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Africa: AIDS Updates & Analysis

AfricaFocus Bulletin
Aug 2, 2008 (080802)
(Reposted from sources cited below)

Editor's Note

"The scale up of antiretroviral therapy in the developing world is the most ambitious public health undertaking of our lifetimes, ...We were told it couldn't be done, and shouldn't be done, but we persevered, set ambitious goals and targets, and now 3 million people are on antiretroviral treatment." - Gregg Gonsalves, International Treatment Preparedness Coalition (ITPC)

As the XVII International AIDS Conference gets under way this coming week in Mexico City (, a report by ITPC is one of many addressing still unresolved debates in the fight against AIDS. ITPC's report, based on detailed case studies in Argentina, Brazil, Dominican Republic, Uganda, Zambia, and Zimbabwe, argues, in contrast to some commentators, that the expansion of the fight against AIDS can help spur improvements in the wider healthcare system, towards the goal of universal care.

Activists are also celebrating the re-authorization of President's Emergency Program for AIDS Relief (PEPFAR), which many observers see as one of few accomplishments that can be claimed for the two terms of President George W. Bush. The program was first passed in 2003, after several years of mobilization by activists in Africa, the United States, and worldwide, that also led to the founding of the Global Fund to Fight Aids, Malaria, and TB, in 2002.

In 2001, USAID administrator Andrew Natsios that antiretroviral treatment programs for Africans were impractical, because Africans "couldn't tell time" ( His statement, while extreme in its wording, reflected common assumptions. There is no doubt that the effect of AIDS activism has been enormous in the last decade, particularly following the AIDS conference in Durban in 2000, in changing assumptions about the need to act and mobilizing resources.

Yet debates continue about the relative balance between treatment and prevention, between disease-specific programs and broader approaches to healthcare, and about the effectiveness of current programs and the difficulty of adapting them to specific national contexts. These debates - and the fact that the gains in both treatment and prevention still fall far short of reversing the death toll and new infections - are an indication that in fact the fight against AIDS is still only beginning. Despite greatly increased awareness and investment over the last decade, The scale of the response is still too small, and scientific knowledge about the complex virus, the social paths of its transmission, and effective strategies to combat it are far from adequate.

This AfricaFocus Bulletin contains press releases from ITPC and from Health GAP, Also included are links to recent books on AIDS & Africa, and to other reports released recently.

Another AfricaFocus Bulletin sent out today contains the executive summary of the a report from the Black Aids Institute, "Left Behind! Black America: A Neglected Priority in the Global AIDS Epidemic."

For previous AfricaFocus Bulletins on health issues, visit

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Several recent books explore different aspects of the complexity of AIDS and unresolved issues in the fight against it.

* Toronto Globe & Mail Africa bureau chief Stephanie Nolen in "28: Stories of AIDS in Africa" approaches AIDS through the stories of 28 individuals. One reviewer noted: "Nolen's book stands out for her insightful descriptions of the human costs as well as the its fluid integration into the stories of aspects of socio-economic conditions and up-to-date science research surrounding the pandemic."

Order from
Powell's Books -
Amazon USA -
Amazon UK -

* Researcher and journalist Helen Epstein, in "The Invisible Cure: Africa, the West, and the Fight Against AIDS," is scathing about simplistic assumptions and faulty policies of the international AIDS establishment, including both multilateral programs and the U.S. PEPFAR. The title is explained by a quote from Beatrice Ware of Uganda. "As a woman living with HIV, I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives."

Order from:
Powell's Books
Amazon USA
Amazon UK

* Researcher David Gisselquist in "Points to Consider: Responses to HIV/AIDS in Africa, Asia, and the Caribbean," sharply criticizes the failure of the international AIDS establishment to pay sufficient attention to the risks of transmission of AIDS through the medical system itself, in the context of generalized epidemics and inadequate health systems. He is particularly critical of the lack of sufficient research to provide reliable estimates of the proportion of cases coming from unsafe injections with reusable needles.

Order from
Powell's Books,
Amazon USA - or
Amazon UK -

For a selection of more new books on AIDS in Africa, published in 2007 and 2008, visit the AfricaFocus Bookshop at or

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New "From-the-Ground" Report Reformulates Simplistic Argument About HIV/ AIDS and Health Care Systems In A Fundamental Way

International Treatment Preparedness Coalition

29 July 2008

Contact: Chris Collins: +1 845 701 0158; Gregg Gonsalves: +27-78-456-3848; Kay Marshall: +1 347-249-6375;

Dr. Jim Kim of Harvard School of Public Health joins International Treatment Preparedness Coalition to release new report and call for broad, systematic approach to HIV/AIDS and health care scale up

New York, Harare, Boston and S o Paulo, 29 July 2008. The International Treatment Preparedness Coalition (ITPC), a group of 1,000+ treatment advocates from more than 125 countries, issued its sixth report on delivery of AIDS treatment today. "issing the Target #6: The HIV/AIDS Response and Health Systems: Building on success to achieve health care for all.: The report is available at

The new report, launched during a teleconference with Dr. Jim Yong Kim, Director of the Fran‡ois- Xavier Bagnoud Center for Health and Human Rights (FXB) at Harvard University and advocates from around the world, provides some of the first from-the-ground research to inform the debate on HIV treatment scale up and its interaction with health systems. It includes reports from six countries: Argentina, Brazil, the Dominican Republic, Uganda, Zambia and Zimbabwe. Dr. Kim praised the report and noted that it is both welcome and timely to set the stage for the next phase of research and investigation for AIDS services and health care systems scale up in developing countries.

