On World AIDS Day 2014 we should reflect that, according to UNAIDS, the global population infected with HIV is over 35 million. 19 million of these 35 million people (54%) do not know that they have the virus. Africa accounts for 71% of all infected which translates into 24.7 million infected persons. The most shocking thing though is that there were over 2.1 million people newly infected in 2013 and most of these were in Africa. This makes HIV the single biggest contributor to the palliative care burden on the continent and as a result HIV is contributing hugely to the palliative care need on our continent.
Some countries in Africa, especially in Southern Africa, have invested heavily into HIV care and prevention efforts. As such they have seen significant reductions in new HIV infections.
Too often though this is still not happening. There is still a lack of adequate investment into ways of attracting people to get tested for HIV. This is, at least in part, to do with inadequate access to HIV testing services in the communities – especially those in the rural areas. This is hindering peoples’ knowledge of their HIV status and therefore resulting in significant delays in patients seeking treatment.
Since those initiated on antiretroviral therapy must first know their HIV status, poor access to HIV testing in turn results into poor access to ARTs leaving people free to spread the disease unknowingly.
In countries where legislation has been introduced that perpetuates or increases stigma, patients have been put at risk as they fear seeking out testing. Stigma remains a major hindrance to access to services.
Poor health systems especially in the rural areas have also contributed to poor access to HIV services.
In many countries, the initiation of a person living with HIV must still be done by a medical doctor. But across much of Africa the doctor-patient ratio is very low. Entire districts in some countries do not have a single doctor.
The supply of HIV and palliative care medicines in some African countries has been less than acceptable. This has resulted in complete absence of some medications such as oral morphine and stock outs of antiretroviral medications, anti TB and other medications. This has resulted in a health system-induced non-adherence to medications and untold suffering for patients and their families but especially women and children. This is neither good for the patients nor for the general populations as risks of medicine resistant HIV and TB are increasing as a result of stock outs and non-adherence.
Tackling mother to child transmissions is also difficult in Africa. Some countries have more women delivering outside the health care system than within. Therefore accessing the majority of these pregnant women with HIV prevention services is often impossible. This is in turn results into delivery of HIV infected babies, a phenomenon already wiped out in developed countries.
Once again good HIV care and prevention provides multiple benefits. Attracting pregnant women back into functional well-facilitated health systems will reduce HIV, infant mortality and maternal mortality.
Tackling these challenges can only sustainably be done through well-funded government programmes. However, as some African countries continue to face growing corruption scandals and growing populations, the money available for health shrinks in real terms. African governments therefore need to strengthen health systems alongside efforts to strengthen the anticorruption systems. Corruption leads to worse HIV figures on the continent as money for services finds its way in the hands of the crafty not the needy.
The misguided belief by some in Africa that access to ARVs is leading to complacency and rising HIV figures should be ignored. We know that universal access to HIV medications has resulted in wiping out paediatric HIV and reduction in new infections in many western countries.
All our efforts should be made towards ensuring universal access to ARVs both as part of a treatment and care package but also as an HIV prevention strategy. A balanced approach to investment in the trio of care and treatment, prevention and research will strengthen our response.
The HIV/AIDS response must also consider that the palliative care demand is increasing on the continent because of HIV, opportunistic infections such as TB, HIV associated tumours such as Kaposi Sarcoma and other non-communicable diseases such as diabetes, high cholesterol and accompanying neurological and cardiovascular diseases.
Scientists in Africa, in partnership with the colleagues in Europe and North America, have produced ground breaking research results for HIV prevention, treatment and care. Several prevention and care models have been documented and African governments ought to adopt these.
Investment into the health systems to ensure good governance and leadership, better human resource development and retention, patient and family-centred service delivery and access to medicines cannot any longer be evaded without hampering the expected progress on the continent.
HIV prevention efforts cannot bear fruit while the health systems are isolated and poorly funded, and not nurtured or monitored. The African political and elite classes need to measure their success by how well they have established and supported functional health systems and how well the HIV epidemic has been controlled. This cannot be the responsibility of poorly paid and scantily equipped health workers.
Strengthening palliative care integration into health system to care for those already infected as well as preventing spread to sexual partners and babies can only improve the chances of the Africans. Governments on the continent ought to commit more resources in the health sector and coordinate the multi-sectorial HIV response.
In addition the countries ought to repeal or review laws that hinder access to essential medicines such as oral morphine or those laws that stigmatise HIV-infected persons and especially key populations including sex workers, the LGBT community, and other minority groups.
Women, girls and children should be seen as a highly vulnerable to HIV yet have limited capacity, ability and room to control and manage what comes to them. Governments in Africa need to deal with issues that expose these to sexual and economic exploitation and also invest into their education, care and protection.
The religious and cultural institutions have played very critical roles in Africa’s development over their years. These have been pioneers in education and health care development on the continent. However some of the emerging religious and cultural practitioners have opposed scientifically proven HIV care and prevention strategies. The governments ought to educate, empower and then regulate these religious and cultural practitioners who promise scientifically unproven and dangerous approaches to HIV care that counteract scientifically proven prevention and care actions.
In Africa over the years, we have seen a couple of leaders defying scientifically proven ways of combating HIV and then advocating for their own “politically thought out approaches” which have no scientific basis. The international community should isolate such leaders and/or those who divert money meant for HIV services to themselves.
Their crimes are putting civilian lives at risk. The international community cannot and should not tolerate this. Our political leaders should be held accountable for the worsening figures.