(January 2001) The continent’s political leaders are set to adopt the African Consensus and Plan of Action against AIDS at an Organization of African Unity special summit on AIDS in April.

The Consensus, which emerged at the African Development Forum (ADF) hosted by the UN Economic Commission for Africa in Addis Ababa in December, is the first time that governments, their development partners, and civil society have taken a collective position to confront HIV/AIDS on the worst afflicted continent.

    Under the plan, all countries should hold national planning workshops by mid-February to turn the Consensus into concrete, national actions. By the end of 2001, countries are expected to have developed national strategic plans of action (many do not have them), and all should have set up national AIDS commissions. The strategies should be backed by legislation and clear allocation of resources in national budgets.

    HIV infections in sub-Saharan Africa rose by 3.8 million during 2000, bringing total infections to 25 million. According to the joint United Nations Programme on HIV/AIDS (UNAIDS), the sub-Saharan African numbers represent some 70 percent of the estimated 36 million people who are living with the disease globally.

    Costs of Escalating the Fight Against AIDS

    The ADF, an annual event bringing together the continent’s political leaders, intellectuals, policymakers, civil society, and international development partners, noted that a key priority in addressing the AIDS crisis in sub-Saharan Africa should be the expansion of levels of current activities.

    The continent already possesses most of the tools needed to change the course of the epidemic. There are examples of political commitment and effective community-based programs. These efforts, however, lack national coordination and are largely fragmented.

    One of the major drawbacks has been money. Conservative estimates from UNAIDS suggest that expanding a wide range of HIV/AIDS interventions would cost US$1.5 billion to US$2.3 billion annually. Providing anti-retroviral therapy would add another US$1.5 billion to US$2.4 billion to the cost, depending on the prices at which drugs are available. Yet, the continent is only spending about US$300 million annually on the fight against AIDS. In 1998, the international community spent US$165 million on HIV/AIDS in Africa.

    Mobilizing Funds Saved Through Debt Relief

    The World Bank’s Multi-Country AIDS Program, which offers US$500 million in loans to Africa to fight AIDS, was shot down by civil society and youth delegates at the December conference. Critics charged that it is criminal to offer loans to a continent that is unable to service its debts. Sub-Saharan African debt amounts to some US$230 billion.

    Instead, the new Consensus calls for urgent debt relief as one way of freeing up funds for HIV/AIDS programs. National governments pay four times more in debt service than they spend on health and education in many African nations.

    Zambia spent US$125 million on debt in 1998, or about 70 percent of social spending. Yet, district health officials only received 22 percent of their health budgets in 1999. (Zambia’s annual health budget is about US$100 million.) While it has an adult prevalence rate of 19 percent, Zambia only spends 73 cents per person on HIV/AIDS programs, according to UNAIDS.

    The proposed plan of action calls for national strategies to channel savings from an international debt relief package into AIDS programs. The enhanced Heavily Indebted Poor Country initiative (HIPC), as the package is called, is being implemented by the World Bank and International Monetary Fund and is supported by the major creditor governments of the Organization for Economic Cooperation and Development, the grouping of wealthy, industrialized nations. Some countries hard hit by AIDS, such as Zimbabwe, are not covered by HIPC.

    The Zambian Way

    The ADF, which attracted 1,500 participants, including several heads of government and of UN agencies, noted efforts by the Zambian government as examples for replication. In the southern African nation, different government ministries have made specific commitments to addressing HIV/AIDS:

    Simple Yet Effective Programs in Uganda

    Uganda has had relative success in fighting HIV. For instance, a simple program involving the provision of a pre-packaged treatment kit for sexually transmitted infections (STIs) known as ‘Clear Seven’ has been hailed by Uganda’s health ministry as a promising approach in treating STIs and in preventing HIV infection.

    The kit consists of a seven-day supply of antibiotics, condoms, partner referral cards, and a multilingual instruction and information leaflet. The kit promotes full-course treatment of STIs, supports condom use, strengthens partner referral, and provides health education.

    The package sells for the subsidized price of US$1.35 and is distributed across the country in informal drug shops licensed to sell over-the-counter drugs. By law, only pharmacies, 90 percent of them located in the capital Kampala, are authorized to sell antibiotics. The health ministry has, however, granted permission to utilize these small shops as points of delivery. The government acknowledges that improving distribution through drug shops is crucial to its anti-AIDS strategy. Workers at these informal drug shops are being trained to sell antibiotics without a prescription.

    The Value of National Political Leadership

    While Uganda has been hailed as a successful AIDS fighter, its policy initiatives have been far from perfect. For instance the 1998–2002 National Strategic Framework for HIV/AIDS was never implemented.

