HIV in West and Central Africa – the state of an epidemic left behind
The UNAIDS, Médecins Sans Frontières (MSF) and African Union 18-month catch-up plan aims to increase treatment access and reduce mortality in West and Central Africa.
With just 42% of the 6.1 million people living with HIV across West and Central Africa aware of their HIV status, the region has fallen far behind their neighbours, and indeed the rest of the world, in their efforts to bring an end to the HIV epidemic.
West and Central Africa contains around 7% of the global population, but is home to 17% of the world’s population living with HIV and 30% of the world’s AIDS-related deaths in 2016.
New infections in the region have declined by only 9% between 2010 and 2016 – compared to 29% for East and Southern Africa. Alarmingly, some 22% of all new global HIV infections in 2016 were among young women in West and Central Africa.
Yet it is their stats relating to treatment which are most dire. Only 35% of people are accessing the treatment they need in 2016, meaning just one in four people were virally suppressed.
It is this slow roll-out of antiretroviral treatment that has set them drastically back in reaching 2020 UNAIDS Fast-Track targets which call for 90% of people living with HIV to be aware of their status, 90% of those diagnosed on treatment, and 90% of people accessing treatment to be virally suppressed.
To address this gap, UNAIDS, Médecins Sans Frontières (MSF) and the Africa Union have devised the Western and Central Africa Catch-up Plan — Putting HIV treatment on the fast-track by 2018. The revised strategy attempts address bottlenecks, increase access to treatment and reduce HIV-related mortality in the region.
Unlike other parts of Africa, West and Central Africa have failed to take advantage of community health workers in reaching communities with HIV testing and treatment. These types of health work need far less training than doctors, but can deliver health services when other human resources are limited – decentralising services to improve uptake. Other barriers include user fees for health care, political complacency, limited donor funding and high levels of stigma.
With a focus on country ownership, improving service delivery, better procurement of drugs and increased funding of the response, the plan aims to get 850,000 people onto antiretroviral treatment, including 60,000 children, and a further 250,000 people, including 60,000 children, newly diagnosed and linked to HIV care. An additional 100,000 pregnant women living with HIV will receive antiretroviral treatment as part of the prevention of mother-to-child transmission.
The good news is that progress is already being made, with a 17% increase in the number of people accessing treatment between 2015 and 2016 alone.
In addition, some eight countries have already started implementing the plan from the beginning of 2016 – four countries considered high-burden (Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo and Nigeria); three countries severely impacted by the Ebola outbreak (Guinea, Liberia and Sierra Leone); and One post-conflict country with fragile communities (the Central African Republic).
Alpha Condé, President of Guinea and Chairperson of the African Union, said. “Among the key strategies of the catch-up plan, innovative care delivery models that further engage community actors, as promoted in the 2 million community health workers initiative, will be key. Communities were instrumental to overcoming Ebola, and this force should be leveraged.”