AIDS in Africa: Two steps in the right direction

Africa’s battle against HIV/AIDS is not won yet. But the good news is, there is a significant decline in new HIV infections and AIDS-related deaths in sub-Saharan Africa and a critical policy shift in South Africa, the country with the largest number of infected people in the world. While Africa’s battle against HIV/AIDS is still far from over, a recent decline in new infections and AIDS-related deaths seems to mark a turning point. According to the lastest update by the Joint UN Programme on HIV/AIDS (UNAIDS), the number of new infections in all of sub-Saharan Africa has declined by 25 percent, amidst signs that the global pandemic may have peaked in 1996. The main cause for the drop, UNAIDS asserts, is the success of prevention and education programmes that have finally begun to change the behaviour of people at high risk, including men who have sex with men, commercial sex workers, intravenous drug users and young women. In South Africa, for example, condom use during the first sexual encounter more than doubled to 64.8 percent between 2002 and 2008. Zimbabwe, Zambia and Tanzania, among the countries hit hardest by the disease, all reported sustained declines in new infection rates. Treatment to prevent HIV-positive mothers from infecting their babies at birth has also made a difference. Between 2004 and 2008, UNAIDS reports, the percentage of women receiving such treatment increased fivefold to 45 percent, producing a sharp drop in the number of babies born with HIV. “New HIV infections and AIDS-related deaths are declining in sub-Saharan Africa,” confirmed Michel Sidibé, UNAIDS executive director. “The drop in infections is a result of the positive impact of ‘combination’ HIV prevention,” an approach that combines public education, access to condoms and other prevention technologies. It also results from a reduction in discrimination and bias against those with HIV and those at high risk of infection, along with policies that have promoted more responsible sexual behaviour. South Africa policy shift Encouragingly, critical HIV/AIDS related policy changes have been made in South Africa, the country with the largest number of infected people in the world. Last December, recently elected President Jacob Zuma stood before a cheering throng in Pretoria and marked World AIDS Day with a pledge “to deploy every effort, mobilize every resource and utilize every skill that our nation possesses” to turn back the advance of the disease. It was the second major speech on AIDS in as many months for Zuma. In the view of most observers it represented a final, welcome break with the controversial policies and pronouncements of his predecessor, Thabo Mbeki. Mbeki’s public doubts about the cause of the disease and his suspicions about the safety of lifesaving anti-retroviral (ARV) drugs were thought to have contributed to South Africa’s grim distinction as the country with the largest number of infected people in the world. Zuma has had his own difficulties with the issue. His 2006 comments about showering after unprotected sex with a woman living with HIV to prevent infection were widely ridiculed and caused outrage among activists. But he added substance to his World AIDS Day speech with the announcement that, beginning in April 2010, the public health service would expand ARV treatment programmes to include all infants testing positive for the virus, a change expected to save thousands of newborns every year. He also announced that treatment to prevent the transmission of the virus from mother to child at birth would begin earlier, as would treatment for those with both HIV and tuberculosis, in line with new recommendations from the UN’s World Health Organization. The new commitments follow those made a few weeks earlier to cut South Africa’s rate of new HIV infections in half and provide ARV treatment to at least 80 per cent of those in need. The changes in substance and tone over the months Zuma has been in office have “shattered years of official ambivalence,” Sidibé of UNAIDS told the crowd in Pretoria. Standing alongside the South African leader, he declared him “the architect of ending the epidemic.” Treatment access and women’s empowerment are criticalDespite the progress, the senior UN official cautions, infection rates in sub-Saharan Africa remain five times higher than in any other region. “The AIDS epidemic continues to evolve. Much more is needed to turn back the epidemic. Countries need to adopt a prevention approach that focuses on those most at risk of infection.” The new UNAIDS report underlines the point. Despite the drop in infections, Africa still accounts for most of the people living with the virus globally, as well as 36 of the 50 countries with HIV rates exceeding 1 per cent of the total population. All nine countries with HIV rates above 10 per cent are African, as are over 90 per cent of babies born with the disease. With new infections far exceeding the number of people able to get ARV treatment, UNAIDS notes, treatment and prevention programmes still lag behind the need. Sidibé notes that reducing infection rates among women, who make up 60 percent of Africans living with HIV, will be key to Africa’s long-term success. “Gender inequalities, sexual abuse, violence, conflict and poverty often increase women’s vulnerability to HIV. Protecting women from becoming infected with HIV and treating women living with HIV can turn back the epidemic.” Entrenched economic and social inequalities and cultural attitudes towards women, however, make overcoming gender aspects of the pandemic particularly challenging. For this reason Sidibé welcomed the announcement last September of the creation of a new UN women’s “super agency” that would consolidate the UN’s scattered gender-related activities under one roof and make them more effective. “We are hopeful that the creation of a new UN agency on women will help address the issue of gender inequality and advance the rights of women and girls, particularly in Africa. UNAIDS will work closely with the new agency to promote women’s access to health and development and deliver critical maternal and child health services to women and girls at the grassroots level.” Michael Fleshman writes for United Nations Africa Renewal magazine. africarenewal@un.org