Perspectives
Volume 196 - Issue 5

HIV and AIDS in Africa: good news and bad news

Author:  Robert G Cumming

Med J Aust 2012; 196 (5): 309. || doi: 10.5694/mja11.11600
Published online: 19 March 2012
Download PDF (62 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

Donor countries withdraw HIV funding just when compelling evidence on prevention emerges

The global epidemic of HIV and AIDS started in sub-Saharan Africa, and there are now 23 million people in the region living with HIV, representing 68% of the world total. In December 2011, I participated in the 16th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA), held in Addis Ababa, Ethiopia. The conference was full of good news about progress against HIV over the past few years, but there was also a great deal of concern about the ability to sustain the momentum.

The 2011 Global HIV/AIDS Response progress report, released on 30 November, showed that the number of new HIV infections in sub-Saharan Africa declined from 2.2 million in 2001 to 1.9 million in 2010, and the number of AIDS-related deaths declined from 1.7 million in 2005 (the peak) to 1.2 million in 2010.1

The decline in AIDS deaths is mainly due to the increased availability of antiretroviral therapy (ART), and the main reason for the availability of ART in Africa is the United States President’s Emergency Plan for AIDS Relief (PEPFAR). President George W Bush established PEPFAR in 2003, and he was guest of honour at ICASA. The 5000 delegates gave him a standing ovation as he approached the podium to deliver his address.

A major cause for optimism at ICASA was the recently published evidence that ART can effectively prevent transmission of HIV, a concept called “treatment as prevention”. Results from a randomised trial published in August 2011 showed that early initiation of ART for the HIV-positive partner in a serodiscordant couple reduced HIV transmission to the HIV-negative partner by 96%.2 Other studies published in 2011 have shown that use of ART by the HIV-negative partner reduces risk of HIV infection.3 This all bodes well for control of HIV in Africa — but only if there is adequate funding.

Overshadowing ICASA was the spectre of cuts to foreign aid to Africa as a result of the global financial crisis. Just before ICASA, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it was cancelling Round 11 of its funding. One of ICASA’s keynote speakers, Canada’s Stephen Lewis, was particularly scathing in his criticism of the Global Fund and its donor countries. Like previous speakers, he warned that a reduction in funding meant that people would die because of lack of access to ART. But Lewis went further. He said: “The decision on the part of the donor countries is unforgiveable ... It’s unconscionable, indefensible, outrageous. It’s murder, that’s what it is: murder.”4

While the Global Fund’s decision to cancel Round 11 was unexpected and shocking, there was, nevertheless, general recognition at ICASA that African countries need to become less dependent on donors in their efforts to control HIV and AIDS. Indeed, the theme of the conference was “Own, scale-up and sustain”. One of the advocacy groups at ICASA — these conferences tend to involve a nice mixture of scientists and activists — was lobbying hard for African governments to spend 15% of their budgets on health, as they had agreed to do in the Abuja Declaration as long ago as 2001.5

Led by its Minister of Health, Dr Tedros Adhanom Ghebreyesus, Ethiopia is one country that is taking a comprehensive approach to improving the health of its population. Dr Tedros has often been called the “world’s best health minister”. His major achievements include training and deployment of 38 000 health extension workers and an increase in medical school admissions from 250 students in 2005 to 2500 in 2012. At ICASA, he spoke of how he has used donor funding for HIV programs as a platform for strengthening the entire Ethiopian health system.

There was only a handful of Australians at ICASA. I worked with HelpAge International, the World Health Organization and UNAIDS (the Joint United Nations Programme on HIV/AIDS) to convene a workshop on HIV in people aged 50 years and older, and Dr Daniel O’Brien from Geelong presented data from his work with Médecins sans Frontières on false positive results from rapid diagnostic tests for HIV. It’s a pity there weren’t more of us. Ethiopia holds a special place in Australia’s relationship with Africa. It is the site of the fistula hospital established by Australian Dr Catherine Hamlin and her husband, and also a new Australian Embassy that will soon start allocating significant funding for maternal and child health. ICASA shows that the next few years will be crucial to health in Africa. Australian doctors should contribute more to the continent with the highest burden of disease.

Author

  • Robert G Cumming MB BS, MPH, PhD1
  • 1. School of Public Health, University of Sydney, Sydney, NSW.

Correspondence: robert.cumming@sydney.edu.au

Competing interests

No relevant disclosures.

References

Provenance: Not commissioned; not externally peer reviewed.

View this article on Wiley Online Library