18 APRIL 2024
Global Fund to Fight AIDS, Tuberculosis and Malaria (Geneva)
By Adv. Bience Gawanas, Vice-Chair of the Global Fund Board
As HIV practitioners gather this week in Yaoundé for AFRAVIH, the largest international Francophone conference on HIV/AIDS, and a few months before the 25th International AIDS Conference in Munich, the Vice-Chair of the Global Fund Board urges renewed focus on promoting equity in the fight against HIV particularly for groups that continue to suffer a disproportionate proportion of HIV infections.
Every step we make in the fight against HIV today is going to be painstaking - we must press harder for progress. In the early years of the fight against this virus, our gains were often rapid and immense because everywhere you looked, there was great need. Those were devastating times: The disease killed three million people in 2000, more than 2.4 million of them in Africa. In the southern tip of the continent, where I am from, the disease was threatening to disintegrate the very fabric of society.
When the world came together to form partnerships like that of the Global Fund and PEPFAR, it was to challenge the injustice that only the rich could get HIV treatment. It was to stop the possibility of losing a generation of people in many low- and middle-income countries as well as those who were stigmatized and discriminated against because they were considered "different".
I am proud to say that we have since come a long way. From less than 50,000 people on treatment for HIV in Africa in 2000 to more than 20 million today, HIV prevention innovations have proliferated, reducing HIV infections dramatically.
And yet, more than 1.3 million people were infected with the virus in 2022.
These infections are now happening primarily amongst the most marginalized: Men who have sex with men, people who inject drugs, trans women and sex workers. More so, their voices are increasingly silenced, and they are under constant threat of violence and abuse, as discriminatory legislation directed against LGBTI people is surging around the world. Among these groups, young people aged 15-24 years old bear a disproportionate burden of HIV and are even more vulnerable, facing greater barriers to accessing health services.
Long Road Remains
In Francophone African countries (24 countries - 373.3 million people), the HIV burden is lower than in the rest of the continent. However, they accounted for 16% of all new HIV infections in sub-Saharan Africa in 2022.
Thanks to concerted efforts from the Global Fund and other partners, the AIDS-related mortality rate in Francophone African countries has declined by 82% between 2000 and 2022. In the same time period, the AIDS-related mortality rate fell by 95% in Burundi, by 91% in Rwanda, and by 90% in Côte d'Ivoire and Burkina Faso.
The number of new HIV infections in Francophone Africa also decreased, from 325,000 in 2000 to 108,000 in 2022. Between 2001 and 2022, HIV incidence rates declined by 92% in Burundi and Rwanda, and by 91% in Côte d'Ivoire and Burkina Faso. Through Global Fund-supported programs, antiretroviral therapy coverage in Francophone Africa significantly increased from 4% in 2005 to 72% in 2022.
Still, a long road lies ahead to achieve key objectives, such as elimination of AIDS in children. As many Francophone countries still have high rates of vertical transmission, it is of the utmost importance to improve both prevention and pediatric care simultaneously.
As HIV practitioners gather this week in Yaoundé for AFRAVIH, the largest international Francophone conference on HIV/AIDS, and a few months before the 25th International AIDS Conference in Munich, the Vice-Chair of the Global Fund Board urges renewed focus on promoting equity in the fight against HIV particularly for groups that continue to suffer a disproportionate proportion of HIV infections.
Every step we make in the fight against HIV today is going to be painstaking - we must press harder for progress. In the early years of the fight against this virus, our gains were often rapid and immense because everywhere you looked, there was great need. Those were devastating times: The disease killed three million people in 2000, more than 2.4 million of them in Africa. In the southern tip of the continent, where I am from, the disease was threatening to disintegrate the very fabric of society.
When the world came together to form partnerships like that of the Global Fund and PEPFAR, it was to challenge the injustice that only the rich could get HIV treatment. It was to stop the possibility of losing a generation of people in many low- and middle-income countries as well as those who were stigmatized and discriminated against because they were considered "different".
I am proud to say that we have since come a long way. From less than 50,000 people on treatment for HIV in Africa in 2000 to more than 20 million today, HIV prevention innovations have proliferated, reducing HIV infections dramatically.
And yet, more than 1.3 million people were infected with the virus in 2022.
These infections are now happening primarily amongst the most marginalized: Men who have sex with men, people who inject drugs, trans women and sex workers. More so, their voices are increasingly silenced, and they are under constant threat of violence and abuse, as discriminatory legislation directed against LGBTI people is surging around the world. Among these groups, young people aged 15-24 years old bear a disproportionate burden of HIV and are even more vulnerable, facing greater barriers to accessing health services.
