IRIN Focus on improving the response to AIDS

In the doom and gloom surrounding the HIV/AIDS epidemic in Africa, what can be overlooked is that there are examples of what works in combating its spread, experts at the Africa Development Forum (ADF-2000) on AIDS stressed this week. “Africa already possesses most of the ‘tools’ – if not the recourses – needed to change the course of the epidemic,” a working paper produced for the five-day forum, hosted by the UN Economic Commission for Africa (ECA), said. “There is an urgent need to build on the lessons learned about HIV/AIDS prevention and care over the past two decades. The major challenge is how to develop successfully, within the resource constraints facing African countries, the scale and reach of the many programmes which are successful in their work but which only help a small percentage of the population,” the paper added. Scaling up the response requires effective leadership at all levels and a change in “mindsets”. For ECA Executive Secretary K.Y Amoako, only leadership “which is the boldest, most persistent, most insightful, compassionate, forceful, cooperative and imaginative we have ever had,” can suffice. An ECA study on approaches to an effective HIV/AIDS response noted that flexibility in policy implementation and grassroots participation are all vital ingredients. However, “scaling-up also requires a general capacity for implementation among state institutions, which entails reversing years of neglect and austerity,” it pointed out. To avoid a fragmentation of effort, a “multisectoral approach” is urged in which the government is partnered by NGOs, development agencies and the private sector in an integrated strategy of social mobilisation that also seeks to overcome AIDS stigma and discrimination. “An important lesson learnt over the past decade is that national HIV/AIDS responses cannot reach the necessary scale through centrally operated programmes,” the ECA briefing paper said. “A decentralised, participatory approach with the involvement of all sectors leads to wider coverage, especially of people at the ‘grassroots’.” Scaling-up also requires resources. UNAIDS has estimated that Africa would need US $1.5 billion a year to achieve “massively higher levels of implementation of all the major components of successful prevention programmes”. A further US $1.5 billion would buy palliative care (but not antiretroviral therapy) for at least half of all AIDS patients in need, treatment and prevention of opportunistic infections, as well as care for AIDS orphans. UNAIDS has pointed out that money is not all: Africa’s health, education and communications infrastructures need to be well enough developed to be able to deliver these interventions, and under the impact of AIDS, many are crumbling. According to the ECA, apart from mobilising donor assistance, governments must also examine their spending priorities and reallocate funds where appropriate. For example, “boosting the educational and economic opportunities of young girls in rural areas not only reduces HIV transmission by providing alternatives to commercial sex but also contributes to sustainable rural development and improvement in the status of women,” a forum document stressed. Debt relief was also repeatedly cited at the conference as a necessity for Africa, with governments held accountable for the spending of the freed-up resources. The bottom line for an effective response to HIV/AIDS in Africa seemingly requires nothing short of a revolution on the continent. “The challenge of HIV/AIDS cannot be addressed outside the context of the poverty that prevails across Africa,” the ECA study on appropriate responses said. “Mobilising public policy against HIV/AIDS is like trying to overcome illiteracy, end domestic violence, establish basic social rights, and provide universal primary health care all at the same time.” In an emotional opening address to ADF-2000, Amoako noted: “Leadership on HIV/AIDS calls for so many of the fundamental things we should have been doing anyway. An Africa where all our leaders, at every level, where each of us here today works for the policies, practices and programmes to reduce HIV/AIDS, is, in fact, the Africa we should all be working for anyway.” In the meantime, campaigners continued to remind the conference that there are a number of simple steps that, if properly implemented, would have a major impact on the epidemic. These include the free distribution of condoms, testing for pregnant women, providing drugs to reduce mother-to-child transmission during birth, and for well-known people living with HIV/AIDS to come out and admit their status.