Stepping up the HIV response
Roseline Sachiti Features Editor
The failure of various interventions to tackle the HIV/Aids pandemic may have left some people despairing.
Over and over again those affected have complained, forcing governments and some non-governmental organisations to roll their sleeves and manage the pandemic.The results have been positive and the battle is far from being lost.
Globally, enormous gains have been made in cure and vaccine research.
Over the years, the number of people receiving antiretroviral treatment has gone up.
Rates of infection have fallen with more evidence on Treatment as Prevention coming up.
However, funding, implementation and political challenges have stalled universal progress with many regions struggling to address their HIV epidemic amidst a backdrop of ever increasing infections.
Just a few weeks remain before the International Aids Conference (IAC) kicks off in Melbourne, Australia, from July 20 to 25, 2014.
This year’s theme is “Stepping up the Pace”.
“Stepping up the Pace recognises that we are at a critical time and we need to capture the optimism that has recently emerged and build on it to ensure that HIV remains on top of the global agenda. The pace needs to further increase to ultimately reverse the trajectory of the epidemic.
“Stepping up the Pace reminds us that we have to energise and revitalise our efforts to increase investments, collaborative research and political commitment. This can be done through controlled and coordinated action, including significant programme scale-up in resource-limited settings, commitment to evidence-based interventions, and more effective and intensive interventions in ‘hotspots’ where key affected populations (KAPs) are being left behind. Crucially, there is the need to involve KAPs and address the stigma and discrimination which they face, including punitive government policies,” says the International Aids Society.
With the clock fast ticking towards the 2015 MDG deadline, there is need to ensure that HIV and AIDS, which is MDG 6, remains a key focus of international development.
Zimbabweans do not want the IAC to remain a talkshow.
They want to see the world step up in finding solutions.
Regional coordinator at Women’s Health, HIV and AIDS Southern Africa,Tendayi Kateketa says issues pertaining to women and girls post the 2015 agenda should be at the forefront at this years’ International Aids Conference.
“It’s important that we build on the current gains and success, for example the advent of ARVs, elimination of mother to child transmission (global plan),” she pointed out.
Issues of sexual reproductive health rights for women and girls, she emphasised, should take centre stage.
“It’s important that young women take up leadership roles and are placed in decision-making processes. We would also like to see young people especially women amplifying their voices in plenary sessions at the women networking zone.
“We also want to see the progress on eliminating gender-based violence against women and girls, especially what makes them vulnerable to HIV and Aids. We expect the National Aids Council to have people living with HIV on their delegation and that they show case progress at country level and resource mobilize for the country.
“Lastly, we hope that the conference will highlight interventions centred on key affected populations – women in prisons, women with disabilities, and HIV mitigation for children,” she said.
Community Working Group on Health (CWGH) Executive Director Mr Itai Rusike says there is need for political will to invest in health.
“An end to AIDS will require unprecedented political will to invest in health particularly AIDS, TB and malaria: broader health systems strengthening and integrating the AIDS response in global health and development efforts.
“A more integrated approach will strengthen the reach and impact of the AIDS response, leverage HIV-related gains to generate broader health and development advances, and enhance the long-term sustainability of the AIDS response,” he says.
Mr Rusike adds that in today’s economic and political climate, it is imperative that the response to HIV extends beyond the health sector to cover other determinants of health.
“Noteworthy, HIV transmission increases in and is reinforced by conditions of inequality, vulnerability, and social marginalization. HIV remains one of the central threats to global health, international development and stability, and therefore has implications across many of the MDGs,” he adds.
Most important, he points out, is for the Melbourne conference to address sexual and reproductive health and rights as this is fundamental to an HIV response that is effective and sustainable.
“A failure to link action to different goals means reduced progress across all targets. For example, HIV prevention goals will not be met without action on education; and goals for education cannot be met without action on nutrition; child health goals will not be met without action on sanitation and HIV prevention; poverty eradication without gender equality, and so on,” says Mr Rusike.
He adds that despite efforts across the continent, health systems continue to require further strengthening and the institutionalization of accountability mechanisms.
“Progress with regards to maternal, newborn and child health remains below set targets and significantly undermines development in the continent. Consequently, renewed commitment at the highest level is critical to reinforcing action to facilitate the delivery of desired results,” he says.
He believes that to succeed, donors and recipients must meet their full commitments under existing funding agreements. This includes commitments to their own bilateral and national programmes.
“Further, it requires the transparent and efficient use of available resources and comprehensive law, policy and service delivery, which address and overcome stigma.
“Civil society has the role of ensuring that the world does not backtrack on gains so far made in fighting HIV and AIDS, moreso ensuring that Africa, which carries the highest burden of disease, consistently prioritizes health in its development agenda,” he adds. Mr Rusike admits that international, regional and national leaders have made numerous global, continental and national commitments on HIV and health.
“Among them the 2000 Abuja Declaration and Framework for Action on Roll Back Malaria (RBM), 2001 Abuja Declaration on HIV and AIDS, tuberculosis and other related infectious diseases (ORID); political declarations on HIV&AIDS of 2006 and 2011. These commitments have stimulated resources and scaled up of programmes to fight these diseases in Africa,” he says.
However, as he points out, it is also clear that much more is needed to achieve health-related Millennium Development Goals.
“Predictable and sustainable health financing is at the centre of achieving universal HIV prevention, treatment, care and support by everyone including the poor and marginalised populations.
“The Abuja Declaration adopted in April 2001 by African leaders declared the response to HIV/AIDS, tuberculosis and other related infections as the highest priority issues in their respective national development plans, committing 15 percent of their national budgetary allocations to health. Ten years down the line, only a handful of countries have achieved this target, with the regional average remaining at 7 percent,” he adds.
Against this backdrop of global financial crisis, many donor agencies are reviewing their financial commitments to funding health and HIV on the African continent.
“Many African countries are facing the real threat of not meeting their budget requirements for implementing the much needed scale up of ART programmes, among other HIV, TB and malaria interventions, relying heavily on the Global Fund and PEPFAR to sustain these programmes,” he adds.
Domestic health financing is at the heart of sustainable and predictable health financing for universal access. The stagnation of aid from traditional source markets has stimulated an increased interest in the possibility of finding new and innovative sources of finance, noting that new forms of financing can provide African countries with innovative means to increase resources for development by also ensuring a more inclusive and sustainable pattern of growth.