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Note: This document is from the archive of the Africa Policy E-Journal, published by the Africa Policy Information Center (APIC) from 1995 to 2001 and by Africa Action from 2001 to 2003. APIC was merged into Africa Action in 2001. Please note that many outdated links in this archived document may not work.


Africa: AIDS Updates, 1 Africa: AIDS Updates, 1
Date distributed (ymd): 020706
Document reposted by Africa Action

Africa Policy Electronic Distribution List: an information service provided by AFRICA ACTION (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Find more information for action for Africa at http://www.africaaction.org

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +gender/women+ +health+ +economy/development+

SUMMARY CONTENTS:

The XIV International AIDS Conference begins in Barcelona, Spain, on July 7. Today's two postings include several related articles. The official conference web site is: http://www.aids2002.com. Daily coverage of the week-long conference is available at http://www.kaisernetwork.org/aids2002

This posting contains a speech by Stephen Lewis at a UN Press conference last week, and selections from the Kaiser Daily HIV/AIDS Report summarizing other recent developments. A related posting today contains excerpts from a speech by Zwelinzima Vavi, General Secretary of the Congress of South African Trade Unions, and from a UNICEF press release.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

AFRICA ACTION NOTES TO READERS

(1) We need your continued support. Thanks to those of you who have supported our work with contributions this year. If you have not done so yet, please read our letter at
http://www.africaaction.org/join.htm for updates on our work and links for making your contributions.

(2) Africa Action is adding new organizing staff. For a job announcement for a Washington-based field organizer, see http://www.africaaction.org/faq/orgjob.htm [link no longer available - 9/02]. Please bring this to the attention of potential candidates.

(3) These e-mail postings will be less frequent during the summer, to allow for staff travel, vacations, and organizational housekeeping. Specific breaks will be announced in future postings.


Statement by Stephen Lewis, the Secretary-General's UN Envoy on HIV/AIDS in Africa
United Nations (New York)
July 3, 2002

[excerpts: full text available at
http://allafrica.com/stories/200207030681.html]

This media briefing is driven, of course, by the publication yesterday of the two new startling reports on HIV/AIDS. For ease of reference, I'll refer to the omnibus Global document as the UNAIDS report, and the document relating specifically to youth as the UNICEF report. ...

Rather, I want to draw attention to two particular aspects, which flow from the reports, and which relate directly to Africa. ...

First: amidst the unrelenting catalogue of horrors --- the prediction of a possible 68 million additional deaths world-wide, 55 million of them in Africa by the year 2020; the ghastly finding that the pandemic has not yet begun to level off in Africa, even in the highest prevalence countries; the bracing public assertion by Dr. Piot that the pandemic is still in its early stages overall --- to this catalogue of horrors, there must be added, in the case of Africa, that the pandemic is now, conclusively and irreversibly, a ferocious assault on women and girls.

We all understood that the percentages were rising. We all understood that women were particularly vulnerable. We all understood that the pandemic was feasting on gender inequality. I'm not sure, however, that any of us understood until now, the full magnitude of the accelerating catastrophe for women. That's where these two reports are indelibly interlinked.

The figures, carefully extracted from the various tables, tell the story. And I make no apologies for using the figures: somehow the world has to be made to understand what's happening.

According to the UNAIDS report, of the 26 million infected adults in SubSaharan Africa (that is between the ages of 15 and 49), women now constitute 15 million, or 58%. That figure is distressing enough, but look what happens when it's linked to the data from the UNICEF report. At the very outset of that document, there is a breakdown of the numbers of young people (defined as 15 to 24) living with AIDS in various regions of the world. For Sub-Saharan Africa, the total is 8.8 million, two-thirds of whom, that is to say 67% of whom, are young women. The ratio, young women to young men, is an explicit two to one.

Put in the context that more than half the new infections now occur among young people --- 6,000 a day --- and you can see what is in prospect for Africa. I'm not a statistician, but if the present reality is 58%, and the future reality is 67%, we're talking about the unthinkable ... a looming cataclysm for the women of Africa.

