HIV/AIDS in Africa: Unresolved Issues and Hard Choices

Remarks By Chinua Akukweas the Moderator of the Panel on Updates on Africa on the Global Challenges of HIV/AIDS organized by the US Congress Human Rights Caucus, April 1, 2004.

The Perspective
Atlanta, Georgia

April 2, 2004

I thank Congressmen Lantos, Wolff, McDermott, Lee and Leach for theiroutstanding leadership on human rights issues in the Congress and HIV/AIDS globally, especially in regards to the unfolding AIDS catastrophy in Africa. The Congressional Human Rights Caucus (CKRC) is widely recognized as the conscience of the US Congress on major social issues. As a former member of the International Human Rights Committee of the American Public Health Association, I am aware of the tremendous contributions of Congressman Tom Lantos and Frank Wolff on human rights issues around the world.

HIV/AIDS in Africa remains a major community, national, regional and international challenge. As of today, MOST individuals infected or affected by HIV/AIDS in Africa are on their own, and often go back to their communities to die with little or no clinical/government support.

Virtually all national governments in Africa with high rates of HIV are struggling to find material and human resources to fight the epidemic. Africa, today, is yet to craft a comprehensive regional strategy and program to stop AIDS. On the international scene, despite flurry of activities by various Western nations and multilateral institutions, very little resources from the West have reached individuals either infected or affected by HIV/AIDS in Africa.

For that young woman with four children dying of AIDS somewhere in Southern Africa, the possibility of Western assistance reaching her or her soon-to-be AIDS orphans is very remote. Yet every Western government, including the United States, is “investing significant” resources in the fight against HIV/AIDS. Every multilateral agency has a “significantly resourced” HIV/AIDS program. Every African leader is “speaking out” against HIV/AIDS, has completed national “action plans” and has ‘directed’ senior cabinet officials to take “charge” of the war on AIDS.

In the 2003 seminar organized by CKRC, I had indicated that more than 12 million AIDS orphans in Africa were largely on their own, at the mercy of inclement weather, dangerous African streets, and criminal elements. Since that presentation one year ago, these orphans are yet to receive coordinated regional, sub-regional or national assistance.

The war on AIDS in Africa continues to suffer from the following unresolved issues:

· Access to lifesaving, available medicines is still a mirage and has become a subject of international tug-of-war between powerful rich nations and desperate poor nations. While this needless battle rages, millions of infected and affected Africans continue to die of AIDS. All eyes are now on Randall Tobias and his team at the US $15 billion, five-year AIDS initiative to break this logjam of research versus generic drugs, and, make these available and affordable drugs easily accessible to millions of Africans dying of AIDS. The announcement today of South Africa’s roll out of its national treatment program is commendable for a nation with the highest number of individuals living with HIV/AIDS, up to 5 million and counting. However, this good news must be juxtaposed with the reality that about 50,000 people will be on this national program by the end of the year.

· Information, education and communication campaigns against HIV transmission in Africa remain unfocused, fragmented, poorly funded and still subject to powerful but subtle morality and ideological battles.

· Coordination of remedial efforts in Africa remains a challenge as African leaders and institutions are yet to develop a continental strategy and program on HIV/AIDS. International assistance (bilateral and multilateral) remains focused on meeting donor needs, priorities and expectations.

· African AIDS orphans are still on their own. By 2010, according to various estimates, up to 20 million AIDS orphans will live in Africa.

· Women continue to bear the brunt of HIV/AIDS in Africa. In many heavily infected countries, girls between the ages of 15 and 19 are four times more likely than their male peers to be infected with HIV. Poverty, lack of viable economic opportunities, and draconian cultural practices continue to increase the vulnerability of African women to HIV infection.

· Lack of international financial resources to fight HIV/AIDS in Africa continues to hamper local and national remedial efforts in Africa. The Global Fund to Fight AIDS, TB and Malaria is struggling to receive all promised monies from Western governments. The Fund’s request for markedly increased resources from the West, especially the United States, is yet to receive a positive response.

· Lack of transparency in government operations in Africa remains a silent but deadly obstacle to the mobilization of international resources against HIV/AIDS in Africa. It is critical for African leaders to remove any obstacle, perceived or real that can hamper speedy remedial efforts against HIV/AIDS in the continent.

To win the fight against HIV/AIDS in Africa, there are four unavoidable hard choices that must be made.

The first choice is to mobilize resources to provide anti-retroviral drugs to more than 4 million Africans that experts believe will immediately benefit from this treatment. The availability of antiretroviral drugs should occur simultaneously with the revamping of health systems in Africa. The United States and the rest of the G-7 nations have a special responsibility to make this happen because of historical and economic ties with Africa. Until HIV/AIDS becomes perceived as a chronic disease in Africa rather than a death sentence, most remedial efforts are unlikely to have much success.

The second choice is that HIV/AIDS remedial efforts in Africa should be decentralized or devolved to local communities where individuals infected and affected by HIV/AIDS live and die. The jury is still out on ongoing international remedial efforts since it is not yet proven that these efforts so far are meeting the needs of individuals infected or affected by HIV/AIDS.

The third choice is that African governments must be held accountable for the prudent use of domestic, continental and international resources mobilized to fight HIV/AIDS in the continent. If the silent tug-of-war between rich nations and African governments continues on this issue, then the capacity to mobilize huge resources will be severely damaged.

Finally, it is crucial, as I have argued in my previous writings, that Africa leads this battle against HIV/AIDS in the continent. To lead this battle, Africa must have a common strategy on HIV/AIDS remedial efforts, and, engage current and prospective international partners with clearly articulated policies and programs.

These are hard choices that will require a change in current practices and norms. However, these choices are necessary to fight the gravest development challenge to Africa’s renewal and prosperity.

Thank You.

Chinua Akukwe ( is a member of the Board of Directors of the Constituency for Africa, Washington, DC and a former Vice Chairman of the National Council for International Health (NCIH) known as the Global Health Council.