Parked on Ouagadougou’s red soil opposite the association’s clinic under the burning sun, the ‘mobile screening’ van is the pride of the African Solidarity Association (Association African Solidarité, or AAS). One of the aims of the AAS, founded in Burkina Faso in 1991, is to fight against HIV. The van simplifies the task of identifying AIDS and raising awareness of the disease amongst the population. “No longer do we need to wait for patients to come to the screening centres; now the screening comes to them,” explains Issouf Nikiema, who works in the clinic. In west Africa today, de-medicalising screening (to take it out into the field and make it available to everyone) is a priority.
An AIDS-free Africa: a decade ago this seemed like an impossible goal. But today more than ever, ending the epidemic is a hope that could well be realised by 2030, in line with the target set by the United Nations following years of medical advances in the treatment of HIV.
To achieve that means respecting the ‘90-90-90’ target, also known as the ‘three 90s’ set out by UNAIDS in 2014, with a deadline of 2020.
It means that by 2020, 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90 per cent of all people receiving antiretroviral therapy will have viral suppression.
Today three-quarters of all people living with HIV now know their HIV status; of those who know their status, 79 per cent were accessing treatment in 2017; and of the people accessing treatment, 81 per cent had suppressed viral loads, according to the latest figures from UNAIDS. It appears that six countries (Botswana, Cambodia, Denmark, Swaziland, Namibia and the Netherlands) have already met their 90-90-90 targets. “The biggest gap is the first 90: in west Africa and central Africa, for example, only 48 per cent of HIV-positive people knew their status,” says the latest report from UNAIDS.
“We have to tackle it from every angle”
“We are looking at an historic opportunity to end the AIDS epidemic,” says Dr. André Kaboré, a member of UNAIDS, speaking to Equal Times in Ouagadougou. This west African country is an interesting case study. As a good example of best practice in the region’s fight against AIDS, Burkina Faso has seen the prevalence rate of HIV among its population (i.e. the number of people with the virus at any given time) fall considerably over the last 20 years from a little over 7 per cent to less than 1 per cent today. Total AIDS-related deaths have fallen by 46 per cent since 2010. These encouraging figures are not synonymous with wiping out the epidemic, however, unless accompanied by a policy to provide wider access to treatment.
Fighting HIV infection is a vast operation that can be divided into different tasks: prevention by raising awareness at every level of society, distributing condoms, providingpre-exposure prophylaxis – PrEP (taking medication to reduce the risk of HIV infection), facilitating screening so that those who are HIV-positive know their status and supporting these people in taking antiretrovirals.
“That’s the problem – we have to tackle it on every front,” says Kaboré, who recalls that in addition to the money spent on treating those infected, a budget must also be allocated for prevention, to ensure there is not a steady rise in new infections.
State funds from African countries are not enough to fulfil this dual task of prevention and treatment. Staying with the example of Burkina Faso, political instability, including terrorist attacks and the jihadi threat, weighs heavily on the public purse. The Ministry of Defence’s national budget rose by 23.41 per cent in 2019. Prioritising security has meant that the health budget has not been increased as much as it should, says Kaboré. When it comes to HIV therefore, the role of the international community is vital.
In face of the growing disparities between rich countries (in which triple therapy – the combination of three drugs which, taken soon enough and with regularity, can considerably increase the life expectancy of patients – has been available since 1996) and developing countries (where, in contrast, patients are still too numerous and the problem has become a blind spot for health policies), there is an urgent need to set up a system of international solidarity.
Created in 2002 in a process driven by the G7, the Global Fund to Fight AIDS, Tuberculosis and Malaria (dubbed simply “The Global Fund”) was designed to mitigate the unequal access to HIV treatments. At the end of 2017 this international solidarity drive raised sufficient funds to save 27 million lives, according to an impact report. Today US$18 billion is needed to step up the fight and have a hope of ending the three pandemics, which is 1.8 billion more than the funds raised between 2017 and 2019.
