Ofeibea Quist-Arcton
30 November 2003
interview
Accra — Ghana's Aids Commission was set up three years ago, getting legal status in 2001. The Commission reports directly to President John Agyekum Kufuor and it has 46 members, including 15 ministers of state and representatives from civil society and the private sector.
Professor Sakyi Awuku Amoa, Director General of the Ghana Aids Commission has been working in the HIV/Aids field for over a decade. In 1989, he was the World Health Organisation administrator who set up the National Aids Control Programme in Harare, Zimbabwe. He returned to Ghana a year later and was appointed to assist in the Ghana National Aids Control Programme for several months before returning to his post at the Institute of Management and Public Administration where he became deputy director-general. More recently, when the Ghana government and UNAIDS were thinking of establishing the Aids Commission, he was the consultant who designed its structure. As he was about to retire, the government appointed him to head it. Ofeibea Quist-Arcton went to meet Professor Amoa at the Commission's secretariat in the capital, Accra. Excerpts:
Setting up an Aids Commission anywhere in Africa only in 2001 seems very late, considering the impact of Aids on Africa.
It took so long because when the pandemic came on, it was seen by the government and everywhere as a disease. So it was the Ministry of Health which was acting as the lead agency. The pandemic was then being managed as a disease under the Ministry of Health.
It was later on that it was realised that the complex and multi-faceted nature of the pandemic demanded a developmental approach - as well as even human rights’ issues to be considered. That required the need to look at a structure that would handle it from a multi-sectoral point of view.
This is what brought the National Aids Commission into being around 2000. It was a real historic development and a realisation that the Aids’ pandemic cannot be handled like an ordinary disease [nor] by bio-medical methods only; and there was a need for a very strong prevention and control strategy that had to be institutionalised [on] a multi-factoral basis. And this is what led to the Aids Commission coming much later than expected.
Let’s talk facts and figures. How many people in Ghana are living with HIV/Aids?
Currently, the national adult prevalence rate is 3.4 percent. This is almost a 50 percent increase in the last two years. In 2000, the recorded prevalence rate was 2.6 percent. In 2001, it was 2.9. And now we’re talking about 3.4. So, overall, we’ve seen a 50 percent increase in the prevalence rate.
The most vulnerable age group is between 15-49, as you find in other places. And in Ghana here, particularly you find that 63 percent of all the Aids’ cases are women. So the infection rate among women is very high. This is followed by the infection rate among young girls and the youth.
Again between the ages of 15 and 24, we also find that the prevalence rate has gone up by 50 percent. And that is something that should worry us, because it means that the most productive age group is being affected by this disease. And we have to do all that we can to make sure that we can either reduce the prevalence rate or just make sure we keep it where it is for the time being.
What are you doing to bring down the HIV prevalence rates?
This brings us to the way that we’re fighting it. We are focusing on five major intervention activities. The first one is the awareness creation. And we have almost achieved 90-99 percent awareness.
The second one is support and care for people living with HIV/Aids. That is very important. When infected individuals find that there is a system to support them, then they will be willing to come.
Our third major area is voluntary counselling and testing. That is a critical tool to bring about behaviour change. When somebody tests and he is found positive, the person will be counselled. He will then know how to live positively, so that he doesn’t go underground and infect other people.
If the person tests negatively, it will then enable him to protect himself. He will lead a positive lifestyle just to make sure that he doesn’t get the infection. So we are focusing a lot on voluntary counselling and testing now as a way to get behaviour change.
Our fourth area is treatment and care. Now this is handled by the Ministry of Health. Until recently, Ghana had not introduced the antiretroviral. We had focused majorly on prevention and control. But now, with the help of the Global Fund, we have got money to buy antiretrovrials that will cover about 2,000 patients. The preparatory work has been completed and the people living with HIV/Aids will be put on the anti-retrovirals starting from January next year and that is for two years. The drugs will be able to cater for 2,000 people for two years.
Two thousand people out of how many living with HIV/Aids?
As I said, we have already about 600,000 Aids’ cases. So the 2,000 is just a drop in the ocean. But I’m happy to note that money now is not a problem, to get more anti-retrovirals. The Ministry of Health is capable of resourcing for more funds. We have put in a second request to the Global Fund for an amount of about 30 million dollars which will enable us to buy more anti-retrovirals and put people on them. So it means that we position ourselves now to bring in treatment.
Now treatment becomes extremely necessary for behaviour change also, because when people get to know that, at least, their life is not hopeless and they can go to the hospital for some kind of treatment, it will give them hope. It will give them confidence. And, you see, when a person has confidence, believes in himself, that in itself will contribute to his healing process. And this will probably help most of them to prolong their lives.
So you roll out the ARV treatment programme first thing next year -
Yes, January 2004 is the starting time. And it will be done in three major hospitals. Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi and St Martin’s Hospital in Manya-Krobo. These are the three hospitals that the government has decided to use as a pilot case.
They are just restricting themselves initially to these three, because of the fact that the physicians need to be trained for them to know how to manage the side-effects of the anti-retrovirals. Then, after about 6 months’ work in these hospitals, they will roll it out to the regions and later on, from the regions to the districts.
So there is the intention, the plan is to go all out. But the ministry is being cautious in terms of how it’s going to roll out the anti-retroviral treatment for these patients.
But it seems that your pilot scheme again marginalises the northern regions of Ghana which observers note are already far less privileged than the south.
If you are talking about starting the programmes from the teaching hospitals, then that is the case. But what we are looking at here is that the ministry is starting from two teaching hospitals. The two teaching hospitals happen to be in the capital, Accra, and Kumasi. The Manya-Krobo one, St Martin’s, is where the original pilot of this drug - particularly how pregnant people would react to it - was started.
They did that study in the rural areas for two years. And it is (from) the lessons from the Atuah Hospital and St Martin’s Hospital that they are now using in the teaching hospitals. So it is true that we are not moving immediately to the north, but it does not mean that they are not going to be part of the process. Only it may take a little bit of time for the drugs to get there. But the ministry has the intention of getting the drugs to all the hospitals.
And how would you assess the cooperation between the Ministry of Health and the Ghana Aids Commission in the roll-out of the ARV programme?
The collaboration has been an excellent one. You will find out that, in a number of countries, there has been some kind of conflict between the Ministry of Health and the Aids’ Commissions, probably because some people did not believe in the multi-sectoral approach. Particularly, some health professionals thought that this is a disease like any other disease and if it has to be handled, it has to be handled by professional health teams.
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