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Targets and results - Africa
Botswana
Uganda
Malawi
South Africa
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Africa has been hit by the HIV epidemic much harder than any other
region. Large variations exist between individual countries in
Africa, but UNAIDS/WHO estimates that 25.4 million people were
living with HIV in the Sub-Saharan region at the end of 2004, out of
a global total of 39.4 million. Across sub-Saharan Africa, UNAIDS/WHO
estimate that 500,000 (11% of those in need) were accessing ARV
treatment at the end of June 2005.
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Botswana
There were estimated to be 350,000 people living
with HIV in Botswana at the end of 2003. This gives Botswana a
prevalence rate of 37% - the second highest in the world. Of all
African countries, Botswana is doing the most to provide its
citizens with improved healthcare and prevention and, perhaps most
importantly, it was the first country in Sub-Saharan Africa to start
to offer ARVs to all who need them through its public health system.
The project aims to improve awareness, education, testing and
counseling. As this progresses, the aim is to implement and
significantly expand HIV treatment and care.
Implementation of the ARV programme started at
Princess Marina Hospital in 2001, and has since expanded to at least
twenty-three sites. Alongside this government/private partnership
are initiatives set up by employers to provide education and
treatment for their employees. About one quarter of people receiving
treatment do so through private facilities.
At the end of 2004, around half (36,000-39,000) of
the 75,000 people needing treatment were receiving it. This
represents more than a doubling of access within six months. Free
public sector provision rose gradually from a few hundred people at
the start of 2002 to nearly 5,000 in September 2003, before soaring
to above 18,000 one year later. The government target is to have
47,500 on treatment (public and private sector) by the end of 2005.
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Uganda
At the end of 2003, there were 530,000 people living
with HIV in Uganda, according to UNAIDS data. The country has had
great success in reducing adult HIV prevalence from above 30% in the
early 90s to 4.1% in December 2003. Uganda's actions have been
widely praised and are seen by many as providing a model for other
nations.
Uganda ran one of the first pilot ARV programmes in
Africa. It began in 1998 and aimed to see how an ARV programme could
be set up and run in a resource-poor country. The 399 patients
involved were responsible for paying for their treatment, and bought
their drugs at negotiated reduced prices. At the end of the two-year
pilot, patients reported good adherence to treatment and virological
and immunological responses to ARVs were similar to those found in
Western countries.5 The Ugandan Ministry of Health has since
incorporated the essential elements of the scheme into its National
Strategic Framework for HIV/AIDS.
In Uganda, programmes are being designed to bring
ARVs to the wider impoverished public sector. There are also some
private initiatives starting, spurred on by the reducing costs of
drugs and the perceived benefits to employers from having healthy
staff. At the end of 2004, UNAIDS/WHO estimated that 40,000-50,000
people were being treated. This represents great progress towards
the government target of 60,000 on treatment by the end of 2005.
However, it is estimated that at least 114,000 people are in need of
drugs.
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Malawi
Malawi has an HIV prevalence rate of 14%, which
translates to 900,000 people infected. Of these, it has been
estimated that at least 170,000 are in need of HIV treatment. At the
end of 2004, just 6% (10,000-12,000) of these needy people were
receiving drugs through the public sector, as well as treatment
initiatives run by aid agencies like Medecines Sans Frontieres.
Although this is still a small number, progress has been made since
reports of 3,760 people on treatment in June 2004.
The government did come up with an ambitious plan to
treat all 300,000 people who needed it and wanted to submit the
US$1.62 billion plan to the Global Fund for HIV, TB and Malaria.
However, after discussions about whether Malawi would be able to
implement such an ambitious plan, the final accepted plan was scaled
down to just 25,000 people, totalling US$196 million over five
years. In the first two years of the five-year project, it was hoped
that 70% of HIV positive pregnant women would be receiving
Nevirapine and 10,000 patients would be on ARVs. Malawi has had
two-year approved funding for its HIV/AIDS programme of nearly US$42
million. An appraisal of the healthcare infrastructure by WHO
however, has confirmed that 50,000 could be treated in the public
sector in the near future. In February 2004, the president of Malawi
announced details of the first national HIV/AIDS policy. Its focus
is to be on sustaining a multisectoral approach, promoting HIV/AIDS
prevention, treatment, care and support.
The government now plans to provide free treatment
to 80,000 by the end of 2005, thus exceeding their 3 by 5 target of
68,000. Progress towards this ambitious goal will be aided by
Malawi's experience in implementing the DOTS strategy for TB
control. The number of sites providing ARV therapy grew from three
in January 2003 to more than twenty in September 2004.
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South Africa
The case for access to ARVs in South Africa has been
the most high profile of all African countries. Data from the UNAIDS
July 2004 report shows that 5.3 million people were living with HIV
at the end of 2003, which gives a prevalence rate of 21.5%. This
means that South Africa has more HIV+ people that any other country
in the world.
Yet it was not until November 19th 2003 that the
government finally gave approval to a plan to provide free ARVs to
all who need them.
The Health Minister Manto Tshabalala-Msimang stated
there would be one ARV 'service point' in each of the country's 53
health districts within a year, increasing to one service point in
every local municipality within five years. In the same week, it was
announced that HIV/AIDS funding was to be increased from R3.3
billion to R12 billion (US$1.8 billion). The executive director of
the Medical Research Council Anthony Mbewu said the cost of
implementing the plan would be US$45 million for the remainder of
2003/04 rising to US$700 million in 2007/08. It was estimated that
400,000 people will fulfil the criteria for starting treatment.
In December 2004, the WHO estimated that
42,000-67,000 were receiving drugs which, given the estimated
837,000 people in need, is a very small figure indeed. Furthermore,
more than half of these people were accessing treatment through the
private sector. Personal reports suggest that, at a local level,
there is a significant gap between the actual proportion of people
who are receiving treatment and the much higher published figure.
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