There are, in both reports, endless pieces of evidence to confirm the pattern. If you cull the tables at the back of the UNICEF document (confirmed in the UNAIDS document), it's hard to believe what emerges. There is a category on the percentages of young people living with AIDS at the end of 2001. The category provides a low range and a high range. For comparison purposes, I'll use the high end because that's where we appear to be heading, given the projections of the UNAIDS report.

On that basis, in Botswana, the percentage of young women living with AIDS is 45%; the comparable figure for young men is 19%. In Lesotho, young women are at 51%, young men at 23%. In South Africa, the numbers are 31% as compared to 13%. In Swaziland, 47% to 18%. In Zambia, 25% to 10%. In Zimbabwe, 40% to 15%. In Namibia, 29% to 8%. In Malawi, 18% to 8%. In Cameroon, 15% to 6%. In Central African Republic, 16% to 7%. In Rwanda, 13% to 6%. The pattern is comparable for all African countries.

Please note that in every single country, the young HIV positive women represent two to three times - or more ---- the infection rates of young men. I despair of the numbing recitation of statistics, but they reveal a relentlessy grim picture. ...

In background papers, prepared by UNAIDS, it is said that one-third to almost one-half of new mothers in the worst-affected countries, could die of AIDS.

And then as if all of this isn't bad enough, we have the UNICEF document, based, I would emphasize, on more than 60 new national surveys --- the most up-to-date definitive material now available --- which shows, in alarming page after page, the astonishing lack of knowledge about AIDS, and transmission, and prevention and sexuality among the young people surveyed.

In the course of those pages, there are the following representative glimpses of reality: in Cameroon, Central African Republic, Equatorial Guinea, Lesotho and Sierra Leone, more than 80% of young women, ages 15 to 24, do not have good knowledge about sex; in Nigeria, 95% of girls, age 15 to 19, perceive their risk of contracting AIDS to be minimal or non-existent; in Nigeria again, 61% of unmarried sexually active young men, 15 to 24, did not use a condom at the last episode of sexual intercourse, and, incredibly enough, 93% of these young men felt no risk or a small risk of contracting HIV; in a large number of African countries, specifically, Somalia, Burundi, Comoros, Uganda, Zimbabwe, Rwanda, Tanzania, Sierra Leone, Chad, Niger, Mauritania, Cote d'Ivoire, Guinea-Bissau, Senegal, Central African Republic, Sao Tome and Principe, Gambia, Togo, a majority of the girls surveyed did not know where to get tested; and in corroboration of what I have already noted, 17% to 22% of girls age 15 to 19 in major urban areas of East and Southern Africa are already infected. In Ethiopia, 14% of young women surveyed, said that they had had sex before the age of 15; in Nigeria the figure is 17%. These two countries, with a combined population of nearly two hundred million, stand at the very precipice of an explosion in the pandemic.

The report also chronicles the sexual violence, the predatory sexual behaviour of older men, the girls pulled out of school to care for sick and dying parents, the complicating malevolence of the sex trade, the growth of the orphan population, and much more. It is a true and full compendium.

If it can be said, as it can, that by the year 2020, the number of deaths from AIDS in Africa will approximate the number of deaths, military and civilian combined, in both world wars of the 20th century, then it should also be said that a pronounced majority of those deaths will be women and girls. The toll on women and girls is beyond human imagining; it presents Africa and the world with a practical and moral challenge which places gender at the centre of the human condition. The practice of ignoring a gender analysis has turned out to be lethal.

And that brings me to the second point I want to make, albeit far more briefly. I listened carefully yesterday to Peter Piot and to Jeffrey Sachs, advisor to the Secretary-General, both of them speaking to the high-level session of the Economic and Social Council. They both made the same unanswerable points: AIDS is wrecking human havoc in every sector of a steadily-increasing number of African countries; we have all the knowledge we need to turn the pandemic around, but to do it, there must be a huge quantum leap in financial resources.

On those truths, there seems to be an international consensus. At the recent G8 Summit, the New Partnership for African Development, or NEPAD, included a strong paragraph which said, unequivocally, that unless the communicable diseases are defeated (and by that they meant primarily AIDS), economic and social development in Africa would be an "impossible hope".

