Africa puts fight against AIDS at forefront

Nigeria summit stresses need for a substantial 'war chest'

By Vincent Nwanma in Abuja

Africa's determination to fight HIV/AIDS and other infectious diseases got a major boost in April from the continent's leaders and UN Secretary-General Kofi Annan. While Mr. Annan proposed the launching of a Global Trust Fund to secure funds to fight the disease (see "Drug price plunge energizes AIDS fight"), African leaders vowed to place the struggle against AIDS "in the forefront and as the highest priority." Concretely, they pledged to allocate at least 15 per cent of their national budgets to "the improvement of the health sector."

"I firmly hope that our own efforts together with a Global Trust Fund will give us the resources that we critically need for the long struggle ahead," Nigerian President Olusegun Obasanjo, told his fellow African leaders at the African Summit on HIV/AIDS and Other Related Infectious Diseases in Abuja, Nigeria, 24-27 April 2001. It was sponsored by the Organization of African Unity (OAU) in collaboration with the UN, as a follow-up to the second African Development Forum, held in Addis Ababa, Ethiopia, 3-7 December 2000 (Africa Recovery, January 2001).

Photo: UN / Evan Schneider

OAU Secretary-General Salim A. Salim had earlier put the resource requirements in graphic terms. "In order to fight this pandemic, tuberculosis and other related infectious diseases, we do recognize that we need massive expansion of financing for basic health programmes across Africa, with a special emphasis on HIV/AIDS," he said. To do this, "we need large amounts of resources, not in a token or symbolic form, but massive amounts, on a sustainable basis," Mr. Salim said.

Mr. Annan agreed. "The war against AIDS will not be won without a war chest, of a size far beyond what is available so far," he said in an address that was intermittently interrupted by applause from the audience. He put the global funding requirements for the fight against AIDS at $7-10 bn annually. "The sum we are asking for is huge, but we should also be conscious of the magnitude of the problem we are tackling," Mr. Annan said.

There currently are 36 million infected people worldwide, with 70-80 per cent of them in Africa. According to former US President Bill Clinton, who also spoke at the summit, AIDS now kills more people in Africa than all the armed conflicts on the continent combined.

The OAU estimates that some $3-4 bn is required annually to fight AIDS in Africa, although only about 10 per cent of that amount now is being committed by African governments. "We recognize that the primary responsibility for mobilizing resources must come from within Africa," Mr. Salim affirmed.

Rwandan President Paul Kagame urged African countries to "specifically" allocate resources to combat HIV/AIDS, preferably by designating a certain percentage of their budgets for such programmes. One way of doing this, in countries where it might apply, might be to "earmark resources that would be freed from debt relief," suggested Mr. Kagame.

An "endangered" continent

The urgency for action was brought forcefully to the summit by Ms. Georginia Ahamefule, a 41-year-old Nigerian who has been HIV-positive since 1995 and now also has tuberculosis. "We the people of Africa are the greatest economic asset you have, yet look at us being slowly but surely wiped out by these two dreaded diseases," she told the African leaders, speaking on behalf of the millions of Africans infected with HIV, tuberculosis, malaria and other diseases. "I wonder what the future of our countries is going to look like in the next 20 years, if you do not act fast."

Although Ms. Ahamefule noted that her tuberculosis should be curable, treatment is threatened by the high cost of the necessary drugs in Nigeria. "My doctor has advised me that if I disrupt my treatment schedule and am unable to complete it, I run the risk of developing an almost incurable form of TB called multi-drug resistant TB. That will indeed be a double sentence of death."

A Nigerian youth activist, 15-year-old Abayomi Mighty, reminded Africa's leaders of their obligations: "You are the people who tell us to go to fight when there is war. You are the people who ask us to join rallies in election campaigns. Now we need you to fight with us against HIV/AIDS. We are the ones dying and wasting."

The Nigerian president agreed that the future for Africa was bleak. "What we have is a pandemic out of control, which is gravely threatening our nations, our children and our future," Mr. Obasanjo told the participants. "We are an endangered continent."

Given such passionate appeals to them during the summit, adopting the Abuja Declaration was perhaps the least the leaders could do. "We are deeply concerned about the rapid spread of HIV/AIDS infection in our countries and the millions of deaths caused by AIDS, tuberculosis and other related infectious diseases," they declared. The leaders also noted that these deaths are occurring "in spite of the serious efforts being made by our countries to control the diseases."

In a framework of action adopted at the end of the summit, the leaders set out priority areas and strategies for implementing identified actions to "arrest and reverse" the rate of infection of HIV, tuberculosis and other infectious diseases. It stresses the need for leadership at the national, regional and continental levels to mobilize society as a whole to fight the diseases, and calls for improvements in information, education, communication and protection of human rights.

