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Reaching a Turning Point

July 2000

While AIDS in Africa has become a full-blown development catastrophe, an historic line has been crossed in the battle against the deadly disease as political leaders speak out and new international resources are mobilized.

AIDS has become the number one killer in Africa, taking more lives -- 10 times more -- than the wars on that continent in 1998. Since the pandemic began, more than 16 million people have died worldwide and 13.7 million of them have been Africans, according to a global survey on the disease conducted by UNAIDS and the World Health Organization (W.H.O.) at the end of 1999.

These staggering statistics mean that AIDS stands to reverse the developmental progress Africans have made over the last two decades in health care, education, life expectancy, economic growth, and human security. AIDS in Africa has become a full-blown development catastrophe.

The facts emerged starkly from a survey conducted by the United Nations Development Program (UNDP) in late 1999. African nations suffered downward changes this year in the Human Development Index, a ranking based on levels of health, wealth, and education. Almost all of the major changes in rank could be attributed to declining life expectancy as a result of AIDS:


  • Average life expectancy at birth in southern Africa, which climbed from 44 in the early 1950s to 59 in the early 1990s, is expected to drop back to 45 sometime between 2005 and 2010.

  • The United Nations Development Program estimates that fewer than 50 percent of South Africans currently alive can expect to reach the age of 60, compared with an average of 70 percent for all developing countries and 90 percent for industrialized countries.

Yet even amidst these grim figures I am optimistic. I believe we are now at a turning point in the 20-year history of the AIDS epidemic in Africa. Everywhere I go, I hear top African leaders speaking out about AIDS as the major threat to the continent's development.

In Ghana two months ago, for example, First Lady Nana Konadu Agyeman Rawlings participated in the launch of a new female condom program, calling the introduction of these prophylactics a "long-awaited global dream come true for Ghanaians."

Bold actions like hers and those of other leaders give me hope that in the coming months and years we will see stronger, more effective responses to AIDS in many more sub-Saharan African nations.

I believe an historic line has been crossed in our battle against this disease as political leaders speak out and new domestic resources are directed to prevention and care programs and new international resources are being mobilized. When governments begin to focus on AIDS as a national priority, tough decisions can be made to create more favorable conditions for those affected by the epidemic, and establish better protections for the poorest and the most vulnerable.

The International Partnership Against AIDS (IPAA) in Africa is working toward those goals in a cooperative effort involving national governments, international organizations, and private sector groups. African governments are leading broad-based national responses. United Nations organizations are coordinating the global response and providing program and financial support to country-level efforts. Donor governments are also supporting action at all levels, providing input into substantive development of the partnership in addition to financial assistance. The private sector is providing expertise and resources to help turn the epidemic around in the workplace, among organized labor, and in the business community. And, finally, non-governmental organizations, including groups of people living with HIV, are working to ensure ownership of the partnership within local civil society and to strengthen regional and country networks.

The partnership's mission is as ambitious as it is simple. Over the next decade, it will help reduce the number of new HIV infections in Africa, promote care for those who suffer from the virus, and mobilize society to halt the advance of AIDS. Specific goals promoted by the partnership include:

  • giving young people aged 15-24 the information and skills they need to prevent infection;

  • providing HIV-positive pregnant women with access to HIV testing and counseling and to drugs that can increase their chances of having healthy babies;

  • including people living with HIV/AIDS actively in all aspects of social, economic, and political life;

  • furnishing AIDS orphans with the means to grow up and lead meaningful lives;

  • providing HIV-positive people with access to care in accordance with locally established standards;

  • ensuring that national and international firms operating in Africa are fully involved in the fight against the epidemic;

  • encouraging decentralization of HIV/AIDS programs and participation of communities; and

  • promoting an end to stigma and discrimination by social and legal means.

Governments in a dozen African nations have already accelerated their own actions in order to contain the disease. Burkina Faso and Cote d'Ivoire have established a national solidarity fund, for example.

The African partnership will also better enable these nations to exchange ideas on the "best practices" already emerging in the sub-Saharan region. In Uganda, sex and health education information and in-school HIV prevention programs for teenagers and youth have contributed to a demonstrated reduction in the rate of infection -- a decline as high as 40 percent in urban areas.

In Senegal, a rapid, broad-based response to the epidemic, supported by both Islamic and Christian leaders, has kept the rate of HIV infection below 2 percent. Recent behavioral surveys indicate that more than 60 percent of men and 40 percent of women aged 15-24 are now using condoms in casual sexual encounters.

