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Africa's new strategies to defeat HIV/AIDS
After more than three decades of wrestling the menacing monster, Africa is finally slowing the rate of HIV/AIDS infections to a crawl.
Over the last decade, progress in tackling the pandemic on the continent has been particularly notable, thanks to heightened emphasis on prevention, treatment and care.
According to the latest report by UNAIDS, Global AIDS Update 2016, new HIV infections declined by 14% between 2010 and 2015 in Eastern and Southern Africa, the world’s most affected region, and by 8% in West and Central Africa.
Despite economic constraints, during this period, sub-Saharan Africa developed the world’s biggest HIV treatment programmes, providing antiretroviral (ARV) treatment to more than 12 million people, compared with 11,000 in the year 2000.
By 2015, for instance, about 10 million people living with HIV in East and Southern Africa and 1.8 million in West and Central Africa were on ARVs, according to the report.
To achieve these results, the countries used several health approaches: affordable prices were negotiated for ARV medicines, service delivery systems were simplified and decentralized, and strong supply chains for ARV medicines and other HIV-related commodities were established.
More and more countries are integrating prevention and treatment at the community level, meaning home-based caregivers are now becoming responsible for delivering treatments and managing patients.
In September 2016, South Africa announced it would provide free treatment to all people living with HIV, regardless of the condition of their immune system. Before, only those with a low level of CD4 cells in their blood—indicating an advanced state of infection—were put on free treatment.
African countries have also expanded prevention methods, such as voluntary medical male circumcision. Since 2007 more than 10 million men have been circumcised in 14 WHO-designated priority countries: Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.
Antenatal care services have helped reduce mother-to-child transmission. More pregnant women are now being tested and those found HIV positive receive medicine to prevent transmission to their unborn babies. This has resulted in a decrease in infections throughout the region.
In Malawi the approach is to provide all pregnant women living with HIV with ARVs for life. This is in addition to other initiatives such as HIV-testing campaigns and linking HIV tests to other health services, which helps to increase HIV screening among the population.
A growing percentage of the programmes in Africa are now funded domestically rather than by external funds. Some countries, such as Zimbabwe, have created an HIV/AIDS tax, while Rwanda has integrated HIV services into its national social insurance scheme, providing free treatment services for those living with HIV.
However, despite Africa’s success in combating HIV/AIDS, challenges remain. Sub-Saharan Africa still accounts for two-thirds of the global total of new HIV infections.
In July 2016, UNICEF announced that AIDS is still the number one cause of death for those aged 10–19 in Africa. Despite progress in prevention, the number of young people—especially girls who are more vulnerable to exploitation by older men—contracting HIV needs to be reduced, says UNICEF.
Adolescent girls and young women represent 25% of new HIV infections in sub-Saharan Africa. Women account for 56% of infections among adults due to gender inequalities, insufficient access to education and health services and poverty, among other reasons.
Reducing new infections, according to WHO, will require increased use of condoms, sustainable programmes to encourage changes in sexual behaviour, affordable methods for preventing infection in high-risk populations and expanded treatments for preventing mother-to-child transmissions.
All in all, targeted policies, strong leadership by governments and civil society and engaging people living with HIV will be crucial in sustaining the progress Africa has achieved so far and in meeting global development goals.