May 7, 2000
"We know a great deal about what works to prevent or slow down the epidemic," said Dr. Piot. "The challenge is to implement it on a scale that will truly have an impact." Dr. Piot was speaking at the Meeting of Ministers of Health of the Organization of African Unity on HIV/AIDS in Ouagadougou.
Burkina Faso, which is hosting the conference, is West Africa's second most affected country, with 350,000 HIV-infected people and a prevalence rate of 7%. It is one of the world's poorest countries and ranks 171 out of 174 countries on the Human Development Index, which the United Nations Development Programme (UNDP) uses to measure standards of living worldwide.
"Unless something is done quickly, this 7% figure will rise to 10%, possibly even by next year," said Christian Lemaire of UNDP, who coordinates the UN system's response to HIV/AIDS in Burkina Faso. "We have already prepared a study which looks at the multisectoral impact of AIDS and it is clear that we need more information about the situation within the country itself, as well as coordinated efforts and a broad and transparent commitment to rolling back the epidemic."
Few developing countries are equipped to deal with the additional burden of AIDS. Across Africa, the impact of AIDS on health systems has been dramatic. The number of patients is on the rise, while nurses and doctors fall ill and die from AIDS, stretching health care beyond its limits. AIDS has also sparked a resurgence of tuberculosis in Africa after years of decline. In some cases, the number of tuberculosis cases has gone up by 500% over pre-AIDS days.
"HIV does to society what it does to the human body. It undermines the very institutions that are meant to defend society -- its teachers, its doctors," Dr. Piot said.
The financial burden of AIDS-related care is also crushing. In several countries, HIV-infected patients occupy 50-80% of hospital beds in urban areas, crowding out patients suffering from other diseases and consuming scarce health care resources. One year of basic medical costs for a person with AIDS is equivalent to two to three times a country's average yearly Gross Domestic Product per capita, with most of the cost borne by the public sector, itself already over-stretched.
To meet these challenges head on, governments in vulnerable countries need to expand and intensify their responses rapidly.
"This is a time of great opportunity," said Dr. Piot. "National governments and the international community are finally waking up to the impact of this epidemic, and are now deeply serious about reversing the damage of the last decade."
The three-day meeting signals the intention of African governments to prepare their health systems for both HIV prevention and care on an increased scale. Participants are evaluating AIDS control activities in Africa and assessing the role and responses of health sectors in reversing the epidemic. The meeting is also identifying realistic approaches to what can be done within Africa's limited means, as well as defining a framework for the African health sector's contribution to the International Partnership Against AIDS in Africa.
Worldwide, 33.6 million people are now living with HIV or AIDS, 23.3 million of them in sub-Saharan Africa. Just last year, 2.6 million people died of AIDS, the highest death rate in any single year since the start of the epidemic.