AIDS in Africa-The story so far

Essay on a serious epidemic in Africa

Manasvini Vimal Kumar Fairleigh Dickinson University

2/3/2014

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AIDS in Africa-The story so far

Even with the death of the legendary AIDS activist and the face of popular South African

soap opera, Lesego Motsepe, better known as Letti Matabane in Isidingo; the conquest over HIV,

does not seem approachable yet. Although fighting the pernicious virus for 16 long years herself,

she propagated that education and a youth crusade against AIDS, and self restraint was the key to

the global worry (Moonze,2002). But the significant question that remains to be answered, is,

whether the efforts being put in are enough? Unfortunately, the story is bigger than being

manifested at present and the earnest efforts have still a long way to go.

The birth of the human immunodeficiency virus can be traced back to the middle of the

twentieth century. Starting with its viral ancestor, the Simian Immunodeficiency Virus, or SIV in

chimpanzees of south east Cameroon, HIV -1 was transferred to humans around

1930(AVERT,2013). Later, around 1940, the HIV -2 strain passed on to humans from monkeys

in Guinea-Bassau (AVERT,2013). Stored blood samples from malarial studies, showed the

presence of HIV virus in Democratic Republic of Congo during 1959; which is expected to have

given rise to an epidemic during 1960s (AVERT,2013). Consequently, many opportunistic

infections suddenly being observed in Kinhasa, led to the realization, that there was an HIV

epidemic during 1970s (AVERT,2013).Thereafter, 1980s saw a widespread rise in the cases of

AIDS along Eastern Africa, primarily due to labor migration, predominant male population,

backward status of women, lack of circumcision and so on (AVERT,2013). Occupations such as

that of sex workers, truck drivers, miners, and paid blood donors provided a niche to the virus

(AVERT,2013).

Sadly, it took us upto1996, to introduce HAART- a combined treatment for the infection

but, only for developed countries, due to its expense (AVERT,2013). Gradually, after a lot of

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contemplation, and prolonged arguments between pharmaceutical companies and governments,

local production and import of expensive medicines for AIDS was allowed to South Africa

(AVERT,2013). An interesting development was the discovery of zidovudine, a drug preventing

mother-to-child transfer of HIV, in 1996 (AVERT,2013). Following a sharp decrease in the price

of anti-AIDS campaign itself, UNAIDS launched Africa's first mother-to-child prevention

program in Botswana (AVERT,2013). Between 2003 and 2005, the sub-Saharan population

receiving ART skyrocketed from 100,000 to 810,000 (AVERT,2013). By 2007, 95% of the

suffering were already being treated and this mitigated the fear that AIDS was untreatable for

poor nations (AVERT,2013). In 2006, 71% in Namibia, 71% in Rwanda, 44% in Kenya, 43% in

Malawi, 42% in Swaziland, and 41% of the affected population in Uganda , was being treated

(AVERT,2013).

Statistically, South Africa reports the highest number of HIV infections with a surprising

17% of the country's population between the age group of 15-49 years, struggling against the

virus (UNAIDS,2012). This is, however, the rosier picture when compared to 2004 figures,

which underlines the success of the joint strife against the disease by United Nations AIDS

program and the government of South Africa (UNAIDS,2012). The cases have declined up to

one third in almost a decade of intensive anti-HIV educational, training, preventive and treatment

campaigns (UNAIDS,2014). Out of the 6.1 million people with HIV in South Africa, 2.2million

are receiving treatment, making it the world's largest HIV treatment program (UNAIDS,2014).

Further, the number of new cases have also plummeted from 540,000 cases in 2004, to 370,000

in 2012, showing a 31.48% decline (UNAIDS,2014). This is partly, due to the intensive program

of Suzuma Sakhe, meaning 'Let us stand and build', launched in one of the densely populated

provinces, with a third of the total population infected with HIV, KwaZulu-Natal

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(UNAIDS,2014). According to Michel Sidibe, executive director of UNAIDS, South Africa is

working hard towards changing the course of the epidemic in the continent and the world

(UNAIDS,2014).

