HIV/AIDS Prevention: Lessons for West Africa
Dr. NestorAzandegbé, President of the Francophone MAQ Subcommittee, highlighted the importance of formulating activities that are “practical and feasible.”
News articles continue to remind us of the toll the AIDS epidemic is taking in Africa. “Out of the cumulative total of nearly 22 million AIDS deaths worldwide, 16 million were African.”1 The transmission rate of the HIV virus has been particularly high in southern Africa. In Botswana, Swaziland, Zimbabwe, Lesotho, Zambia, South Africa and Namibia, at least 1 adult in 5 is living with HIV.2 For the first few years, the disease showed up largely among sex workers and young males. But then HIV spread to other groups, and in many countries it has taken a hold on the general population. In the wake of the epidemic, AIDS is leaving children orphaned, and mothers are transmitting the disease to their infants.
In Sub-Saharan Africa, the AIDS epidemic is clearly crippling the economic and social infrastructure.Treatment for AIDS is expensive and difficult to administer. “The triple therapy using anti-retroviral drugs costs between 10,000 to 15,000 [US] dollars per person for an annual dose in the United States.”3 Even if global pharmaceutical companies find ways to provide Africa with affordable anti-retroviral drugs, the local healthcare systems may not be able to prescribe and monitor the complex drug regimen that is required. According to Tom Quinn, an epidemiologist at Johns Hopkins University,“anti-retroviral drugs are so complex they should not be given without supervision.” Quinn says, “A normal regimen often consists of 17 different tablets; they have to be taken three times a day; a lot of them have to be taken with a fatty meal so that they are absorbed better; and using the US standard, people on these drugs need to be tested at least four times a year.”3 Multiple variations of the HIV virus have already been discovered. And, without a strong medical infrastructure to ensure correct use of the medications, it is feared that deadly drug-resistant strains of the HIV virus will emerge.4
The costs of treating HIV infection far outweigh the costs of prevention. “By spending an average of 200 [US] dollars [per person], a country can prevent one HIV infection. On the other hand, medical costs for treating one [AIDS-related] infection, even without using expensive anti-retroviral drugs, would cost about 700 [US] dollars per person each year.”1
Given the tremendous costs, both human and economic, that AIDS has already incurred in eastern and southern Africa and the significant barriers to effective AIDS treatment, it is crucial that we focus on prevention in West Africa.“In West Africa, even though the prevalence rates remain less important in relation to other regions in Africa, the pandemic is spreading rapidly in a number of countries.”5 In this region, the patterns of HIV transmission that have already brought so much human suffering to other parts of Africa are beginning to repeat themselves. Table 1 shows HIV/AIDS statistics for the nine West African countries that fall within the scope of the Francophone MAQ Subcommittee’s current activities.
Table 1. Estimated HIV/AIDS Prevalence, End of 1999
Country Adults and Children Living with HIV/AIDS Adults Rate
(%)Benin 70,000 2.45 Burkina Faso 350,000 6.44 Cameroon 540,000 7.73 Guinea 55,000 1.54 Ivory Coast 760,000 10.76 Mali 100,000 2.03 Niger 64,000 1.35 Senegal 79,000 1.77 Togo 130,000 5.98 Source: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2000
Although HIV/AIDS prevention is an urgent issue, many West African nations currently lack the political focus and the consistent and dedicated management needed to halt the progression of the epidemic. Lessons learned from success stories in countries like Senegal should be heeded. “Political commitment at the highest level is an incontestable guarantee of success… [This level of commitment] could explain Senegal’s success in the fight against AIDS.”6 Senegal acted early and at a national level. “Senegal’s success [in the fight against AIDS] has aroused much interest, especially with regard to the stabilization of the [HIV] prevalence at 2% for several years.”6 Local advocates will need to seek support and funds from whatever sources are available (including nongovernmental and community-based organizations) to carry out interventions. The following prevention interventions are key to a successful campaign:
Dr. Ibra Ndoye, National Program Coordinator for the Fight Against AIDS in Senegal.
- Provide a strong focus on prevention among core transmitters (i.e., sex workers and their clients).
- Implement a variety of HIV/AIDS prevention programs that reach adolescents and young adults.
- Promote condom use and reduce the condom stigma. Emphasize that consistent and correct usage of condoms can provide dual protection— protection not only against sexually transmitted diseases, but also protection from unwanted pregnancies.
- Use mass media and social marketing strategies continuously to update the general public about what AIDS is, and remind them how the AIDS virus is being transmitted, and what individuals can do to reduce their own risk of infection.
- Explore and communicate ways to change sexual behavior that can reduce the rate of HIV transmission.
- Train FP/RH providers to counsel clients about ways to reduce their risk of acquiring HIV/AIDS.
- Promote infection prevention practices that can protect healthcare workers and their clients.
- Encourage the development and use of HIV counseling and testing centers.
- Work at the policy level to ensure supportive legislation for prevention and care of persons affected by HIV/AIDS.
At the February 2001 meeting of the Subcommittee’s Executive Bureau, in Dakar, several members emphasized the need to take action as we join in the fight against HIV/AIDS in West Africa. Dr.NestorAzandegbé, President of the Subcommittee, highlighted the importance of formulating activities that are “practical and feasible.” Pape Gaye encouraged the Subcommittee to engage in realistic and concrete actions that go beyond discussions held at conferences.
Lessons learned from success stories in countries like Senegal should be heeded.... Senegal acted early and at a national level. Dr. Penda Ndiaye pointed out that the Francophone MAQ Subcommittee is positioned to make a unique contribution in the fight against HIV/AIDS in West Africa. The Subcommittee has been designed to:
Dr. Penda Ndiaye, Population Council/Dakar, pointed out that the Francophone MAQ Subcommittee is positioned to make a unique contribution in the fight against HIV/AIDS in West Africa.
- Build upon synergies (among organizations, agencies and individuals in several West Africa countries)
- Benefit from diversity (among it members: leaders, service providers, researchers)
- Foster sustainability (by implementing activities that last more than a few years)
- Encourage exchange (sharing experiences and lessons learned in the different countries)
- Mobilize strength locally (at the country level among the 9 country subgroups)
Combating HIV/AIDS will not be an easy task. But it is a task that we cannot afford to postpone.
1G Mutume. Janvier 2001. African leaders declare war on AIDS. Africa Recovery: Nations Unies 14(4).
2J McGeary. Février 2001. Death stalks a continent. TIME Magazine 12 février 2001: 36-45.
3G Mutume. Mars 2001. Development: AIDS battle bigger than pharmaceuticals, say health officials. World News, Inter Press Service, Baltimore, Maryland.
4J McGeary. Février 2001. Paying for AIDS cocktails. Who should pick up the tab for the Third World? TIME Magazine 12 février 2001: 54.
5West African Initiative (WAI) for a Response to the HIV/AIDS Pandemic. 1998. UNAIDS.
6 Réunion Internationale Consultative sur les Priorités d’Intervention en matière de VIH/SIDA en Afrique de l’Ouest. Rapport Général. Du 27 au 29 septembre 2000. Dakar, Sénégal.
