AFRICA: Call for better strategies to fight AIDS
[This report does not necessarily reflect the views of the United Nations]
© UN DPI
Kofi Annan - looking for new approaches to combat AIDS
GABORONE, 28 July (PLUSNEWS) - UN Secretary-General Kofi Annan has been urged by delegates attending a conference on scaling-up the response to HIV/AIDS in Africa to act as a global champion for countries looking to develop generic anti-AIDS drugs and stem the brain drain of health workers.
"One of the recommendations is that we need to ensure a sustainable supply of ARVs [antiretrovirals] through governments, and not just the donor organisations, by assisting African countries to manufacture generic drugs," said Vuyisele Otukile, chief executive officer of Botswana's Youth Health Organisation (YOHO).
"We also need to empower traditional birth attendants, including other health providers like lay counsellors, to do rapid testing of HIV/AIDS on site and be able to give Nevaripine [the drug that can cut transmission of HIV by more than 50 percent] to HIV-positive mothers," he added.
The delegates were attending a two-day meeting in Botswana this week, hosted by a UN Commission on HIV/AIDS and Governance in Africa (CHGA) to examine the challenges of scaling-up HIV/AIDS treatment and care. The session was the second in a series of five planned regional meetings organised by the commission, which was set up by Annan to address the unique challenges posed by the epidemic in Africa.
Botswana, a middle-income country that has won plaudits for its national rollout of ARV treatment, has nevertheless struggled with the lack of capacity in its public health system to handle an estimated 37 percent of adults infected.
Noting a problem faced even more acutely by other African countries, Ernest Darkoh, the head of Botswana's national ARV programme said, "Most capacity challenges being tackled today existed long before HIV epidemic began ... the current situation is one where supply is grossly inadequate to meet demand.
"We do not have the staff to deal with it ... The critically ill and dying clog the system. Those at the back of the queue we only get around to when they are also dying," he told delegates.
"Although women and children are a priority group for access to ARVs, this is not happening. There is a need for rapid decentralisation of the ARV programme," said Connie Osborne, the UN Children's Fund HIV/AIDS project coordinator in Botswana.
Six issues identified by delegates as crucial in the fight against the pandemic were the sustainability of the long-term emergency response, better use of existing resources, more skills sharing, overcoming stigma and discrimination, decentralisation of initiatives and the need for HIV/AIDS education at an early age.
"Strategies for intervention should recognise target audience interests and rights, like women, children, people living with HIV/AIDS, traditional leaders and communities. We need to be very clear how we impart information to specific age and gender groups," said Otukile.
Concern was expressed over the lack of community participation in local programmes. "In Botswana we could do more to push a grassroots initiative. We need to start engaging with chiefs, traditional leaders, farmers and village youth in their own settings," said Dr Banu Khan, national coordinator of the National AIDS Coordinating Agency.
While a lot of biomedical research has been done, delegates said there was a lack of emphasis on social aspects of the epidemic, such as psychosocial support, community mobilisation and skills development, which was critical for successful decentralisation.
Experience from pilot projects has shown that community participation, especially by males, is key to the success of PMTCT interventions, because of the power men traditionally wield in relationships.
Given the impact of years of underfunding on the health system, and the ongoing brain drain of health personnel to better-paying jobs overseas, community workers provide an important resource. They can help link HIV-positive people with support services, reduce stigma, improve adherence to care and treatment by monitoring patients, and encourage safer behavioural practices.
"We as policy-makers are making decisions without listening to community needs, including people with HIV/AIDS," said Lisa Jamu, deputy country representative for Population Services International Botswana.
CHGA is served by 21 commissioners. Their role is to produce a report in 2005 that will provide African policy-makers with effective mitigation strategies and policy options to combat the impact of the epidemic.