Washington, DC — It seems the need is almost bottomless. United Nations Secretary General Kofi Annan has called for a "Global Aids Fund" - a war chest of US$7-10bn to be replenished at that level for at least the next five years. "We just have to convince those with the power to spend - public and private donors alike - that this would be money well spent," he said, at the biggest AIDS conference ever held in Africa, in Abuja, Nigeria, last April.
Much of that money will have to be spent in Africa. So far, some 28.1 million people on the continent have been infected with HIV; over 13 million children have been orphaned because of deaths from the disease. Sub-Saharan Africa is the region worst affected by HIV and Aids, according to the UNAids and World Health Organization. The 3.4m new HIV infections in Africa in 2001, represent almost 70% of the global total for the year.
So is there any good news to report? Well, at least it has become almost impossible to sweep the problem under the mat, as many African governments were happy to do just a few years ago. Almost no one now denies that a serious problem exists.
At the second African Development Forum held in Addis Ababa, December 2000, some 1,500 African leaders, policymakers and civil society organizations, including people living with HIV/Aids, pledged coordinated action to develop an African response to the pandemic and all over Africa this year, people have been following through on that promise, perhaps most encouragingly, at grass roots level where many local campaigners have led the way for their national leaders to follow.
At a World Aids Day rally in Abuja, on Thursday this week, Nigerian President Olusegun Obasanjo said: "We will take the fight to all the places we should take it: schools, communities, homes, religious institutions and everywhere, we will leave no stone unturned. Feel free to discuss it."
In Kenya, whose leaders were once among the most reluctant to face up to the pandemic, the medical association this week directed its members to breach doctor-patient confidentiality in order to try and curb the spread of the disease.
Again, in Nigeria in September, at their monthly meeting, members of the 'Journalists Against Aids' (JAAIDS) NGO vowed to become personally involved in campaigns to fight HIV-related stigma in rural communities. One of the women journalists at the meeting recalled that when a woman-friend of hers became ill with Aids she was taken back to her village for home-care. But no-one there was willing to care for her, or even share the same room with her. Food was passed to her through the door and she was left alone. She was dead in a matter of weeks.
But the paucity of resources, still deeply-entrenched social taboos, and pockets of official resistance to confronting the problem head on, have meant that in most places, campaigners have had to battle to make any progress.
One important battlefield was in South Africa, where huge multi-national pharmaceutical companies, claiming patent infringements, challenged a proposed new law which would allow South Africa to import medicines from the cheapest source - perhaps India or Brazil - and thus give far greater access to anti-Aids drugs. Public outcry inside and outside of South Africa ultimately forced the companies to drop their suit.
In Kenya, last June, despite intense pressure from pharmaceutical companies, parliament passed the Kenya Industrial Property Bill 2001, which permits Kenya to import and produce affordable generic drugs to combat HIV/Aids. "Patient rights have won over patent protection," said Indra van Gisbergen, a lawyer with Médecins Sans Frontières in Kenya.
And yet another battle took place on South African soil when, just a month ago, one of South Africa's leading research institutions, the Medical Research Council (MRC), challenged the basis of the government's policy restricting use of anti-retroviral drugs. The government, led by President Thabo Mbeki, has insisted that poverty, violence and road accidents, plus a range of diseases other than Aids, are South Africa's primary causes of death. But the MRC found that Aids was responsible for roughly 40 per cent of deaths among South Africans between the ages of 15 and 49 and that, for all adults, Aids was the cause of nearly 20 percent of deaths - more than any other cause.
This battle continues, with the government clinging to its position: "The MRC research is not absolutely definitive," Joanne Collinge, a spokeswoman for the Health Ministry, told reporters following the release of the report, "and its mortality rates are estimates rather than exact calculations."
President Mbeki's apparent skepticism about putting Aids at the top of his government's priorities has been noted and criticized worldwide, amid genuine astonishment that so great a crisis should generate so much argument. The dispute has generated the growth of a coalition including churches, NGOs and trade unions, broader and more militant than anything seen since anti-apartheid days.
There are examples of effective action against the Aids pandemic in Africa. Both Uganda and Senegal are being held up as models of effective strategies to confront the Aids pandemic. Uganda, especially, has led the way, mounting an unusually aggressive and frank campaign as soon as what was known as "slim disease" in the 1970s, was found to be Aids. By the early 1990s, infection rates were dropping dramatically - from 30 percent to 10 percent among pregnant women and in general, from 44 percent in 1988 to under 30 percent in 1989. The Ugandan experience has demonstrated beyond reasonable doubt, that a wholehearted and open message endorsed by a nation's most powerful and influential voices, can turn the tide.
Likewise, in Senegal, the Dakar government has mounted a potent campaign, mobilizing religious leaders in this predominantly Muslim nation. Key groups, like long distance traders, migrant workers and prostitutes, were targeted for information about prevention and health support. Thanks to the campaign, HIV/Aids prevalence rates, which started at much lower levels than Uganda's, have remained low - currently between 1 and 2 per cent.
But these success stories are the exception, despite widely increased awareness of the threat that HIV/Aids poses - especially among the young. In South Africa, at current rates of infection, it is projected that more than 50 percent of the under-15 population will die from Aids over the next 10 years.
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"Young people have been sidelined by governments and the international community in the fight against Aids, even though they are bearing the brunt of the disease and have much to contribute in reducing the spread of the HIV virus," charges Youth Against AIDS, an international network of young activists fighting the disease in Africa.
One of these youths, HIV-positive, 16-year-old Palesa who lives in Kliptown, South Africa, wrote recently of herself and other infected friends - "We had become a crowd of walking dead."
"We must not be seen as a problem," says another one of these young activists, 24-year-old Lydiah Bosire from Kenya who co-founded Youth Against Aids in 1999, "but rather as a potential source for the solution."
Although attitudes are slowly changing across the continent and, therefore, people's sexual and social behavior, it is almost certainly too early to declare any victories in Africa's fight against Aids. Most observers think, at long last, much of Africa seems to be taking serious steps toward confronting the disease.
The United States has contributed just US$200m to Kofi Annan's Global Aids Fund but many have protested that it is too little, given the extent of need. The jury is still out as to whether Africa will get anywhere near the resources it needs to wage an effective war on the disease that has taken the lives of so many of its people.
