Africa-Press – Gambia. The world commemorates World AIDS Day on December 1 after the World Health Organization (WHO) established it in 1988. Africa is the world’s most affected continent by AIDS, with two-thirds of all HIV-infected people worldwide located there.
Acquired immunodeficiency syndrome (AIDS) is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). It continues to be one of Africa’s biggest societal challenges and obstacles on the path to development.
According to some estimates, about 38.4 million people worldwide are infected with HIV, with 25.6 million living in sub-Saharan Africa. What’s more, out of this figure, 1.85 million are younger than 15. Presently, people aged between 15 and 24 account for a third of all new infections on the continent, according to the WHO.
Nonetheless, AIDS rates vary significantly between African countries with the majority of cases concentrated in the southern part of the continent, while North Africa and the Horn of Africa have significantly lower infection rates. As of 2021, there were 20.6 million people with HIV (53%) in eastern and southern Africa and five million (13%) in western and central Africa, according to the US Department of Health & Human Services. The most affected countries include Swaziland, Botswana, Lesotho, Malawi, Namibia, Nigeria, Kenya and Zimbabwe.
According to Ajayi, factors driving the spread of HIV include poverty, transactional sex, lack of sex education, inadequate medical care, limited access to sexual and reproductive health services, exposure to sexual violence, discriminatory laws criminalizing HIV transmission, sex work and same-sex relationships, to name a few.
Obstacles to Progress The international community has been aware of the problem for decades, taking efforts to curb the spread of the life-threatening condition.
In early 2000, affordable antiretroviral drugs began arriving in the continent to save those living with the HIV burden. As of December 2021, 19.5 million Africans living with HIV received medicines to keep them alive and well, up from five million in 2010, according to the Joint United Nations Program on HIV and AIDS (UNAIDS). Despite the visible progress, new HIV infections remain high on the continent.
UNAIDS insists that ending AIDS is achievable, citing a tested set of approaches that are proven to work, including in challenging circumstances. Earlier, the UN set an ambitious goal to eliminate the AIDS epidemic worldwide by 2030.
However, international observers refer to economic and financial hurdles in the way of the effort, including embarrassing cases of apparent fraud committed by some private charities and pharma firms under the guise of life-saving initiatives.
In March 2017, Wall Street analyst and investigative journalist Charles Ortel alleged in his interview that the Clinton Foundation (founded by former US President Bill Clinton) used its initiative to fight AIDS worldwide since 2002 to cash in on African AIDS/HIV sufferers. Ortel quoted the foundation’s messy documentation and IRS filings, which led him to believe that the charity could have a cut of the money it collected for the noble cause.
In October 2003, the charity inked agreements with four manufacturers of cheap generic antiretroviral (ARV) drugs to provide Africans infected with HIV with affordable medicines. To complicate matters further, the list included Ranbaxy Laboratories Ltd, India, which pleaded guilty in May 2013 to felony charges relating to the manufacture and distribution of certain ineffective adulterated drugs.
Ortel, who has been conducting a private investigation into the Clinton Foundation’s alleged fraud and pay-to-play schemes, did not rule out that the Indian firm, backed by the Clintons, delivered adulterated drugs to Africans with HIV/AIDS, thus exacerbating the infection. There is no information on whether the Clinton Foundation had a well-trained medical staff to orchestrate its HIV/AIDS initiative, the Wall Street analyst noted in 2017.
Moreover, US investigative journalists revealed in 2013 that ARV drugs which Ranbaxy sold to the South African government to treat its AIDS-ravaged population had not been properly tested. They also alleged systemic fraud in Ranbaxy’s worldwide regulatory filings.
In addition to the incidents when African governments got potentially ineffective medicines, many African states neither have enough professional health workers nor developed infrastructure to transport and store ARV drugs – which require refrigerated storage – given that 600 million people in Africa lack access to electricity, according to the International Energy Agency (IEA). The recent UNAIDS report Dangerous Inequalities revealed that inequalities and poverty are obstructing the end of AIDS on the continent.
“Poverty, which in some instances is growing (in part due to COVID-19) continues to put adolescent girls and young women in harm’s way,” said Adamson Muula, professor and head of Community & Environmental Health at Kamuzu University of Health Sciences, Malawi. “Poverty abounds in places where there is deficient leadership and statecraft not understood. Unfortunately, those people who have to fight HIV and AIDS may not have the means to influence national leadership.”
The overall lack of education concerning HIV transmission, myths and stigma accompanying the deadly disease also make it hard to eradicate it, according to Dr. Nelson Musoba, director general of Uganda AIDS Commission.
African Countries Making Progress Regardless of existing negative factors, African governments have demonstrated success in the fighting of the deadly disease.
In November 2012, UNAIDS reported a more-than 50% reduction in the rate of new HIV infections across 25 low- and middle-income countries – more than half in Africa. The next decade also demonstrated positive data.
For instance, Botswana became the first HIV-affected country to be certified by the WHO in December 2021 for achieving an important milestone in eliminating mother-to-child transmission of HIV.
In particular, the country brought the mother-to-child HIV transmission rate to under 5%; provided antenatal care and antiretroviral treatment to more than 90% of pregnant women; and achieved an HIV case rate of fewer than 500 per 100,000 live births, according to the international health organization.
For its part, Eswatini has achieved the 95-95-95 target, which means that 95% of the country’s people living with HIV know their HIV status, of whom 95% are accessing treatment and that 95% of people on treatment have a suppressed viral load. The ‘95-95-95’ deadline is 2030, meaning Eswatini reached the target a decade in advance.
But that is not all: more African countries have made excellent progress, including Cape Verde, Kenya, Lesotho, Malawi, Nigeria, Rwanda, Uganda and Zimbabwe, according to Torpey.
“Malawi has been reporting lower incidence than was the case over the past several years,” emphasized Adamson Muula. “International partnerships such as the US government’s PEPFAR program (also tackling malaria) and the Global Fund (also fighting malaria and tuberculosis) and resilient national health systems have ensured that the pandemic is reduced.”
Uganda, a landlocked country in East Africa, has been battling the HIV and AIDS epidemic for the last 40 years, noted Dr. Nelson Musoba. He explained that the country used the UNAIDS global approach “to customize it here at home and worked with that.” There are things that have been done on the national level, but there are also mechanisms and best practices taken from the global experience, he explained.
According to Muula, “it is pleasing to see” that for some time, the world has joined hands in the fight against HIV and AIDS, although challenges remain.
“African countries have individually and in partnership with others mounted interventions which have started to bear good fruit. In several African countries, the incidence (new cases) has been dropping each year,” he stressed.
The professor particularly singled out the universal “Test and Treat,” which, according to him, has become a “game changer” in Africa. He also noted that in places where such health services are provided, reasonable levels of acceptability are often achieved.
African countries can defeat the AIDS/HIV pandemic if they coordinate their efforts within the continent and instrumentalize international support, according to Dr. Glory Florentine, clinical doctor, trauma psychologist and SRHR expert from Tanzania.
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