It is not often that news from the health sector is good. Mostly, it is gloomy stuff. It is, for instance, another outbreak of Ebola, and the near-certainty that it will claim thousands of more lives before it is brought under control, a task made enormously difficult by the actions of armed groups and certain cultural practices. It is the discovery of a hitherto unknown virus with the potential to cause untold havoc. Or it is a combination of religious groups, fanatics and charlatans of all sorts fighting vaccination. There doesn’t seem to be new groundbreaking inventions in medicine to lift the gloom. The discovery of life-changing things like anaesthesia and penicillin seems such a long time ago. Even the relatively more recent inventions of the last century, such as organ transplant and immune-therapy seem to belong to another era. Today’s artificial intelligence and its application to medicine appear to be in the future, at least here in Africa. But occasionally you get an uplifting story. For a while now, Rwanda has been reported to be on the verge of eliminating the threat of cervical cancer among Rwandan women. That optimism comes from a vaccination campaign against the virus that causes cervical cancer that the Rwandan authorities have been carrying out for the last nine years. According to the World Health Organisation (WHO), cervical cancer is the second most common cancer, but also the deadliest, among women in Africa. In Rwanda it is the most common. The promise, therefore, of wiping out that threat is itself good news. The fact that it is actually being done is a cheering story. There is a similar story with HIV and AIDS. Contracting it is no longer a death sentence. Of course, it remains incurable, but with increased awareness, more access to healthcare and medication, and personal discipline, it is controllable and those already infected can live normal and productive lives. And national and global efforts continue to bring it under check. National and global efforts continue to check it. And so, yesterday the International Conference on Aids and Sexually Transmitted Infections in Africa (ICASA) opened its twentieth meeting in Kigali to assess progress towards eliminating it in Africa by 2030.”. It is an ambitious goal but also achievable. The gathering in Kigali brings together all the important people in the fight against AIDS. There are political leaders at the highest level, First Ladies of African countries who have made the fight their own, heads of international organisations such as the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), scientists, researchers and human rights activists. For the next six days, all these people will be giving us depressing statistics on the situation of AIDS in Africa. They will tell us, for instance, that Africa accounts for about a quarter of the global burden of disease and that over half of Africans do not have access to essential health services, and millions die from preventable diseases. They will also say that Africa represents only one per cent of global health spending. Most of the funding comes from external sources. These are not very good stats. But they will also have some positive figures. For instance, deaths due to AIDS have reduced by 55% in the last fifteen years. Some countries have gone some distance to achieving UNAIDS target of 90-90-90 by 2020. The 90-90-90 strategy formula that by next year, 90% of people living with HIV know their HIV status, 90% of those diagnosed receive sustained anti-retroviral therapy (ARVT), and 90% of all people receiving ARVT have viral suppression. Rwanda’s score here is 84-98-90, meaning that we have attained the target on viral repression, exceeded that on ARVT, but still fall short on those who know their status. This is generally a good result. If the situation was similar in the rest of the continent, it would be possible to say that the fight against AIDS is on the way to being won. Still, what is happening in Rwanda offers is instructive. The country has not achieved the results on the UNAIDS 2020 targets by accident. It has been the result of good practices such as financing of healthcare programmes and use of community health workers. Good politics and governance, global cooperation and mobilisation of domestic financing, and strong national health systems are key, as President Paul Kagame said at the opening of the meeting. Everyone agrees that there is progress, but there could be more. Some things have changed but others have remained the same and they stand in the way of further progress. One of them is a judgemental attitude towards people living with AIDS as Ms Winnie Byanyima, UNAIDS Executive Director, said in a BBC interview on Monday. AIDS is still considered a disease of sin and shame and irresponsible behaviour. The answer to which is openness as Kagame said in his opening address. So the ICASA meeting will not be all doom and gloom. There are some bright spots. One of them is that, although the death sentence has not been removed, it has at least been commuted to life. That is no small victory as human rights activists will know. The views expressed in this article are of the author.
