 24 percent of all admissions to the state-run hospital in the provincial capital, Ondjiva, were AIDS-related illnesses. "You can sense when you are there that the figures may be rising," Lewis said. He praised the Angolan authorities for their commitment, but warned that if the disease were left unchecked, the country would face a war even "more terrible than the civil war which has now ended." "They [the Angolan authorities] will be reeling with the assault of the force of the pandemic. When it grips the heart of a country it is ferocious and devastating; everything crumbles before it and only a super-human effort can resist it - that is the challenge that faces the government now," he noted. Lewis said Angola was about to receive a helping hand of about US $90 million from the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis (TB), which will fund part of the government's $160 million national strategic plan for HIV/AIDS, expected to be finalised within the next two months. As part of its implementation, the UN Development Programme (UNDP) would ensure the money was distributed to the people and areas most in need. Avoiding escalation was crucial. "I think the urgent priority is prevention ... [it] should be focused on the high risk groups - the returning refugees, the truck drivers, commercial sex workers, the army, the street children - all those groups where there is a significant prevention need and where the pandemic can spread quickly," Lewis stressed. As part of preventive measures, rolling out voluntary counselling and testing (VCT) centres and educating the population about the risks of the disease and how to avoid them, would be key. "We were sitting listening to people [with HIV/AIDS] pour out their hearts. Time and time again they talked about information; they made it clear that what they felt was needed in the country was much more radio, much more television ... billboards and print and messages circulated through the schools and the communities," Lewis said. The UN Children's Fund (UNICEF) believes that nine out of 10 young people aged between 15 and 19 have insufficient knowledge about the disease, and more than two-thirds do not know that using a condom could prevent infection - especially worrying in a country where the youth are sexually precocious. "Angola is at the early stages of awareness-raising; it's behind other countries - that is absolutely true," Lewis noted. "The best preventive vehicles, in my experience in Africa, tend to be the age group 15 to 24, who move from school to school and community and community, using drama, drums, song, dance ... all the cultural artistry of a country, to convey very effectively and straight-forwardly the message around sexuality. A lot of that has to happen in Angola," he added. The need to treat the disease was also vital to install a sense of hope among those living with HIV/AIDS. "If you're going to encourage the rolling-out of prevention of mother-to-child transmission or VCT centres, then the treatment will give people a lot of hope," Lewis pointed out. "When they get tested and [find] they are positive, they will know that it's not a death warrant." He urged the Angolan authorities to learn from success stories in Uganda, which had managed to slash its prevalence rate to 6 percent from around 30 percent in the late 1980s, and Senegal, which had also effectively controlled its HIV/AIDS problem. "There could be a triangle of hope where Uganda in the east and Senegal in the west join with Angola in the south as three models of maintaining and confronting the pandemic successfully," he said. "Countries facing the devastation of the pandemic seldom have this phenomenal choice."