"The report shows that each country situation is complex. Every country has made thousands of decisions, good and bad. What we are seeing now is that funding for HIV is, for the first time in history, directed at chronic care for a chronic condition. We have the opportunity to think hard about what it will take to keep a large population of people healthy over their entire lives. What we know is that it takes more than just antiretrovirals. This report takes us to the point of reformulating in a fundamental way the argument over HIV and health systems," Dr. Kim said. Matilda Moyo, a co-author of the report's Zimbabwe chapter said, "What we found was that HIV/AIDS services, particularly provision of antiretrivirals, have become a lifeline for the health care system in Zimbabwe. In the midst of the economic and political crises, a consistent focus on HIV health services has been an oasis in a whole desert of the collapsing health delivery system."

Problems in Zimbabwe include extreme shortages of healthcare workers, with one doctor often responsible for providing services for 8,000 patients, frequent drug stock outs and a crumbling healthcare infrastructure. "Some donors such as the Global Fund have come together to provide much needed financial resources for Zimbabwe," added Moyo. "For example, efforts have been made to invest in infrastructure through HIV programs which has boosted the general health delivery system."

Alessandra Nilo, a co-author of the report's Brazil chapter, said, "In Brazil, HIV/AIDS services have been scaled-up in conjunction with the expansion of general public health. The scale up of AIDS services has also had positive impacts on human rights, education and sexuality in Brazil." Brazil has been cited as a great success story for developing strong HIV treatment and prevention programs as well as general public health programs. Nilo added, "Despite the success of integrating HIV and general health systems, we still identified clear and distinct benefits for maintaining dedicated HIV-related services."

"The AIDS response in Zimbabwe, Brazil and other countries shows that new investments in health can have dramatic impact. But a simple reshuffling of health resources toward more generalized health functions at the expense of effective disease-specific programs, such as HIV/AIDS, would jeopardize the remarkable advances that have been made and leave the more than six million people who urgently need AIDS treatment without this care," said Chris Collins, a co-coordinator of the report.

"The scale up of antiretroviral therapy in the developing world is the most ambitious public health undertaking of our lifetimes," said Gregg Gonsalves, a co-coordinator of the project. "We were told it couldn't be done, and shouldn't be done, but we persevered, set ambitious goals and targets, and now 3 million people are on antiretroviral treatment."

"AIDS is a disease of primary health care, and we need to strengthen health systems to provide for the future of AIDS treatment," Gonsalves added. "We are the heirs of Alma Ata. We will make comprehensive primary care -- health for all -- a reality. We'll be told again that it is impossible. Well, we've done the impossible and will do it again. What ITPC is about is finding out what people need and what is happening on the ground, and then pushing to make the changes that will save people's lives."

"If the UN's health-related Millennium Development Goals (MDGs) are to have and chance of being realized, we need to do for health systems what we've done for AIDS, while increasing the momentum of the response to AIDS," added Collins.

Key findings from the report include:

  1. The HIV/AIDS response to date has had sizeable positive impacts on health care in many settings: building infrastructure and systems, raising the bar on quality, extending the reach of health care to socially marginalized groups, and engaging consumers.
  2. But new investments in HIV/AIDS services have also exposed existing fragilities in health systems. In some cases expanding demand has stretched already overextended human resources and placed increasing burdens on infrastructure.
  3. The engagement of health consumers and advocates in AIDS scale up has forced global and national leaders toward a more vigorous sense of accountability and urgency, both critical elements in the success of AIDS programming.

# # #

About the International Treatment Preparedness Coalition

The International Treatment Preparedness Coalition (ITPC) was born out of the International Treatment Preparedness Summit that took place in Cape Town, South Africa in March 2003. That meeting brought together for the first time community-based HIV treatment activists and educators from over 60 countries. Since the Summit, ITPC has grown to include more than 1,000 activists from over 125 countries and has emerged as a leading civil society coalition on treatment preparedness and access issues. On the web at

President Signs Landmark $48 Bn Global Health Bill

Activists say the bill is a major step forward, but critical changes are still needed

Health GAP (Global Access Project),

July 30, 2008

Contact: Kaytee Riek, +1 267-334-6984,

Washington, DC - After a year of negotiations, today President Bush signed into law a $48 billion bill that continues US programs aimed at addressing global AIDS, tuberculosis and malaria. The bill, named after the late Congressmen Tom Lantos and Henry Hyde, passed both the House and Senate by overwhelming majorities.