In the formal G8 response to NEPAD, called the Africa Action Plan, under the section titled "Improving Health and Confronting HIV/AIDS", there appears this language: "To this burden (meaning other communicable diseases) has been added the devastating personal and societal costs resulting from AIDS, the consequences of which stand to undermine all efforts to promote development in Africa ... Therefore, recognizing that HIV/AIDS affects all aspects of Africa's future development and should therefore be a factor in all aspects of our support for Africa, we commit to ...". And then there follows a series of predictable commitments which resonate with goodwill and purpose.

What has not yet resonated are the dollars to meet the commitment. The shortfall is staggering: billions and billions of dollars meant to prolong and save human life in Africa over the next generation. The Global Fund is desperately underfunded. The Secretary-General has asked for $7 to $10 billion a year to fight the pandemic. This year the Fund has roughly $800 million. Peter Piot uses the figure of $10 billion overall from all sources. Everyone agrees on that range or higher. This year we're closing in on $3 billion.

Jeffrey Sachs says the necessary money is readily available; it's a simple matter of arithmetic. He argues, as the MacroEconomic Commission on Health argues, that to reach the Millenium Goals for Health would require setting aside, annually, one penny of every ten dollars of income in the rich countries ($25 billion required out of a $25 trillion pot). But the penny won't drop.

These two reports make as eloquent an argument as we're ever likely to hear for the world to come to its senses. For the African continent, it means economic and social survival. For the women and girls of Africa, it's a matter of life or death.


KAISER DAILY HIV/AIDS REPORT
A free service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv

Excerpts from issue of July 5, 2002

GLOBAL CHALLENGES

1. $27 Billion Boost for HIV Prevention Programs Could Avert Majority of Projected HIV Infections Worldwide

Nearly two-thirds of the HIV infections projected to occur worldwide by 2010 could be prevented if an additional $27 billion were allocated to HIV prevention programs, according to two studies released yesterday, the Boston Globe reports (Donnelly, Boston Globe, 7/5). In the first study -- published in the July 6 issue of the Lancet -- epidemiologists, demographers and mathematicians from UNAIDS, the World Health Organization, the U.S. Census Bureau and the private organization The Futures Group International created a model to predict the future of the epidemic and how new infections could be averted. The researchers predict that an additional 45 million people worldwide will become infected with HIV by 2010 but add that 29 million of these infections could be prevented if HIV prevention efforts are rapidly expanded or instituted. Such efforts include advertising campaigns, school and workplace education, condom distribution and needle-exchange programs, the study states.

According to the study, while the majority of HIV infections could be averted if fully expanded programs were in place by 2005, half of the projected benefit would be lost if the projects were not in place until 2008 (Brown, Washington Post, 7/5). The researchers project that the cost of such a "concerted, global campaign" would require a quadrupling of current spending on HIV prevention. "These deaths are not inevitable. We can actually do something which can substantially decrease this epidemic," WHO epidemiologist and study co-author Dr. Bernhard Schwartlander said (Garrett, Newsday, 7/5).

The model did not take treatment into account because the researchers said that there is "no research to quantify how the use of antiretroviral drugs changes population-wide transmission of HIV" (Washington Post, 7/5) Schwartlander said that "prevention and treatment efforts are intertwined, and there should not be a debate of funding one over the other."

Prevention Plan Outlined

A separate study released yesterday outlined a plan for expanding current HIV prevention programs and creating new ones. The study was drafted by the Global HIV Prevention Working Group, an independent panel of 40 "leading HIV prevention specialists" that was assembled by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation (Boston Globe, 7/5). The group convened to evaluate the projections made in the other study and "determine what an all-out global HIV prevention campaign would take," Newsday reports (Newsday, 7/5). The group proposes a number of initiatives, including allowing countries to set their own priorities for funding, boosting health system infrastructure, expanding successful prevention programs, mobilizing political leadership, improving HIV surveillance and "dramatically" increasing access to treatment. To successfully achieve these goals would require an additional $4.8 billion annually by 2005 and a total of $27 billion in funding by 2010. Helene Gayle, co-chair of the working group and an official with the Gates foundation, said, "We are going to continue to face devastation if we don't as a world community wake up to this and put in the resources that we need to make the difference. By presenting some practical solutions, and some things we know are doable, it's not just saying 'Give us the money and trust us.' It's 'Give us the money ... and there are solutions available today'" (Boston Globe, 7/5). ...

