The achievements of the global community in tackling HIV/AIDS over the course of the Millennium Development Goals were truly remarkable. In the period between 2000-2013, new cases of HIV infections fell by 40 percent in many parts of the world. Also many across the world received greater access to antiretroviral treatment (ART) and drugs to help increase life expectancy and improve quality of life. This is particularly true of east and southern Africa where, even though the disease still remains prevalent, the life prospects of many HIV and AID sufferers has improved greatly.
However, despite these levels of success, parts of Africa have gone unnoticed in the global fight to tackle HIV and AIDS. In west and central Africa, a region that covers 25 countries, a Doctors Without Borders report released today has highlighted that 27 percent of all global deaths attributable to the AIDS pandemic occur in these countries. Furthermore, the region also represents 21 percent of all new HIV infections as well as 45 percent of the global total of children born HIV positive.
Dr. Mit Philips, health policy analyst at Doctors Without Borders, said that the delaying of treatment and poor provision of antiretroviral drugs in countries in west and central Africa is similar to scenes in southern and South Africa in the early 2000s, “where people who were often on the verge of death were brought to you in hospital.” Given the level of success globally in tackling the HIV and AIDS crisis, Philips adds that “this is something we rarely see any more in other contexts.”
As a result, countries in the region have been neglected, both in terms of funding and awareness. Southern and eastern Africa, where there is still the highest global prevalence of HIV and AIDS infections, it is still seen as a priority region for donors and aid agencies alike.
Many face challenges accessing antiretroviral services, with Doctors Without Borders estimating that 76 percent of people in need of treatment live in the region. The stigma and discrimination that people living with HIV face is still very real, often ensuring that the disease is not given the priority it deserves.
But if the symptoms of this crisis are becoming increasingly pronounced in the region, why then have international donors not done enough to provide some of the same basic services and drugs that people living with HIV elsewhere in Africa have access to? The report highlights that, west and central Africa have lower prevalence rates than countries in the southern part of the continent. Often this means that the visibility of HIV and AIDS sufferers is not as pronounced, “resulting in poor knowledge of the disease among the general population, political leaders and health workers,” which drives stigma and lack of investment.
Often this drives the approach that if it is not as prevalent and visible a burden on health services, it shouldn’t receive as great a proportion of international and domestic financing. However, this approach is highly problematic and has left many in the region with treatment gaps and drugs shortages, further complicating the suffering of those infected by HIV and the presence of fatal diseases that sometimes accompany AIDS, such as tuberculosis and malaria.
The issue worries Philips, who claims that “there are currently 6.6 million people living with HIV, of which 5 million people are not on treatment.” Of the 5 million people living with HIV in the area, just more than half of this number live in Nigeria alone, according to the Doctors Without Borders report. Elsewhere, the report adds that in Kinshasa, the capital of the Democratic Republic of the Congo, around 77 percent of health facilities visited in their study had experienced one or more shortages of at least one type of antiretroviral drug in the previous three months. As a result, 68 percent of these patients were sent away without the necessary medication. Four thousand of these patients were not tested due to a short out of necessary diagnostic kits.
Often one of the hardest challenges is convincing donors of the need to carry on and scale-up context specific investment in the face of success. In fact, many of the global champions in the fight against HIV and AIDS, such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), The World Bank and European donors, have taken their foot off the gas and are, conversely, scaling down their investment, not up. In many ways, Philips says that the fight against HIV and AIDS has been “a victim of its own success.”
International funding from organizations that finance the fight against HIV and AIDS, such as The Global Fund, is important not only in providing access to drugs and treatment, but as part of the wider response of strengthening the health systems to provide more sustainable solutions. The successes of embedding responses to the HIV and AIDS epidemic in southern and eastern Africa within health systems are proof in the viability of this funding, and must be used as examples elsewhere, Philips said.
The growing HIV and AIDS epidemic in west and central Africa threatens to challenge the central slogan of the Sustainable Development Goals, to “leave no one behind.” The region is still lags behind even the Millennium Development Goals targets.
“I definitely think that, in the region, there is unfinished business for the MDGs, for the people that have been left behind Philips said.
Many people in the region have been left behind in a response that has been diverted toward countries with higher visibility and prevalence of the disease. These very people will continue to be left behind unless recognition of the crisis is met with funding and support is increased and improved. For Philips, the international community must take this “opportunity to make sure that patients can access the lifesaving treatment and drugs that they need.”