Progress and challenges

The summit heard some cheering news, however modest it was. On both malaria and HIV/AIDS, there were reports of progress toward finding treatments. The World Health Organization announced it had developed a new drug for treating children with malaria. Introduction of the drug into Africa, it said, would reduce the number of children who die from malaria by 100,000 annually. One million sub-Saharan Africans now succumb to the disease each year.

Named Artesunate -- derived from the Chinese herb artemisia annua -- the anti-malaria drug has been developed for rectal use and is quickly absorbed. It halts the course of the disease, thus "allowing the patient to regain consciousness and reach a health centre for further definitive curative treatment with oral anti-malarial drugs," WHO said in a statement.

WHO also commemorated Africa Malaria Day, on the anniversary of the Roll Back Malaria campaign launched by African leaders here in Abuja a year ago. The campaign, a partnership involving WHO, the UN Children's Fund, the UN Development Programme and the World Bank, aims to halve the number of malaria cases by 2010. A number of malaria-endemic African countries now are implementing malaria control programmes. In Nigeria, the government has reduced taxes and tariffs on mosquito bed-nets "to assure their availability and affordability," WHO noted.

While there is no vaccine for the prevention or cure of HIV/AIDS, the International AIDS Vaccine Institute (IAVI) announced it is working on five preventive vaccines for use in Africa. IAVI President Seth Berkley told reporters that the first human trial of the preventive vaccines began in March in Nairobi, Kenya, and would last for up to a year. He explained, however, that even under the most optimistic scenario, the vaccines would not be available for seven years.

President Obasanjo announced that the Nigerian government has begun a pilot project for treating 10,000 AIDS sufferers with anti-retroviral medicines, using low-cost drugs imported from India.

Despite these developments, the journey will still be long. "Let us not fool ourselves, the HIV/AIDS epidemic is here to stay," said UNAIDS Executive Director Peter Piot. "Therefore, we should embark on short term urgent action while building capacity for the long term."

Ending stigmatization

The summit marked a step forward, not only in the fight to prevent new infections, but also to break the cycle of silence and stigmatization. The few "people living with AIDS" (PLWAs) who participated in the summit helped put flesh and bone on the issue. Because of the social stigma associated with the disease, many of those infected decline to declare their status, while many others will not even go for testing.

"We all have come a long way, living with the virus, crossing many milestones ... milestones of shock, fear, uncertainty, denial, guilt, shame, blame, and of course hope," said Mr. Mohammed Farouk Auwalu, a Nigerian activist and one of those who spoke on behalf of the PLWAs.

"In spite of the duration of the epidemic and the emerging scientific advancements, there is still an enormous level of stigmatization and ruthless discrimination," said Mr. Auwalu, a former military intelligence officer. "Even young children are not spared."

Ms. Ahamefule's case is typical. Her employers tested her blood without her consent. When they found she was HIV-positive, they dismissed her from work. Aggrieved, she took her case to court. The court threw her case out. She subsequently went before an appeals court, where the case is at present.

Ms. Yinka Jegede, a 22-year-old Nigerian nursing student living with the virus, had a similar experience. Her school authorities were not happy with her decision to declare her HIV status. Consequently, the school suspended her for a time, and now she has to spend an extra year completing her studies. Speaking at the opening ministerial session, she demanded a change of attitude towards PLWAs. "Our rights must be recognized in full." She also urged governments to involve PLWAs in national policymaking on AIDS and recognize their leadership roles.

Participants agreed that those living with the virus have a role to play in the search for a breakthrough. "National leaders must take the initiative to break the silence and encourage people with AIDS to talk," said Mr. Clinton.

Plans and partnerships

Money may be critical for the prosecution of the war on HIV/AIDS, but without plans for action, African nations stand little chance of making meaningful progress. In formulating such plans, it is important to be "focused," said President Kagame of Rwanda. "This is a problem that we have to live with for a long time," he said, urging his fellow leaders not to dwell "on short-term measures."

The leaders recognized this point. "We are fully convinced that containing and reversing the HIV/AIDS epidemic, tuberculosis and other infectious diseases should constitute our top priority for the first quarter of the 21st century," they said in the Abuja Declaration.

Formulation of national plans, speakers argued, would give African countries ownership of the battle against AIDS. In addition, the mobilization and commitment of domestic resources would demonstrate political will, which most participants agreed was crucial for success in the fight against HIV/AIDS.

Such action, in turn, would help convince the international community of Africa's dedication to the fight and provide a basis for stronger partnership with the continent. "There is only one way forward and that is the way of partnership," said Mr. Piot.

Related boxes:
[ Abuja Declaration ]
[ Kofi Annan: A call to action ]

Material from this article may be freely reproduced, with attribution to
"Africa Recovery, United Nations".
We would appreciate a copy of the reproduction.

Africa Recovery
Room S-931
United Nations
New York, NY 10017 USA

Tel: (212) 963-6857
Fax: (212) 963-4556
Email: africa_recovery@un.org

Website: www.africarecovery.org
Contact us by email: africa_recovery@un.org