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C. Baryomunsi: Reducing AIDS Requires High Commitment at All Levels
Written by Chris Baryomunsi, Technical Advisor on HIV/AIDS, United Nations Population Fund
Thursday, July 10, 2003
Presented to Assembly 2003, “Global Governance at a Turning Point: Innovative Approaches to Peace in a Changing World, July 10-14, 2003
HIV/AIDS is a problem that has existed for two decades in most of our communities. At this point, every country in the world has reported a case of HIV/AIDS. Never in history has there arisen such a widespread and fundamental threat to human development as HIV/AIDS.
When we look at the epidemiological trends at the end of 2002, we see that about 42 million people are infected with HIV/AIDS. Of those, about 70 percent are from sub-Saharan Africa. The first part of my presentation will focus on the effects of HIV/AIDS in sub-Saharan Africa. After that I will review the case of Uganda and propose a few strategies that I think should be implemented as we work to contain the problem of HIV/AIDS.
The problem has become an international issue even though we acknowledge that 70 percent of those afflicted live in sub-Saharan Africa. HIV/AIDS is a growing problem in other parts of the world, especially in the Caribbean (Haiti, Guyana, Jamaica) and also in China, Southeast Asia, Eastern Europe, the Ukraine, the Soviet States and even North America. The epidemic is still in its infancy and the long-term consequences are not yet known.
Women appear to be at higher risk of contracting HIV/AIDS in developing countries. For a long time, sub-Saharan Africa was the only continent where more women than men were infected. But other regions, including North American are now catching up. In Africa we estimate 58 percent of those with HIV/AIDS to be women, whereas in North Africa and the Middle East, it is now 55 percent. In the rest of the world men still outnumber women. This is mainly because of the modes of transmission of HIV. In the rest of the world we find it is mainly homosexuals and intravenous drug users who contract HIV/AIDS. But irrespective of the main mode of transmission, what we see is that, as the epidemic grows, eventually it is sexually transmitted.
Statistics are that 10 people per minute get infected globally. Botswana currently has the highest prevalence rate in the world with 38 percent of its population infected, but South Africa, Namibia, Swaziland, Zambia, Zimbabwe are also heavily infected. South Africa has the highest number of people living with HIV/AIDS in absolute numbers, followed by India, This situation can be compared to Uganda where when one reviews the statistics 1990 to 2001, one can see a dramatic decline in prevalence rates in that country.
For other countries throughout the world, the infection rates are increasing rapidly. The question often arises why there are such high prevalence rates in Africa. Currently, we do not have concrete reasons why Africa is so heavily affected. Some of the factors that we can consider are poverty, poor governance, and lack of political commitment.
Civil war and rebellions are common. One has only to look at countries such Uganda, Sudan, Liberia, Congo, and Burundi. It is important to note that we know that there is a very strong relationship between social disruption and rebellion and HIV increase.
Poor healthcare, traditional cultural and religious norms, high levels of illiteracy, low status of women are other factors that predict higher HIV/AIDS rates. The strands of the virus that people have contracted in Africa appear to be very virulent and strong and they spread very fast compared with strains that we see in other parts of the world. Also, some studies have looked at malnutrition as a possible cause of high HIV/AIDS rates in Africa.
This particular chart shows changes in infection rates in a number of countries. For most countries infection rates have increased, with the exception of Uganda. In some of the countries such as Botswana, Kenya, Malawi, Uganda, Zambia, Zimbabwe we see that HIV/AIDS is seriously eroding the gains in life expectancy which most of these countries had achieved in the 1950s and 60s. We estimate that, if a country has a prevalence of 10 percent or more, a child has a life expectancy 17 years less than he or she should have had were HIV not present in the country.
Another other issue we are facing is the enormous number of orphans. We estimate that about 13 million children have been orphaned throughout Africa due to HIV/AIDS. In Uganda alone we have about 2 million children who have been orphaned since the onset of HIV/AIDS. The impact of HIV/AIDS on household production and earnings, investment and consumption, health and mental health costs, and other areas is tremendous.
One of the major issues in Africa relates to the treatment of people living with AIDS with anti-retroviral drugs. These are estimates of what countries would need as percentages of the minister of health budgets if all patients with AIDS were to be treated with anti-retroviral drugs. In Ethiopia, we estimate that by 2014 the country will require up to 40 percent of the national health budget to treat AIDS patients. In Kenya, by 2005, they will require more than 50 percent of the health budget and in Zimbabwe, they will require close to 80 percent of the health budget. In Uganda, currently we estimate that we need to spend 40 percent of the national health budget to treat HIV/AIDS alone. And this has a lot of implications.
The first case of HIV/AIDS was identified in Uganda in 1982. Since that time, they have implemented many programs and awareness has risen more than 99 percent. Almost everybody knows about HIV/AIDS. In the early nineties, Uganda had a high prevalence rate in the urban areas. One of the questions people keep asking is: What happened in Uganda?
First, we had comprehensive interventions as early as 1986 when the current government took over. There was substantial political support, especially from the President, who was personally interested and involved in the campaigns against HIV/AIDS. Another important point was that there was a multi-sector approach where everybody including religious leaders, faith based organizations, NGOs, and others was given a role in the battle against the spread of the disease. HIV/AIDS was addressed with a policy of openness, and, of course, there was the ABC motto of HIV/AIDS prevention: abstinence, faithfulness, and promotion of consistent and correct condom use in the population. Furthermore, we had voluntary counseling and testing services as early as 1990, and there was an aggressive promotion of condoms, combined with treatment and control of sexually transmitted diseases, which resulted in a decrease in multiple sexual partnerships and networks.
Senegal and Uganda are examples of countries that have relatively low HIV/AIDS prevalence rates. Some of the features that we saw in those countries were a high level political commitment, a multi-sector approach, comprehensive programs, and the involvement of civil society.
In summary, we need to research and review strategies that have worked effectively, either to follow what has worked in a number of communities or to study some of these strategies and scale them up. We need to emphasize addressing HIV/AIDS prevention among young people because you find this is a segment of the population that is highly infected in many countries.
Consequently, we need to address the issue of leadership and commitment at all levels, whether religious leadership or political leadership at every stage of life. Also, we need to look at the continuum of response, prevention, treatment, care, and mitigation of the impact all of which must be addressed at once. Furthermore, we must address the economic, political, social, and character factors that influence communities at large when there are high rates of infection. Rather than looking at HIV/AIDS as a health issue, we must see it as an issue of human development and attack it from all sides.
Finally, the issues of resources, finances, of technology and anti-retroviral drugs, micro-herbicides, female condoms, male condoms, prevention, voluntary counseling and testing, prevention of mother child transmission, treatment of opportunistic infections, and orphans all need to be addressed. HIV/AIDS remains a problem for all of us. The cost of inaction will be devastating and we must act now.