One year on from the launch of the Abuja+12 roadmap to address AIDS, TB and malaria in Africa, what progress has been made?
At last week’s Abuja+12 Special Summit in Nigeria, African leaders reviewed the progress made on a roadmap to address AIDS, TB and malaria, which they adopted last July.
Commitments by African leaders are critical considering that sub-Saharan Africa has just over 10% of the world’s population, but is home to more than 60% of all people living with HIV. The Ivory Coast is west Africa’s most affected country with a prevalence or around 3.4%.
AIDS Watch Africa is an organisation that took on responsibility for monitoring progress toward the three action pillars of the Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa. So what impact has there been for people living with HIV in the Ivory Coast?
Sustainable funding for HIV
The first action pillar centres on creating more diversified, balanced, and sustainable financing models. In the Ivory Coast there is still a heavy dependence on external donors with HIV funding coming mainly from the US Presidential Emergency Plan for Aids Relief (PEPFAR). In 2009 the government’s contribution to the AIDS response was estimated around 7%, according to the report Abuja+12: Shaping the Future of Africa.
While innovative funding models such as taxes on cigarettes and mobile phones have been implemented in countries like Zambia and Rwanda, the Ivory Coast launched its ‘campagne petite monnaie’, a multi-sector project for increasing HIV resources. In 2012, this campaign raised around USD 370,900 to support activities of non-governmental organisations working on HIV.
Bertin Kouakou from the National Aids Funds said: “Campagne petite monnaie is an example that resources can be mobilised from home.” Yet a huge need remains for treatment and services and the lives of many people living with HIV in the Ivory Coast still depend on external aid.
Local production of medicine
The second pillar of the roadmap focuses on expanding access to medicines through local production and regulatory harmonisation, but there is still a long way to go with this. In 2001, at a summit in Nigeria, African heads of state issued the Abuja Declaration – a commitment to spend at least 15% of domestic annual government budgets to improve the health sector – at a time when it was still extremely difficult to access HIV treatment in Africa.
Just 11 years later, some 7.5 million people in Africa are receiving antiretroviral therapy. In the Ivory Coast, the number of HIV patients on treatment has increased from 4,000 in 2001 to 89,400. However, some 190,000 patients are still in urgent need of treatment and 46% of children eligible for treatment are not receiving any.
While applauding efforts made to provide treatment for free, people living with HIV denounce poor service quality including experiencing stigma and discrimination by health workers.
HIV and stigma
Many studies have reported on the stigma people living with HIV have experienced, including ITPC’s West Africa’s Hostile Environment. Such attitudes are likely to prevent people living with HIV from seeking services; women living with HIV, including pregnant women, are frequently the target. Oka Marina a woman living with HIV in Anyama said: “Midwives don’t treat us well, they are contemptuous and they yell at us on visits when we are in labour.”
Some patients also still face an interruption of services. Aby Bomon , 25, explains: “I am eight months pregnant and I will deliver soon. But I have not started treatment for HIV because the results of my CD4 are not available as the machine is not working. I am only using co-trimoxazole.”
While neighbouring countries sometimes mention drug stockouts, people living with HIV in the Ivory Coast have noted changes in their treatment and delays in drug supplies along with poor quality services. To address this issue, members of the ECOWAS multi-sector committee on HIV and AIDS had requested the West African Health Organization to work with partners in the region to set up a regional reserve stock of antiretrovirals.
Establishing strong leadership
This reserve stock will be pre-funded and integrated into the common stock of the country’s medical store to allow flexibility and quick response to requesting countries. It will focus mainly on the risk of rupture of the most common first line treatments. If implemented well, this project will significantly improve the lives of people living with HIV as they will no longer face interruptions to their treatment.
Like all such plans to combat HIV, it will be dependent on establishing strong leadership, governance, and oversight – which is the third pillar of the Abuja+12 roadmap. And civil society has a key role to play in this leadership; advocacy groups have previously proved their worth, having a significant impact on policies such as providing antiretrovirals for free.
As the Abuja+12 summit closed with five recommendations to achieve a healthier and HIV-free continent, people living with HIV, community activists, health service providers and civil society organisations continue working to reverse the course of the epidemic in the Ivory Coast.
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