Long Road Remains
In Francophone African countries (24 countries - 373.3 million people), the HIV burden is lower than in the rest of the continent. However, they accounted for 16% of all new HIV infections in sub-Saharan Africa in 2022.
Thanks to concerted efforts from the Global Fund and other partners, the AIDS-related mortality rate in Francophone African countries has declined by 82% between 2000 and 2022. In the same time period, the AIDS-related mortality rate fell by 95% in Burundi, by 91% in Rwanda, and by 90% in Côte d'Ivoire and Burkina Faso.
The number of new HIV infections in Francophone Africa also decreased, from 325,000 in 2000 to 108,000 in 2022. Between 2001 and 2022, HIV incidence rates declined by 92% in Burundi and Rwanda, and by 91% in Côte d'Ivoire and Burkina Faso. Through Global Fund-supported programs, antiretroviral therapy coverage in Francophone Africa significantly increased from 4% in 2005 to 72% in 2022.
Still, a long road lies ahead to achieve key objectives, such as elimination of AIDS in children. As many Francophone countries still have high rates of vertical transmission, it is of the utmost importance to improve both prevention and pediatric care simultaneously.
Another key objective is to reduce stigma and discrimination as barriers to HIV prevention, care and treatment. The West Africa regional Stigma Index 2.0 report, based on data from 10,910 people living with HIV in seven countries in the region, found that, among key populations, people who inject drugs and transgender women had the biggest difficulties in accessing testing, care and treatment.
HIV Challenge is One of Equity, Not Science
The fight against HIV is no longer a challenge of science, but one of equity. For us to accelerate progress once again, we must reclaim that strong spirit of equity that animated us two decades ago. That means focusing on the communities most affected by HIV. In Africa, the focus on adolescent girls and boys is an urgent imperative.
Although HIV incidence in adolescent girls and young women has greatly declined in the past decade, 4,000 girls and young women still get infected with HIV every week across the world, mainly in sub-Saharan Africa. This is unacceptable. This group continues to suffer conditions that are the most iniquitous of all, with structural injustices that predispose them to diseases.
If we are to prevent HIV infections in this population, we must bring together diverse partners to invest in long-term efforts to keep girls in schools.
Education turns girls into women with the possibility of more equal opportunities, and protects them from diseases such as HIV. Educated girls register lower rates of teenage pregnancies, sexual violence, early marriages, and ultimately lower HIV infections.
We must also accelerate investments in programs that support comprehensive sexual and reproductive health and rights, particularly for adolescent girls and young women.
And we must ensure that young women and girls are front and center of projects that seek to engage them. These are some of the goals the Global Fund partnership is seeking to achieve with projects such as Voix EssentiELLES and the HER Voice Fund, which strive to meaningfully engage young women and girls in key health programs and decision-making forums in their communities.
To end the HIV infections in young women and girls, we must also reduce infections amongst their sexual partners. That means investing in efforts to transform cultural and social norms that predispose men and boys to HIV and that shape their engagement with girls and women in their communities.
It also means that men at high risk of HIV infection are tested and supported to start and stay on treatment. Protecting heterosexual men and boys from HIV can also help protect women and girls from HIV.
We must seek to renew our focus on promoting equity. We know how to do this. We did it at the turn of the millennium with our drive for equity in HIV treatment. Let us now move forward and end this unfinished fight by reducing HIV infections among the most affected communities. To get there, we can be reenergized by the goals and the unyielding spirit of those golden years of progress in the fight against HIV.
This op-ed was originally published on Health Policy Watch.
Africa: Empower African Youth So They Can Put an End to Aids
The Global Fund
16 APRIL 2024
By Patrick Fouda
Ahead of the largest French-language international conference on AIDS--to take place in Yaoundé from April 15 to 19 (AFRAVIH)--the RAJ+ AOC group of activists and social entrepreneurs and one of its leaders, Patrick Fouda, are urging African societies to trust that young people can effectively combat the epidemic that has ravaged the continent for too long.
When AIDS swept across Africa at the end of the last century, many of our governments were denying or downplaying the problem and it was the young people who mobilized. Large numbers of them were affected so they gave their energy, and even their lives, to fight a scourge which offered little hope of survival before antiretroviral drugs became widely available. They organized into associations and demanded that the world grant them the right to drugsand health care. Their fight was a resounding success.