2. Debate Over Funding for Treatment, Prevention to Be 'Centerpiece' of XIV International AIDS Conference

The debate over how to divide funds between prevention and treatment efforts will be the "centerpiece" of the XIV International AIDS Conference that begins on Sunday in Barcelona, the Wall Street Journal reports. While those favoring prevention programs and those favoring treatment programs agree that the $2 billion in the Global Fund to Fight AIDS, Tuberculosis and Malaria is "paltry," the "clash" between the two groups will "profoundly affect" the distribution of the funds.

At next week's conference, treatment advocates, doctors and people with HIV/AIDS plan to present research supporting funding for HIV/AIDS treatment programs and stage "massive" protests, the Journal reports. Treatment Action Campaign Chair Zackie Achmat said those treatment advocates also are planning a "new pan-African treatment movement, demanding everything from vitamins to antiretrovirals."

Prevention Has 'Long-Term Impact'

The Bill & Melinda Gates Foundation's new HIV/AIDS and tuberculosis prevention taskforce, which is focused "almost solely" on prevention, also will "tak[e] center stage" at the conference, the Journal reports. The group, led by AIDS prevention expert Dr. Helene Gayle, advocates HIV/AIDS prevention through condom use, voluntary HIV testing, behavioral changes, needle-exchange programs and research of microbicides and HIV vaccines. The taskforce focuses on prevention "because it has the best long-term impact," according to Gayle. "It's relatively simple to say dollar for dollar that prevention is more cost effective," AIDS Vaccine Advocacy Coalition Director Chris Collins said, adding, "The more complex point is what happens in societies where one in five or one in three people in the professional class are wiped out."

Shifting Focus

Although the South African government has focused almost exclusively on prevention, the HIV infection rate there has continued to rise, according to Achmat, who advocates a Medicins San Frontieres program that links prevention and treatment to fight HIV/AIDS. But economists say that such programs are "expensive" and "take many years" to implement. Meanwhile, pharmaceutical companies are "relieved" that the debate over prevention and treatment efforts has "shift[ed] focus" away from the debate over the high cost of AIDS drugs, the Journal reports (Zimmerman/Schoofs, Wall Street Journal, 7/3).

4. Constitutional Court Denies South African Government's Right to Appeal High Court Ruling on Nevirapine Distribution

South Africa's Constitutional Court today denied the government's right to appeal the Pretoria High Court's December ruling that the government must provide nevirapine to HIV-positive pregnant women in state hospitals to reduce the risk of mother-to-child HIV transmission, SAPA/SABCnews.com reports (SAPA/SABCnews.com, 7/5).

The court's ruling -- a "victory" for HIV/AIDS activists, including the advocacy group Treatment Action Campaign, which originally filed the suit against the government -- "removes the last obstacle put up by the government" for universal distribution of the drug, according to Reuters/Lexington Herald-Leader.

Chief Justice Arthur Chaskalson said that the government's restriction of the drug's distribution to 18 pilot sites "fell short of its constitutional obligation to offer the best treatment available." He added, "Government is ordered without delay to remove the restrictions that prevent nevirapine from being made available for the purpose of reducing risk of mother-to-child transmission of HIV at public hospitals and clinics that are not research and training sites" (Chege, Reuters/Lexington Herald-Leader, 7/5). TAC leader Zackie Achmat, who is HIV-positive but refuses to take antiretroviral drugs until the government makes them available to all South Africans, "welcomed" today's decision and said that the court's ruling "gave him hope that the government would change its position on making antiretroviral drugs available as therapeutic treatment for all HIV-positive people, not just for mother-to-child transmission prevention" (SAPA/SABCnews.com, 7/5). According to Patricia Lambert, special adviser to Health Minister Manto Tshabalala-Msimang, the government planned to "study the decision" before releasing a statement. The universal provision of nevirapine, which can reduce vertical HIV transmission rates "by up to half," could prevent at least 30,000 infants from contracting HIV from their mothers each year in South Africa (Reuters/Lexington Herald-Leader, 7/5).


This material is being reposted for wider distribution by Africa Action (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Africa Action's information services provide accessible information and analysis in order to promote U.S. and international policies toward Africa that advance economic, political and social justice and the full spectrum of human rights.

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