Health GAP with many allies worked over the last 12 months, in African countries and across the U.S., to help develop and support the passage of this landmark legislation. "Many said it could not be done, but the bill is now law, " said Paul Davis, Health GAP s Director of US Government Affairs. "However, there are still US policies that stand as serious barriers to AIDS prevention and sexual and reproductive health, and we will continue to challenge these harmful policies. But the passage of this bill is a huge step forward for people with AIDS worldwide.

This groundbreaking global health bill begins to address critical lessons of the past five years of global AIDS programs. Health GAP activists in particular applauded the bill s new support for the efforts to correct the shortage of health workers that has frustrated efforts to scale up access to care and treatment. The bill calls for supporting poor countries efforts to achieve 2.3 doctors, nurses and midwives per thousand country residents, with direct support to train and retain 140,000 new health workers. The bill also places an emphasis on training and retention of new doctors and nurses.

"Millions of people living with or at risk for AIDS, tuberculosis and malaria can look forward to new hope and support thanks to the leadership and staff of Rep. Lantos and Berman, as well as Senators Biden and Lugar for pushing this bill through Congress, despite significant hurdles, " said Davis. "These leaders would not have been successful without the strong support they got from Representative Lee, Payne, and Waxman as well as Senators Reid, Feingold, Kennedy, Kerry and Coleman, Hagel, Specter, along with others. And at the 11th hour when things look grim, Senators McCain and Obama weighed in with others to "unstick" the bill.

The legislation also overturns the HIV travel and immigration ban that has been in place since 1992. The ban denied entry, either as a tourist, student or resident, to any non-US citizen living with HIV or AIDS. "This much-derided ban has no place in public policy, and only reinforces the stigma associated with HIV infection, " said Health GAP Board member Amanda Lugg of New York City. "Finally the US has joined almost every other nation in removing discriminatory barriers against the travel and immigration rights of people living with HIV."

Just a few weeks ago, passage of the AIDS, TB and malaria bill seemed uncertain. Seven Senators led by Tom Coburn had placed a "hold " on the legislation, in spite of broad bipartisan support ranging from President Bush to both presidential candidates. "Groups from across the political spectrum raised a ruckus in their respective ways, and Senator Reid stepped up and made it a priority to pass this legislation," said Health GAP board member Jose DeMarco from Philadelphia.

Activists, while grateful for passage of the legislation, said that changes were still needed to make sure the programs are fully effective. "Lifesaving provisions on treatment, prevention and care were stripped from the bill as a result of compromises," said Health GAP s grassroots organizer Kaytee Riek. "This bill is a major step forward, but critical changes are still needed." Activists detailed five major areas of concern with the legislation:

  • Treatment: The bill does not set a specific target for the number of people to receive treatment, but instead relies on a "formula" for determining the number of people set to receive treatment, which would fluctuate based on annual appropriations. Without clear targets, it is very difficult to program for the future. In fact, the formula creates an economic incentive against treatment scale-up. This extremely problematic feature of the formula has been confirmed as intentional by Senator Coburn s staff.
  • Funding: Congress authorized spending $48 billion over five years on AIDS, TB and malaria. But the legislation calls for programming that will cost at least $59 billion over five years. House and Senate appropriators need to commit to the major increases in spending required to fulfill the expanded program in the bill.
  • Abstinence-only funding: The Hyde/Lantos bill does overturn a previous requirement that 1/3 of prevention funding be directed towards abstinence-only programs. This has been replaced with a "reporting requirement" which mandates that the Office of the Global AIDS Coordinator submit a report to Congress if a country with a generalized epidemic spends less than 50% of sexual prevention funding on programs promoting abstinence and faithfulness.
  • Health Care Workers: During negotiations, Congress dropped two provisions that would require recipient programs to provide urgently needed health care for health care workers, as well as a provision that would have instructed the US Treasury to oppose the International Monetary Fund s policies that seek to limit poor country spending on health and education.
  • Sex Worker 'Loyalty Oath': The bill does not address a current US policy that requires recipients of US foreign assistance funds to certify that they oppose prostitution. This"pledge" increases stigma for hard to reach populations and can lead to fewer sex workers having access to HIV prevention and treatment programs.
  • Sexual and Reproductive Health: US policies that limit the ability of recipients to provide family planning services are harmful and must be overturned by a future Congress or President. The bill is silent on integration of family planning programs with AIDS programs. US policies create increased fragmentation on the ground and deny resources to organizations providing family planning services/organizations that must choose between sexual and reproductive health and care for AIDS, TB and malaria. Effectively, US policy limits availability of health care to sick patients.

Other Recent Reports and Commentaries relevant to AIDS in Africa

Annual Report on the Global AIDS Epidemic

Politics of Prevention - A Global Crisis in AIDS and Education

Center for Health and Gender Equity
Another 5 Years of Flawed Prevention Policy?

Global AIDS Alliance
Scaling Up for Zero Tolerance: Civil Society Leadership in Eliminating Violence Against Women and Girls in Ghana, Rwanda, and South Africa

Nigeria Health Watch Blog
"Another International AIDS Conference"
by Chikwe Iheweazu and Ike Anya

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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