Today, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners, most African countries are running major programs to combat the disease. The programs include health care, the distribution of antiretrovirals and preventive products, and responding to the stigmatization of and discrimination against HIV-positive people. The results are encouraging. Since 2010, West and Central Africa has managed to reduce by 50 percent the number of new HIV infections and AIDS-related deaths.
This generally positive picture does, however, have a darker flip side: in Africa, young people aged 15 to 24 are still the most HIV-vulnerable group. Young women face harmful gender norms that reduce their ability to protect themselves against HIV and AIDS. Such norms also put them at risk of transmitting the virus to their children through lack of access to prevention of mother-to-child transmission (PMTCT) treatment. Young people under the age of 25 may face laws, customs and social structures that exclude them from effective HIV prevention education. Every week, over 300 teenagers in West and Central Africa become HIV-positive, and many are unaware of it. For example, in my country of Cameroon, only 4 out of 10 teenagers know their HIV status. Yet knowing one's serostatus is an essential step in benefiting from antiretroviral treatment and other health care services. As for children under the age of 14, the situation is of even greater concern. In West and Central Africa, two thirds of HIV-positive children do not receive any paediatric antiretroviral medication at all. In addition, almost half of HIV-positive pregnant women do not have access to PMTCT, which explains why one quarter of the world's HIV-positive children live in West and Central Africa.
And yet, while HIV continues to wreak havoc among the under-25 age group, young people are, paradoxically, the population that is the least frequently consulted or listened to at the national and regional levels regarding matters related to sexual health and HIV. Yesterday's young people, those who were at the helm of the first response to HIV/AIDS, are now parents, elders and leaders who manage HIV/AIDS programs and are barely receptive to this major, current, and timeless issue in the response to HIV and AIDS. The participation of the most affected communities at all levels of the HIV response that our elders built by winning hard-won battles, is still the most important but least acted upon principle in the fight against AIDS, as far as young people are concerned. We will only succeed in eliminating the disease if the leadership is passed on from one generation to the next and by training and empowering young people so that they can become fully involved in the response. This is essential for two reasons: This is necessary for two reasons: Firstly, without the input of young people, national programs and development partners struggle to identify HIV and AIDS needs because HIV-positive or at-risk young people are not a homogeneous population. Rather, they are interconnected groups with different needs: young girls, urban youth, adolescents from remote areas, teenagers who have dropped out of school, young migrants or refugees, or young populations made vulnerable by stigma and discrimination. Secondly, if we fail to identify the needs, programs will be unable to address all adolescents and young people using approaches that suit each of the different groups. For example, some young people are afraid to go to their local health center for HIV screening because they fear being recognized or stigmatized. Whereas they would turn to more informal structures, such as youth associations, to obtain self-tests to use at home.
Without the essential contribution of young people, we risk sacrificing our common dream of putting an end to AIDS. Indeed, the more a country, a culture or a program excludes HIV-affected communities from decision-making on sexual health and HIV, the more frequently the disease is transmitted and is therefore able to persist. In Africa, those communities are predominantly young people.
The situation requires more targeted investments in PMTCT, paediatric antiretrovirals, youth education on gender and HIV prevention, anti-stigma and anti-discrimination programs, and strengthening the leadership and institutional capacity of youth-led organizations. All the above are essential if we are to maintain the gains of the past and secure our future. And they must be built, implemented and evaluated with, by, and for young people.
We are the future of Africa. If nothing is done, many of us will continue to die due to lack of appropriate health care, medication and prevention. Unless urgent, concerted action is taken with us, for us and by us, many of us will be condemned to a lifetime of living with a now-preventable virus. The road to eliminating HIV and AIDS began with yesterday's young people. And it will end with today's young people. They will put an end to the epidemic and enable the emergence of the first AIDS-free generation in Africa in half a century, if their voices are heard and if they participate fully in the response.
Patrick Fouda, Co-founder and Executive Director of the West and Central Africa Network of Positive Adolescents and Youth (RAJ+ AOC)
This op-ed was originally published on Jeune Afrique.
16 APRIL 2024
By Patrick Fouda
Ahead of the largest French-language international conference on AIDS--to take place in Yaoundé from April 15 to 19 (AFRAVIH)--the RAJ+ AOC group of activists and social entrepreneurs and one of its leaders, Patrick Fouda, are urging African societies to trust that young people can effectively combat the epidemic that has ravaged the continent for too long.
