Washington, DC — Nothing is surprising anymore about the HIV/AIDS epidemic in Africa. However, the recent announcement by the United Nations agency coordinating the epidemic (UNAIDS) that the wave of HIV infections and AIDS deaths are yet to reach a crescendo is bound to elicit the usual flurry of print and electronic media articles and programs. Politicians will not be left out in the usual "statements" and "action steps." Ditto for the civil society organizations, bilateral and multilateral agencies, and professional groups.
What has not changed, and sadly, may never change, is what to do about the unprecedented HIV infections and AIDS deaths in Africa. According to the UNAIDS, at least 28.5 million Africans are living with HIV/AIDS in Africa. A 15-year old teenager in Lesotho has a 74 percent chance of contracting HIV on or before his/her 50th birthday. More than 19 million people are already dead of AIDS in Africa, and an additional 55 million may die within the next two decades. Almost 39 percent of all adults in Botswana are currently living with the disease. One third of adults in Zimbabwe are also living with the disease. In southern Africa, at least half of all new mothers may die of AIDS.
What has not changed and may never change regarding the HIV/AIDS epidemic in Africa, include the following:
1. Africans will not have access to lifesaving antiretroviral drugs.
According to the UNAIDS, only 30,000 of the estimated 28.5 million people living with HIV/AIDS are on antiretroviral therapy. Despite the nearly "90 percent" reduction in the cost of needed drugs and various "access to care" initiatives and dialogues in Africa, millions of people will die due to lack of available drugs. The international community is essentially writing off millions of Africans.
2. Some Africans will be chosen to live or die of AIDS.
Already, a current "debate" is over whether to focus "initially or exclusively" on antiretroviral therapy for pregnant mothers and their babies. Very soon, African countries will have to focus their attention on the segment of their population that the donor nations have chosen to save.
3. Not much may come from African governments.
As the epidemic marches on, African governments, with limited financial resources, will have very little impact on remedial efforts. In addition, the effects of corruption, political instability, conflicts (intrastate and interstate), diminishing middle class, and debt repayments to Western creditors will effectively end any hopes of serious remedial action by African leaders. The lack of African led and focused continental organization to manage the AIDS epidemic will continue to leave the vast continent at the mercy of decisions made by policy makers outside of Africa. The tepid attention to HIV/AIDS in the New Partnership for Africa's Development (NEPAD) initiative by African leaders is another ominous sign.
4. Inadequate funding for HIV/AIDS remedial effort will not go away.
No matter the official statements from Western capitals, it is becoming increasingly obvious that inadequate funding for HIV/AIDS remedial efforts in Africa has limited political "collateral damage" to policymakers in either the executive or legislative branch of government. We are not aware of any Western leader or head of a bilateral or multilateral development agency that is at political or career risk from the unprecedented HIV infections and AIDS deaths in Africa. The UNAIDS indicates that donor funding to fight AIDS in Africa "increased 6-fold" from $165 million in 1998. However, the modest $10 billion a year requested by the United Nations Secretary-General, Kofi Annan last year to fight AIDS in low and middle-income countries is still more than 80 percent under-funded. It is no coincidence that the Global Fund to fight HIV/AIDS, TB and Malaria is struggling for funds in the midst of massive need. The Fund, today, has about $800 million dollars to spend this year. The dithering of the Fund regarding access to lifesaving antiretroviral therapy suggests that the organization is unlikely to become a global rallying ground for much needed funding to combat the epidemic.
5. Preventive efforts will continue to be a major challenge.
A recent joint report by the UNICEF, UNAIDS and the World Health Organization suggest that large proportions of young people, including Africans, are not receiving preventive messages about HIV infection. According to this report, more than 80 percent of young women (15 to 24 years) in Cameroon, Equatorial Guinea, Lesotho, Sierra Leone and Central African Republic are not sufficiently aware of HIV and associated risk factors. The lack of access to antiretroviral drugs also stymies efforts to test for the virus. More than 90 percent of infected Africans are unaware of their status. Uganda, Senegal, and Zambia appear to have turned the corner on HIV infection following aggressive information, education and communication campaigns. However, other African countries have not been as successful. We are concerned that sooner rather than later, African countries may be forced to choose between prevention and treatment options, as HIV/AIDS funding fails to meet the exponential rise in infected and dying individuals.
6. The socioeconomic underpinnings will not abate.
Poverty is alive and well in Africa, with more than 40 percent of the population living on less than one dollar a day. HIV/AIDS, according to the UNAIDS, is a major economic and social development crisis in Africa. Largely due to AIDS, life expectancy in Botswana is now less than 40 years, the lowest since 1950, according to the UNAIDS. The life expectancy for Sub-Sahara Africa is now 47 years instead of 62 years because of AIDS. African leaders championing NEPAD estimate that the continent requires up to $64 billion of investments to meet a sustainable growth rate of 7 percent a year. The June 2002 G-8 conference in Canada made a promise to spend about $6 billion in Africa. We do not believe that there is the political will in the West or in Africa at this time to tackle poverty and other socioeconomic issues that fuel the spread of HIV infection in Africa.
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Conclusion
The slow and steady AIDS death march continues unabated in Africa. Statements of "action and concern" usually follow every major policy document on HIV/AIDS. What has not changed is the fate of 28.5 million Africans living with HIV/AIDS. We have condemned these Africans to a long and painful death march. Many talented men and women, who happen to live in Africa, will die because of our inaction.
Dr. Chinua Akukwe is a member of the Board of Directors of the Constituency for Africa, Washington, DC, and former Vice Chair of the National Council for International Health (NCIH) now known as the Global Health Council, Washington, DC (cakukwe@att.net). Melvin Foote is the president and chief executive officer of the Constituency for Africa, Washington, DC (MFoote2420@aol.com).