The IPAA and partnerships like it will be the foundation on which to build more effective resistance to this epidemic. Individual sectors can not be successful alone; government, business, educators, and all society's players must be engaged to achieve success. We see it happening not only in these African programs, but elsewhere too -- the cooperation between government, non-governmental organizations, and others is working.

Thailand's government demonstrated the importance of partnership when it launched an impressive program after a 1989 study showed that 44 percent of the sex workers in Chiang Mai were HIV positive. Despite the illegal status of prostitution in Thailand, the government worked with brothel owners to urge 100 percent condom use in brothels. They launched mass media campaigns to encourage respect for women and discourage men from visiting sex workers, and improved access to care for people living with AIDS. As a result, HIV prevalence has declined significantly -- especially among young people.

Success stories like these can help other nations and communities guide their own decisions in shaping future programs. We need to work harder to ensure that "best practices" in the fight against this disease are shared.

We have learned that success in reducing transmission is not random; the most effective HIV prevention programs have key features. They benefit from political commitment and work on many levels at the same time, promoting safe behavior and providing care and support for people affected by HIV. They offer a broad range of prevention measures, including access to cheap and good quality condoms, confidential counseling and testing, prevention of mother-to-child transmission, and early treatment for other sexually transmitted diseases, which multiply the risk of infection with HIV. Other critical elements are long-term education and mass media campaigns to ensure broad public awareness about HIV -- especially among young people in W.H.O.m over half of all infections now occur. Finally, the communities affected and people living with HIV are actively involved in the planning and execution of AIDS programs.

Attention to youth, during their most sexually active and experimental years, is critical. About half of all the new cases of HIV infection involve young people between 15 and 24 years of age. While the young may be the most vulnerable population, we also find that they are the most receptive to prevention messages and will adopt more responsible behaviors.

Besides explanations of what the disease is and how it's transmitted, it is also important to challenge harmful concepts of masculinity, including the way adult men look on risk and sexuality and how boys are socialized to become men. At the same time, young women must be educated to recognize their vulnerability to infection, their responsibility to protect themselves, and their right to insist upon protection in sexual relationships.

Prevention programs will help us contain future HIV infections, but we must not forget the needs of more than 33 million infected people who need our care today. The UNAIDS Secretariat and who are trying to provide well-founded guidance and support to countries to assist in building health systems that can respond to the epidemic, and to find ways of ensuring that community-level care initiatives are encouraged and supported.

To that end, together with W.H.O.., UNICEF, the World Bank, and UNFPA, we have opened a new dialogue with five international pharmaceutical companies to explore ways to accelerate and improve the provision of HIV/AIDS-related care and treatment in developing countries. The pharmaceutical companies involved -- Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome, Merck & Co., and F. Hoffmann-La Roche -- have indicated their willingness to work with other stakeholders to find ways to broaden access to care and treatment, while ensuring rational, affordable, safe, and effective use of drugs for HIV/AIDS related illnesses. The companies are offering, individually, to improve access to, and availability of, a range of medicines. Other pharmaceutical companies have also expressed interest in cooperating in this endeavor.

But that's but one step in improving the lives of HIV infected persons. We need to ensure that the lowering of the price of some medicines stimulates the development of more comprehensive care strategies. We recognize that even at heavily discounted prices, the cost of antiretroviral therapies will continue to be beyond the reach of public sector subsidies and therefore unavailable to the majority.

This is a time of great opportunity when it comes to AIDS in the developing world -- a time of political opportunity, as exemplified by the strong commitment to respond to AIDS by numerous heads of state, and by the debates on AIDS in Africa at the U.N. Security Council in January 2000, initiated by Ambassador Richard Holbrooke, and at the World Bank/IMF Development Committee last April. It is also a time of opportunity in terms of resources, with the U.S. government, as well as other donors, greatly increasing funding for AIDS programs in the developing world. Africa alone will need $1,600 to $2,600 million per year to ensure effective prevention programs and basic care.

But amidst all this analysis of costs, programs, strategies, and multi-sectoral cooperation, there is one commodity that does not emerge, perhaps the most precious one. That is hope, which is certainly critical to reversing this appalling epidemic. It is my role, and that of all those engaged in this struggle, to keep that hope alive.

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This article was provided by U.S. Department of State.
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