HIV response in Africa

Reducing the burden

HIV advocacy programs are significantly responsible for the global community’s success in reducing the burden of HIV. Advocacy initiatives built on proven approaches of the HIV response and critical lessons learned from the intersecting HIV and pandemics have particularly proven effective in Africa. These, among many other issues, were incorporated into the Common Africa Position (CAP) at the 2021 High-Level Meeting of the ‎General Assembly on HIV/AIDS. The draft position was crucial in negotiating ‎Africa’s voice during the 2021 High-Level Meeting (HLM) of the UN General ‎Assembly on HIV/AIDS, which took place between 8th and 10th June 2021, to ‎adopt a new political declaration to guide the future direction of the ‎HIV/AIDS response.‎

Prime examples are the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA)‎ and Free To Shine Campaign. Launched by the African Union (AU) in 2009, the CARMMA aims to reduce high rates of women dying in childbirth (maternal mortality) and children dying before they reach the age of 5 years due to preventable causes. Co-led by the AU Commission and the Organisation of African First Ladies Against HIV/AIDS for Development (OAFLAD), Free to Shine is a bid to prioritise children, adolescents and mothers in the fight against HIV.

The AU Commission recently launched the ‎#ProtectedAndInformed digital campaign in collaboration with UNAIDS to strengthen advocacy for HIV ‎prevention and care in Africa.

“We encourage the AU Member States to unite people and organisations at the local and global levels to advance the progress of these advocacy initiatives,” said Amira Elfadil.

Winnie Byanyima added: “We need to enable every girl in Africa to complete secondary education and be safe ‎and strong. It is heart-breaking that so many girls get infected with HIV in Africa: six in ‎seven new infections among adolescents aged 15-19 in Sub-Saharan Africa are in girls. ‎Empowering adolescent girls and young women to complete secondary education ‎helps keep them safe, reduces their risk of HIV infection by as much as 30 – 50% in ‎some countries, prevents early marriage and early pregnancies and moves them ‎towards gender equality. This is what we aim to achieve with the Education Plus ‎initiative launched at the Generation Equality Forum in June and co-led by UNAIDS, ‎UNICEF, UNESCO, UNFPA, and UN Women.”

Sands said “We know the pandemic has disproportionately impacted the people most affected by HIV, ‎TB, and malaria: the poor, the marginalised, those without access to health care. Because of ‎the disruptions resulting from COVID-19, the people at greatest risk of HIV infection have ‎had less access to the information and tools they need to protect themselves.‎ Despite the setbacks in 2020, there were signs of resilience as countries across Africa and the ‎world adapted HIV programs in the face of COVID-19”.

Due partly to investments from the ‎Global Fund and partners like PEPFAR, African countries rapidly adapted services to ‎implement multi-month dispensing of HIV drugs, secure community ART delivery and HIV ‎self-testing and other service innovations.

“‎We know the situation in many countries would have been even worse without the rapid and ‎determined actions across the Global Fund partnership to mitigate the impact ‎of COVID-19 on HIV, and nowhere was this more apparent than in Africa. As we enter 2022, we must sustain this agility, a sense of purpose, and unity. So many of the ‎poorest and most vulnerable people and communities in Africa depend on us for their lives ‎and health,” added Sands.

Policy action and advocacy require to be fully resourced to be implemented with consistency and optimal efficiency. Achieving the global HIV goals and targets will also require a peak of annual HIV investments in ‎Africa. The continent must continue to raise a generation of strong advocates for HIV financing and equality.

“The support of our global partners has been incremental in enabling the work of the AIDS Watch Africa Secretariat, through which the AU Commission leads advocacy, accountability, and resource mobilisation efforts to advance a robust African ‎response to end AIDS, tuberculosis and malaria by 2030‎. In collaboration with the AU Development Agency (AUDA-NEPAD), the Secretariat is also leading the African Leadership Meeting (ALM) on Investing in Health Declaration to increase domestic resources for health reorienting ‎health systems in Africa,‎” said Amira Elfadil.

“We at UNAIDS are calling for an investment of US$ 29 billion by 2025 in the AIDS ‎response. This price tag is a shared responsibility and would be invested to scale up ‎HIV treatment and prevention services, put people at the centre and tackle the ‎inequalities, reducing annual new HIV infections from 1.7 million in 2019 to 370 000 in ‎‎2025. But every year, HIV resources have fallen far short and insufficient progress in the ‎HIV response is only increasing the long-term costs that will strain already ‎overburdened health budgets. While lessons learnt and resources from HIV should be ‎leveraged for other diseases, this shouldn’t happen at the expense of further progress ‎against AIDS. We cannot afford to lose the ground we have gained against HIV,” said ‎ Byanyima.

Sands said, “The economic outlook is extremely challenging, and we recognise the enormous pressures governments are facing to cut and prioritise public spending, but we cannot afford to go backwards in the fight against HIV, TB or malaria. There is no middle ground when fighting diseases as formidable as HIV or COVID-19; we are either winning or losing. We must prioritise health spending to defeat COVID-19 and regain momentum on AIDS, TB and malaria. This will require more funding, plus unprecedented agility and coordination between partners”.

“The Global Fund acted quickly in response to the pandemic, investing over $4 billion to support countries responding to COVID-19 to mitigate the impact on the three diseases. This is on top of the $4.2 billion we invest annually for HIV, TB and malaria interventions. We are committed to working with partners and governments to identify innovative means of crowding in extra financial resources, including by leveraging blended finance mechanisms and Debt2Health swaps,” he added.

In conclusion, we have achieved much in the fight against HIV in Africa, but we can do more. On this World AIDS Day, we jointly call on global leaders and communities in Africa to unite against the inequalities that obstruct progressive HIV response on the continent and serve those left out of essential HIV care and services.

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Amira Elfadil is Commissioner for Health, Humanitarian Affairs and Social ‎Development, African Union ‎Commission, Winnie Byanyima  is Executive Director of UNAIDS, and Peter Sands  is Executive Director of the Global Fund.