This sum could be raised at the next meeting of the Global Fund, on 10 October 2019 in Lyon. The problem is that the target amount announced by French president Emmanuel Macron on 11 January this year, after talks with the director general of the World Health Organisation (WHO, based in Lyon), falls far short of what is needed, according to NGOs. For the 2020-2022 period, US$14 billion are foreseen: “that is US$3 to US$4 billion less than what is needed,” says Aurélien Beaucamp, president of the AIDES association.
“Forty years after smallpox was eradicated, humanity can reach another milestone for progress and health. It is time to be ambitious and show political courage: the money needed amounts to just 0.0025 per cent of global wealth.”
“It is a derisory sum compared to what we hope to achieve: a world without AIDS, tuberculosis or malaria,” insisted ten global associations (including AIDES, Sidaction and Médecins du Monde) at the end of 2018, when they signed a petition calling on heads of state to take action.
NGOs are also keen to point out that raising money to fight AIDS will reduce the number of new infections which will in turn reduce the cost of treatment from 2020.
Ongoing projects that just need more support
Financial resources are now the missing fuel for the ending-AIDS machine. In the field, in west Africa for example, NGOs have lost no time and have clearly identified the most effective means of leading the fight. On the matter of PrEP for example, a cohort study has been set up to measure the feasibility of PrEP in Ouagadougou, Abidjan in Côte d’Ivoire, Lomé in Togo and Bamako, Mali. The final results will be presented in 2020.
During this time, still in west Africa, NGOs are focusing on medical screening (to bring the service closer to vulnerable populations, who sometimes fear being watched by others if they go to hospital) or self-testing.
There is also peer-education, which needs to be strengthened. Peer educators are individuals from the vulnerable populations (such as sex workers and the LGBT community) who are trained to raise awareness about HIV amongst their peers.
Outside the Bobo-Dioulasso centre, sheltered from curious eyes, the REVS PLUS association has set up a clinic that sees sex professionals and members of the LGBT community every day for screening. In a rectangular meeting room where several fans hum, tables have been set out in a U-shape for members of the association, most of whom are young gay men rejected by their families. The theme of today’s discussion? Sexually transmitted diseases. The peer-educator leading the discussion, a sort of ‘big brother’, has a set of pictures in his hand to show his audience the symptoms of the papilloma virus, syphilis and genital thrush.
The role these facilitators play is essential, because the last few years have shown that they have real mobilising power in their communities. “We find it easier to trust someone who shares the same lifestyle as us,” explains Charles Somé, a facilitator with REVS PLUS. There are about 80 facilitators in Burkina Faso now, but the idea is to get funds to train and pay more of them.
In general, many NGOs are trying to promote leadership from within the community. “We prefer to develop skills within the population rather than turn up and tell people what to do. Our work therefore is focused on strengthening their advocacy skills. Moreover, they are the ones who find the resources to establish their leadership on the ground,” explains Camille Sarret from the Coalition Plus network, an international group of community organisations fighting against AIDS and hepatitis.
Fighting back against AIDS in one generation
Today, the response to the AIDS epidemic could be finished in less than a generation, according to UNAIDS. In 2018, for the first time since the turn of the century, the number of deaths dropped below one million (900,000). The number of people living with the virus is also declining steadily. There are three times more people on antiretroviral treatment than in 2010. All that is missing is the political will to seriously contain the epidemic on the African continent.
Even for basic supplies, the fight against AIDS in Africa is suffering from a lack of means. “We can run out of condoms on a daily basis,” says Romain Ouedrago, the peer-educator coordinator for the AAS clinic in Ouagadougou.
“Without the help of countries that can afford it, we will not succeed. But I remain optimistic. Our progress is encouraging, but we must also stay the course on prevention, especially with young people who see the medical progress being made… and therefore have the impression that we can be cured of AIDS,” says Didier Bakouan, permanent secretary for the National Committee for the Fight Against AIDS, speaking to journalists in Ouagadougou. The call for international solidarity has been made – now all that is needed is the response.This story has been translated from French.
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