Nairobi — Supporters of the Treatment Action Campaign (TAC) attend a prayer service in Sharpeville, South Africa, on March 20. Increased access to ARV therapy will help remove stigmatisation and discrimination. Picture: AP

More than 4.5 million of the 30 million people living with HIV/Aids in Africa are in need of antiretroviral (ARV) treatment, but only 50,000 of them have access to the drugs, a senior World Health Organisation (WHO) official said last week.

According to Dr Matshidiso Moeti, the WHO adviser for HIV/Aids in Africa, besides the low number of HIV-positive people on antiretrovirals, only 23 per cent of those infected with HIV on the continent and in need of essential medical care have access to it.

Dr Moeti was speaking at a workshop on treatment and management of HIV/Aids in Harare, Zimbabwe, attended by experts from 17 East and Southern African states, including Kenya, Uganda and Tanzania.

Speaking at the workshop, the WHO's Africa director of the Division of Communicable Disease Prevention and Control, Dr Antoine Kabore, observed that the lack of care and low usage of ARVs was contributing to the devastating effects of the pandemic across the continent through loss of expert personnel and economic productivity.

"Apart from reducing HIV/Aids-related deaths, improved access to care and treatment would contribute to forestalling the collapse of the educational and health systems through the loss of human capital such as teachers and health personnel, reduce hospitalisation costs, improve investment in healthcare, reduce the cost of caring for orphans, stabilise productivity through the retention of workers, improve food security, and avert immense general social dysfunction," Dr Kabore said.

According to the executive secretary of the Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa, Dr Steven Shongwe, scaling up access to ARV therapies will require visionary political and professional leadership, careful planning and mobilisation of resources, and strict adherence to WHO and UNAids guidelines.

"Increased access to ARV therapy will help remove stigmatisation and discrimination as more people will share their experience and be motivated to know their HIV status, thus bringing hope instead of despair," Dr Shongwe said. Last week's three-day workshop was meant to, among other things, come up with a status report on HIV/Aids care and treatment in the 17 participating countries, and develop a framework for scaling up and implementing access to quality care and treatment.

A clearer picture of the status of care and treatment of people living with HIV/Aids in Africa emerged in Harare where Dr Moeti said that worldwide, 42 million people were estimated to be infected by HIV, with about six million of them needing ARV treatment.

At the end of 2002, about 30 million Africans were estimated to be HIV-positive.

The figure could be more, as many still do not know or may not be motivated to find out their sero-status because of stigma and discrimination, she said.

On the status of ARVs in nine countries surveyed early in 2002, Dr Moeti stated that while ARVs were registered in most countries, where two combinations of these were commonly used, only three countries had ARVs on their Essential Drugs List.

Six of these countries had ARV guidelines. The cost of ARV therapy in all countries surveyed had dropped to around $300 per patient per year, down from about $10,000 about a decade ago.

On HIV testing and laboratory services, on which WHO has also conducted a survey of 30 countries this year, Dr Moeti said that resource, capacity and supply problems continued to be rife, with voluntary counselling and testing (VCT) services in the region being limited, diagnosis and treatment of opportunistic infections uneven, the treatment of infected children relatively neglected, and palliative care services relatively underdeveloped.

However, she said that there were encouraging responses at the national, regional and global levels to stem the tide of the disease in Africa. Some of the measures so far taken include the implementation of strategic national plans , the establishment of mechanisms to co-ordinate responses, and the development and adoption of regional and global health sector strategies.

Others are the various declarations by global, sub-regional and regional bodies; a drop in the prices of ARV medicines and diagnostics; and increased access to resources available at the Global Fund for HIV/Aids, Tuberculosis and Malaria, and other initiatives.

She said that a comprehensive care package for access to care and treatment included VCT as an entry point to care; management of opportunistic infections; TB/HIV management; provision of antiretroviral treatment; procurement and management of HIV/Aids medicines; the strengthening of laboratory services; nutritional support; palliative care and psychological support, and community- and home-based care.