    Development of the strategy began in 1996, and was planned to include two years of consultations among stakeholders — a core group of representatives from 11 key organizations and ministries. But the strategy lost momentum. Among other problems, many ministries had not fully understood or accepted their role in a multisectoral approach and were not prepared to make new resources available for the program.

    President Yoweri Museveni has now taken personal charge of the planning process, an action that has resulted in government-wide implementation of a new strategy for 2000–2005. The move has been hailed as an example of the decisive role that national political leadership can play.

    Lowering the Cost of Drugs

    The ADF noted that there is much that African governments could do to promote the availability of affordable drugs. A study of the prices of brand-name medicines used in the suppression of HIV in Kenya, Uganda, and Norway found that the drug nevirapine is twice as expensive in Kenya as it is in Norway. Nevirapine reduces the risk of transmission of HIV from mother to baby during pregnancy or birth from approximately 30 percent to 2 percent.

    The plan of action outlines a number of steps governments could take to make cheaper, generic drugs available. Such measures include making optimal use of the safety clauses in international patent legislation when countries develop their own patent laws.

    Under rules of the World Trade Organization (WTO), countries are obliged to grant 20-year patent protection for drugs. This minimum standard had to be enshrined in national law by 2000 in many developing countries and by 2006 in least developed countries. Poor countries can, however, circumvent these rules by writing safeguards into their own national laws. These safeguards — under the WTO agreement known as the Trade Related Aspects of Intellectual Property Rights (TRIPS) — may include:

    Scaling Up Prevention and Treatment Services

    Overall, the greatest challenge facing Africa’s leaders in their battle with HIV/AIDS is the need to expand services for prevention and treatment of the disease. In many ways, the Kagera region of Tanzania — a region of 1.9 million people with 200,000 AIDS orphans — characterizes the problem. Even though this rural area was one of the first regions to be hit by AIDS some 16 years ago, its drug and prevention programs are limited.

    A tiny number of under-funded health posts, hospitals, and 10 nongovernmental organizations (NGOs) provide HIV/AIDS services. The NGOs operate mainly in two of five districts, with the other three having virtually no services. In the two districts on which they concentrate, the NGOs reach no more than 5 percent of the population, providing counseling and testing, treatment of opportunistic infections, home-based care, and support to orphans.

    Such low coverage characterizes most of sub-Saharan Africa. In Côte d’Ivoire, only two out of eight regions have any programs in rural areas, and the services are confined to prevention. In most other countries in Africa, HIV/AIDS services are only available in the largest cities, and even there, the reach is limited.

    Gumisai Mutume is a Zimbabwean journalist with Inter Press Service in Washington, DC.

    For More Information

    More from ECA on African Development Forum 2000: www.uneca.org/adf2000.

    Latest UNAIDS data on HIV/AIDS in Africa: www.unaids.org.

    The Consensus calls for:

    • More grants instead of loans from the international community to fund the continent’s anti-AIDS programs.
    • More national financing by African countries.
    • Reductions in the prices of anti-retroviral drugs to ensure access to cheap treatment.
    • Deeper, faster debt relief to assist in efforts to curb the spread of HIV.
    • Legislation and national policies in Africa that assist in the fight against AIDS.
    • The Office of the President encourages the inclusion of HIV prevention messages in all speeches of top political leaders.
    • The defense ministry is developing a fund to help raise and educate military officers’ orphans.
    • The agriculture ministry proposes to train agricultural extension workers in social mobilization techniques for HIV/AIDS prevention and care.
    • The local government ministry is reviewing land policies, in line with the debate on the need to extend to women the right to own land and inherit property. In many traditional communities, women lack these rights.
    • The tourism sector is incorporating HIV/AIDS into the curricula of wildlife management schools and hotel and tourism institutes.
    • Compulsory licensing. Member states may allow the use of a patent by a third party without the owner’s consent. There are no limitations regarding the grounds for issuing a compulsory license, but certain conditions apply, such as making efforts to obtain a license on reasonable commercial terms. This condition can be waived in cases of national emergency.
    • Parallel importing. When enshrined in national law, this measure allows cross-border trade in a patented product without the manufacturer’s permission. Parallel imports allow countries to import brand-name products from countries where they are sold by the patent holder or licensee at lower prices.
    • Bolar provisions. These provisions allow generic manufacturers to prepare production and regulatory procedures before patents expire so that upon expiration, they can immediately begin selling their products. This means that less expensive, generic products can be available much more rapidly after patents expire.