Furthermore, other South African nations of Botswana, Lethoso and Swaziland show a

high adult prevalence rate of 24.8%, 23.6% and 25.9% respectively (AVERT,2013). On the

other hand, West African nations of Nigeria, Cameroon and Gabon are relatively better at 5.8%,

5.3% and 3.7% respectively. For Nigeria, however, this represents 3.3 million of the total

population, which is diminishing (AVERT,2013). East African countries of Uganda, Kenya and

Tanzania show prevalence exceeding 5% (AVERT,2013). Overall, out of 34 million of the

world's suffering population, 69% resides in sub-Saharan Africa (AVERT,2013)

By the same token, the human immunodeficiency virus is not only taking a toll on the

health of Africans, but, it is also affecting their economies severely. As a result of the heavy

prevalence of HIV positive infections, African economies are suffering and development is being

hindered because there is not enough work force, as average life expectancy is quite low and not

all the people infected, are receiving the treatment. Lack of health care workers and medicines,

has made the situation even worse. The Center for Strategic and International Studies, has

suggested a threefold path for dealing with AIDS in Africa. The first is that stakeholders'

responsibility in Africa be increased, towards designing and implementing national health

policies; second, exploring ways to make the treatments sustainable, and third, urging US to

partner with African governments on global health issue.

However, the news on the treatment front is not up to the mark yet. According to the

news from National Academies, the number of cases in sub Saharan Africa will soon overshoot

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the treatment resources available by 2020 (National Academies,2010). Thus, it will become an

extremely challenging task to allocate the resources correctly (National Academies,2010).

This calls for an increased emphasis on prevention, care for the affected and the prospect of

responsibility shared between the governments and UN or US (National Academies,2010). It has

been estimated that by 2020, there will be more than 30 million people affected by HIV(National

Academies,2010), out of which, 12 million will require Anti retroviral treatment(National

Academies,2010). But, it would be available for merely 7 million, as the costs are unsustainable

if solely dependent on foreign aid (National Academies,2010).

Additionally, not only does it leave the average life expectancy of the affected

population, under 55 years, it also renders them disabled to carry out any health care duties,

partly because of the opportunistic infections and partly, due to compromised immunity

(National Academies,2010). Hence, there is always a dire need of foreign health care workers,

posing a challenge to already struggling economies with global recession, that want to look after

their own people first (National Academies,2010). In 2003, the US presidential plan, called

PEPFAR-President's Emergency Plan for AIDS Relief, was launched to attract global attention

and efforts to fight the disease and address the gap between the number of people requiring

treatment and the availability of anti retroviral treatment (National Academies,2010).

But, the dilemma is that treatment itself is a form of prevention, because early treatment

would render more people requiring it in short term, whereas, decreasing the number requiring it

in the long term (National Research Council, 2011). This implies that decreasing the incidence in

2010, might only partly decrease the challenge by 2020 (National Research Council, 2011). The

critical decisions lie in deciding treatment action early versus late treatment; coverage with

second line versus first line of treatment; deciding on program quality as against quantity, and,

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whether investment should focus treatment or prevention (National Research Council,2011). The

strategies adopted by joint UN program for the treatment of AIDS, are- first, scaling up

treatment, prevention and care programs, by relying on people outside the clinical health sector,

like management and support staff; second, encouraging task sharing among physicians, nurses,

and allied healthcare professionals, to address bottlenecks, especially in remote areas; third,

harnessing the expertise and building capacity of allied healthcare professionals; fourth, tapping

the potential of information and communication technology by introducing teleconsultations,

telereferrals, maintaining electronic health records and electronically training healthcare workers;

fifth, exchanging of technical assistance from other countries and finally, coordinating care in

primary health functions and national public health institutes.

In conclusion, the story so far, concludes that the path we are treading is right, but, it is

just the beginning of the end, and there is still a long way to go, and onerous targets to reach.

Considering the gravity of the situation, and rising to the occasion, Mr. Patrice Motsepe, a South

African billionaire, has donated USD 10 million towards the fight against HIV/AIDS (Forbes,

2014). But, it may take hundreds of such philanthropists together, to address the epidemic.

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References

(2013, August). National Institute on Drug Abuse -the science of drug abuse and addiction.

Avante Garde award program for HIV-AIDS researc.h. Retrieved from:

http://www.drugabuse.gov/about-nida/organization/offices/office-nida-director-od/aids-

research-program-arp/avant-garde-award-hivaids-research.

Nsehe M.(2014, January 27). South African billionaire Patrice Motsepe gives $10 million to fight

HIV/AIDS in Africa .Retrieved from:

http://www.forbes.com/sites/mfonobongnsehe/2014/01/27/south-african-billionaire-

patrice-motsepe-gives-10-million-to-fight-hivaids-in-africa/

UNAIDS. National commitment and policies instruments counties. Retrieved from:

http://www.unaids.org/en/dataanalysis/knowyourresponse/ncpi/2012countries/

(2013). AVERT averting HIV and AIDS. Retrieveds from: http://www.avert.org/history-hiv-

aids-africa.htm

(2014.January,30). Center for strategic and international studies- Africa program. Retrieved

from: http://csis.org/program/africa-program