World AIDS Day

Less than a decade ago, AIDS was moving unchecked through our communities, leaving death and suffering in its path. Fewer than 50,000 Africans were receiving life-saving antiretroviral treatment. Now, thanks in part to programs such as the Global Fund, and the strong commitment of our governments, nearly 4 million Africans—enough to fill Soccer City Stadium more than 44 times—are able to access the treatment they need to live longer, more productive lives. Our governments’ collective leadership on HIV/AIDS is strengthening, the stigma toward those living with the disease is declining, and 22 countries in sub-Saharan Africa have reduced new HIV infections by more than 25 percent. The South African Government’s new policy in particular, which has significantly increased its investments in treatment for AIDS and prevention of HIV, has already begun to show positive results. Specifically it has reduced the numbers of babies born with HIV transmitted from their mothers; increased the numbers of people receiving ARVs treatment and living longer with HIV/AIDS, when in the past it would have been a sure death sentence.

But there is a grave threat to this progress: a global recession that has tightened the budgets of African and donor governments alike. The tremendous gains we’ve made over the last decade in the fight against HIV/AIDS are now in jeopardy, and recent global financial meetings in Canada and New York have shown that even donors who understand the importance of global health investments are seeing aid budgets increasingly squeezed. At least for now, large donor funding increases for AIDS seem to be a distant dream.

So what does this mean for Africans and African leaders? To maintain progress, we must continue to insist on the resources needed to keep our people alive, while at the same time taking a very hard look at how we can do even better with what we have. Indeed, there is much we can do to improve both the efficiency and effectiveness of the resources that are allocated towards the prevention, treatment and care of HIV/AIDS. There are three steps we can take.

Firstly, we must improve prevention. The promise of treatment for everyone living with AIDS cannot be fulfilled until we slow substantially the rate of new infections. Funding must be focused on interventions that are proven to be effective and are targeted to those who are most at risk. We must overcome cultural barriers to reaching young people with accurate information about HIV, and we must provide them with access to condoms if they are sexually active.

We now have the tools to virtually eliminate mother-to-child transmission of HIV, so there is no excuse in 2010 other than our own inaction for children being born HIV positive. Ensuring that mothers have access to anti-retroviral drugs during pregnancy and teaching mothers how to minimize the chances of passing the virus on to their newborn can cut the risk of infection almost entirely. We need to seek out HIV-positive women, offer them quality family planning services, and provide education and treatment for those who become pregnant.

For young men living in countries with high rates of HIV, male circumcision by a trained medical provider needs to be widely available – it can reduce by over 60% the risk of a man getting infected from an HIV-positive woman.

Secondly we must improve governance and transparency. Even with all the resources and good intentions, programmes will only be successful if they are well managed and citizens are fully informed and engaged. Primary responsibility lies with our Ministries of Health and of Finance who must work together to prioritize domestic spending for HIV/AIDS; and to report on where the funds are going and what results they are producing. Where external aid is utilized, our leaders at all levels need to get tough on criminals who try to siphon off resources for AIDS treatment, and work in partnership with donors and civil society to ensure that our in-country capacity to track and evaluate funding is as strong as possible. The citizens of donor countries that provide assistance are also entitled to know that we have an aggressive intolerance for corruption of any kind. Equally importantly donors should seek to ensure that national health systems are not undermined, while delivering or implement HIV/AIDS programs on the ground.

Thirdly, we must make the case for Africa. Far from advocating perpetual indefinite donor dependence, but so long as we continue to rely on their assistance to aggressively fight AIDS, it is in our interest to be more vocal about the successes of these funds and how they can be best utilized. Indeed, as resources become increasingly tight, and donors change eligibility and prioritization criteria, it will become ever more important for our leaders, celebrities, and citizens when they travel abroad to represent us, to be unabashed in detailing both how effective investments have been saving lives as well as sharing what works and has not worked in each of our countries. It is up to the leaders to partner with civil society so as to be able to advise donors on such key issues as when integration should be a focus, where clinics are best situated, how cultural practices should influence policy, which local partners are strong. We are our own best advocates, and donors need to hear from us.

On World AIDS Day I hope that we can all make a commitment to fulfilling our responsibilities to help end AIDS in Africa in our lifetime. It will take all of us, working together as one, to make a difference.