When AIDS swept across Africa at the end of the last century, many of our governments were denying or downplaying the problem and it was the young people who mobilized. Large numbers of them were affected so they gave their energy, and even their lives, to fight a scourge which offered little hope of survival before antiretroviral drugs became widely available. They organized into associations and demanded that the world grant them the right to drugsand health care. Their fight was a resounding success.
Today, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners, most African countries are running major programs to combat the disease. The programs include health care, the distribution of antiretrovirals and preventive products, and responding to the stigmatization of and discrimination against HIV-positive people. The results are encouraging. Since 2010, West and Central Africa has managed to reduce by 50 percent the number of new HIV infections and AIDS-related deaths.
This generally positive picture does, however, have a darker flip side: in Africa, young people aged 15 to 24 are still the most HIV-vulnerable group. Young women face harmful gender norms that reduce their ability to protect themselves against HIV and AIDS. Such norms also put them at risk of transmitting the virus to their children through lack of access to prevention of mother-to-child transmission (PMTCT) treatment. Young people under the age of 25 may face laws, customs and social structures that exclude them from effective HIV prevention education. Every week, over 300 teenagers in West and Central Africa become HIV-positive, and many are unaware of it. For example, in my country of Cameroon, only 4 out of 10 teenagers know their HIV status. Yet knowing one's serostatus is an essential step in benefiting from antiretroviral treatment and other health care services. As for children under the age of 14, the situation is of even greater concern. In West and Central Africa, two thirds of HIV-positive children do not receive any paediatric antiretroviral medication at all. In addition, almost half of HIV-positive pregnant women do not have access to PMTCT, which explains why one quarter of the world's HIV-positive children live in West and Central Africa.
And yet, while HIV continues to wreak havoc among the under-25 age group, young people are, paradoxically, the population that is the least frequently consulted or listened to at the national and regional levels regarding matters related to sexual health and HIV. Yesterday's young people, those who were at the helm of the first response to HIV/AIDS, are now parents, elders and leaders who manage HIV/AIDS programs and are barely receptive to this major, current, and timeless issue in the response to HIV and AIDS. The participation of the most affected communities at all levels of the HIV response that our elders built by winning hard-won battles, is still the most important but least acted upon principle in the fight against AIDS, as far as young people are concerned. We will only succeed in eliminating the disease if the leadership is passed on from one generation to the next and by training and empowering young people so that they can become fully involved in the response. This is essential for two reasons: This is necessary for two reasons: Firstly, without the input of young people, national programs and development partners struggle to identify HIV and AIDS needs because HIV-positive or at-risk young people are not a homogeneous population. Rather, they are interconnected groups with different needs: young girls, urban youth, adolescents from remote areas, teenagers who have dropped out of school, young migrants or refugees, or young populations made vulnerable by stigma and discrimination. Secondly, if we fail to identify the needs, programs will be unable to address all adolescents and young people using approaches that suit each of the different groups. For example, some young people are afraid to go to their local health center for HIV screening because they fear being recognized or stigmatized. Whereas they would turn to more informal structures, such as youth associations, to obtain self-tests to use at home.
Without the essential contribution of young people, we risk sacrificing our common dream of putting an end to AIDS. Indeed, the more a country, a culture or a program excludes HIV-affected communities from decision-making on sexual health and HIV, the more frequently the disease is transmitted and is therefore able to persist. In Africa, those communities are predominantly young people.
The situation requires more targeted investments in PMTCT, paediatric antiretrovirals, youth education on gender and HIV prevention, anti-stigma and anti-discrimination programs, and strengthening the leadership and institutional capacity of youth-led organizations. All the above are essential if we are to maintain the gains of the past and secure our future. And they must be built, implemented and evaluated with, by, and for young people.
We are the future of Africa. If nothing is done, many of us will continue to die due to lack of appropriate health care, medication and prevention. Unless urgent, concerted action is taken with us, for us and by us, many of us will be condemned to a lifetime of living with a now-preventable virus. The road to eliminating HIV and AIDS began with yesterday's young people. And it will end with today's young people. They will put an end to the epidemic and enable the emergence of the first AIDS-free generation in Africa in half a century, if their voices are heard and if they participate fully in the response.
Patrick Fouda, Co-founder and Executive Director of the West and Central Africa Network of Positive Adolescents and Youth (RAJ+ AOC)
This op-ed was originally published on Jeune Afrique.
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