A former director of the United Nations Commission on HIV/Aids and Governance in Africa has painted a gloomy picture of efforts to bring the pandemic under control across the continent.
”There is absolutely nothing optimistic about HIV in Africa, 25 years after the virus was discovered,” said Nana Poku, who is now a professor in the Department of Peace Studies at the University of Bradford, in the United Kingdom.
”The biggest issue we fundamentally got wrong is prevention. The ABC strategy doesn’t work,” he added.
Poku was speaking on Wednesday at the Johannesburg-based South African Institute of International Affairs (SAIIA), at the launch of the latest issue of International Affairs — a journal published by the London-based Chatham House (formerly known as the Royal Institute of International Affairs).
The March edition of this publication, edited by Poku, is titled Governing a pandemic: HIV/Aids.
The ABC strategy encourages abstinence until marriage, being faithful to one partner — and condom use to prevent transmission of HIV during sex, particularly in cases where a person has multiple partners.
While the approach may not have yielded results across the board, it is widely viewed as having played a key role in one of Africa’s few success stories concerning HIV/Aids: the reduction of adult HIV prevalence in Uganda.
This hit a peak rate of 15% in 1991, but was at just over four percent at the end of 2003 (the latest figure to be made available by the Joint United Nations Programme on HIV/Aids — UNAids).
According to UNAids, over 60% of people who have contracted the HI-virus live in sub-Saharan Africa, even though this region only houses about 10% of the global population.
Almost 26-million Africans are HIV-positive.
Poku was equally downbeat about strategies that might be adopted in place of the ABC approach.
”We don’t know what works. We haven’t done enough studies,” he said. ”We need to spend more time in learning the disease.”
However, not everyone at the SAIIA gathering agreed with Poku.
”I think we know a lot about what works: we know that HIV is spread through sex, we know that taking an HIV test helps you to know your status, we know that ARVs (anti-retroviral drugs) save lives — and we know that prevention works,” said Mark Heywood, head of the Aids Law Project at the University of the Witwatersrand in Johannesburg.
”What’s missing is integrating all this knowledge … in the fight against the virus,” he said.
Heywood is also a founding member of the Treatment Action Campaign, a Cape Town-based non-governmental organisation that has been outspoken in pushing for wider access to ARVs in South Africa.
At present, the country has more people infected with the HI-virus than any other state: about 5,5-million. Latest figures from UNAids put adult prevalence in South Africa at 21,5%.
Heywood further blamed a failure of governance for the extent to which Aids had advanced in South Africa.
”If there was political will and determination in South Africa, we could have prevented millions of infections,” he noted.
The TAC has accused President Thabo Mbeki of worsening the Aids pandemic by questioning whether HIV causes the syndrome, and by querying the safety of anti-retroviral treatment in the absence of research findings to support such concerns.
The group successfully took the government to the Constitutional Court in 2002 to compel authorities to make nevirapine available nationally for preventing mother-to-child transmission of HIV.
In addition, Heywood expressed concern about the situation in neighbouring Zimbabwe, where years of political turmoil and economic mismanagement have severely undermined health services.
He noted that last year’s Operation Murambatsvina had dealt a blow to Aids treatment efforts. This campaign was carried out by Zimbabwean officials, supposedly to rid the country’s main cities of unauthorised buildings, and of the illegal trade in fuel and other scarce, basic goods.
However, a July 2005 report by the United Nations Human Settlements Programme found that the operation quickly became a ”nationwide demolition and eviction campaign” in which 700 000 people lost their homes, means of earning a living — or both.
Another report on Murambatsvina issued last August by the Johannesburg-based ActionAid, said that about 15% of affected households surveyed by the non-governmental group had apparently experienced a loss of ARV treatment because of the campaign.
According to UNAids, Zimbabwe’s adult HIV prevalence stands at 24,6%.
Addressing those present at SAIIA on Wednesday, Poku said the failure to contain Aids was taking a severe toll on Africa: ”The virus is taking the most productive sector of the society. It is killing people between the ages of 15 and 49 years.”
More than 20-million Africans are said to have lost their lives to Aids-related diseases.
”In a few years there will be in excess of 30-million orphans in Africa. ”[The continent] is struggling to cope with societies of very young and old people,” Poku added.
”Governments should focus more on prevention. For me, prevention is the key.” ‒ Sapa-IPS