HIV/AIDS And Africa: Back To The Drawing Board

By: Chinua Akukwe

The Perspective
Atlanta, Georgia

November 27, 2002

After 21 years of dealing with the HIV/AIDS epidemic in Africa, it appears that Africa has now reached the crossroads. According to the United Nations agency coordinating the pandemic (UNAIDS) nearly 30 million Africans live with HIV/AIDS. More than 21 million Africans are dead of AIDS. At least, four African countries-Botswana, Lesotho, Swaziland and Zimbabwe- have more than 30 percent of its adult population living with HIV/AIDS. Only 30, 000 Africans have access to lifesaving, available antiretroviral medicines. Despite these unfolding ugly scenarios, Africa is yet to mount or lead a credible fight against the number one developmental crisis in the continent.

On a "positive" note, African leaders committed to spending 15 percent of their national budget on health care at the 2001 Abuja summit on HIV/AIDS. Many African countries have "completed" or at the "advanced stages" of completing national strategic plans against the epidemic. Many African leaders now "speak out" against the disease. Many African countries are now "streamlining" their HIV/AIDS remedial efforts in their anti-poverty strategies. African leaders are now fine tuning an ambitious development initiative known as New Partnership for Africa's Development (NEPAD). However, for a continent that is losing its most productive citizens on a daily disease and is dealing with a ballooning AIDS orphan problem, these "positives" are clearly not enough. Africa must go back to the drawing board and come up with a comprehensive strategy and operational mechanism to fight this deadly disease.

What are these HIV/AIDS strategies and operational mechanisms?

The first important strategy is that Africa must stop looking outside the continent for leadership in the fight against HIV/AIDS. Charity must begin at home. I call on the leadership of the African Union, NEPAD, UN Economic Commission for Africa (ECA), African Development Bank, the civil society and professional groups to create an African body to fight AIDS in the continent. This African led and managed institution will be responsible for setting priorities for both for local and external funded activities; resolving lingering issues about access to care; overcoming infrastructure impediments; and, implementing information, education and communication (IEC) strategies. Today, in Africa, any external organization can decide which part of Africa it wants to assist in the fight against HIV/AIDS and the priorities for its assistance.

The second strategy is that HIV/AIDS must become an integral part of NEPAD. It is not possible to talk about Africa's renaissance or economic growth without a serious attention to the number one development priority of the continent. The third strategy is that Africa must mobilize its professionals in the continent and Western countries to fight this epidemic. The fourth strategy is for Africa to develop and implement a common approach to developmental assistance from the West. NEPAD is a good start but needs to demonstrate internal capacities and mobilization of resources, and also carry along all key stakeholders, including the civil society.

Regarding operational mechanisms, it is crucial for Africa to focus on two key issues: medical and health related aspects of HIV/AIDS, and, the developmental consequences of HIV/AIDS. The medical and health related aspects of HIV/AIDS include a strong resolution to provide lifesaving drugs to Africans living with HIV/AIDS. Anything that stands in the way of this resolution must be tackled jointly by all African governments. In addition, African leaders must commit to reach every high risk African with a credible IEC message on how to prevent HIV transmission and how to avoid re-infecting other people if already living with the virus.

To deal with the developmental consequences of HIV/AIDS, African leaders should focus on accelerated food production since nutrition is an important facet of the fight against the disease. UNAIDS concluded that the current famine in Southern Africa is related to the ongoing HIV/AIDS epidemic in the region. Coupled with accelerated food production, African leaders should regard the reduction of agricultural subsidies by Western nations as one of their most important developmental strategies. According to the Chief Economist of the World Bank, the average subsidy to every cow in the European Union is now about US$2.50, higher than the daily incomes of Africans where more than 40 percent live on less than one dollar a day. To overcome widespread economic crisis, Africa must trade its way out of poverty.

Additionally, African leaders in the interest of their own people and not due to pressures from donor nations should focus relentlessly on improving the social and economic circumstances of their citizens. Poverty is at the nexus of the HIV/AIDS epidemic in Africa as individuals continue to take calculated behavioral risks in the daily struggle to fend for themselves and their families. Finally, the elimination or drastic reduction of Africa's unsustainable debt in a swap for accelerated expenditures in health care and social services is very crucial in the short term to create a breathing room for governments struggling to meet the basic needs of their citizens.

After years of living in Washington, DC, I know that nobody will help Africa unless it is ready to help itself. I am also aware that it is highly unlikely that the West will step up its developmental assistance to Africa if there are lingering doubts about the commitment of African governments. I am also aware that if Africa does not mobilize its resources-home and abroad-in the fight against HIV/AIDS, developmental partners will continue to make obligatory gestures rather than substantial commitments. There is a growing donor fatigue about HIV/AIDS in the West, and advocates for greater commitment will receive a substantial boost if Africa gets its act together. Will Africa seize the opportunity to lead the world in the fight against HIV/AIDS? I hope so.

About the Author: Dr Chinua Akukwe ( is Member of the Board of Directors of the Constituency for Africa (CFA), Washington, DC and Former Vice Chairman, National Council for International Health (NCIH) now known as the Global Health Council, Washington, DC. He has written extensively about HIV/AIDS and development issues in Africa:

Chinua Akukwe (2002). African-African American cooperation in the global fight against HIV/AIDS. Remarks at the US Secretary of State Open Forum. September 2002. Available at (http:

Chinua Akukwe (2002). HIV/AIDS in Africa: An integrated regional approach. AFRICA NOTES, July/August 2002, pages 7-11. Institute for Africa's Development, Cornell University, Ithaca, New York.

UNAIDS (2002). Report on the global HIV/AIDS epidemic. June 2002. Geneva: Author.

UNAIDS, World Health Organization (2002). AIDS epidemic update. December 2002. Geneva: Author.

United Nations General Assembly (2002). Report of the Secretary-General on progress towards implementation of the Declaration of Commitment on HIV/AIDS. Released August 12, 2002. A/57/227. New York: Author.

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