Reports indicate that the World Health Organisation intends to supply ARVs to 3 million HIV/Aids sufferers in Africa, while UNAids seeks $5 billion for a similar project by 2005.
“What you are looking at is the possible diversion or the rerouting of funds from the antiretrovirals and condoms to safe injections. If this hypothesis (that unsafe needles are the largest contributor to infections) is accepted, it will form what I can call a big turn-around in the battle against HIV/Aids. And it will precipitate a big controversy too,” said a WHO official who declined to be named.
The monthly bill for Africa’s anti-retroviral requirement is an estimated $600 million. A UN official said last week that $6 billion was required by 2005 to provide ARVs and for basic treatment and treatment services to 2.5 million infected adults
But as figures trouble the world, a lobby emerged at the ongoing ICASA talks ready to pour scorn on the conventional wisdom that largely connects increased HIV transmission in Africa to heterosexual sexual contact. It now demands a re-evaluation of the position.
What proponents – who include researcher David Gisselquist — have done is to challenge decades of research findings used to account for the flourishing HIV/Aids transmission in Africa.
“We called this briefing because we are deeply troubled about the lack of the attention being given in the Aids community, the media and at this conference to the role of the needle reuse and other unsafe medical practices play in the transmission of Aids in Africa,” said Lilian Salerno, director of Safe Needle Technology, a Geneva-based non-governmental organisation that promotes safe injections.
“Specifically, WHO/UNAids has focused on the role of sexual transmission in Africa to the point of excluding virtually all other causes. This is not only misleading, it is also dangerous. We cannot solve this terrible health care crisis until we recognise that it exists,’ she told a packed news conference at the Kenyatta International conference centre, the venue of the biennial ICASA conference.
According to the World Health Organisation global programme on Aids, 80 percent of HIV infections in the continent is due to heterosexual transmission, 10.8 per cent from mother-to-child transmission, 6 per cent from blood transfusions, 1.6 per cent per cent from contaminated medical injections and other healthcare activities and 1.6 per cent from homosexuality.
But the emergent lobby trashes this thinking. To link the increase rate to sexual activity is to subscribe to “hypocrisy”, one of them claimed at a news conference. Yet the architects of the new crusade argue that it could lead to refocusing of the anti-Aids strategy to “the real cause” of increased infection rates.
They estimate that with a $100 million annual budget towards safe injections, Africa’s HIV/Aids rates could be cut down by 30 per cent.
Last March, Dr Gisselquist testified before the US Senate about his findings collected in 19 years of research. He observed that at least a third of Aids exposures on the continent were due to contaminated needles in medical treatment.
The proponents flooded the conference venue with findings they said corroborated their thinking. They also unleashed copies of articles by leading international news organisation to back up their stand. Among the articles distributed to the Press Centre were those by the Washington Post, titled Neglecting the Needles, and another by news wire agency Associated Press.
In the Washington Post of August 21, 2003, two physicians – Holly Burkhalter and Eric Friedman – argue that the risk of unsafe health care is “substantial”. In Africa, they say, a quarter of the blood used in transfusion is not screened while as many as half of injections in the continent and in Asia are unsafe because of needle re-use.
However, ICASA officials moved to play down the spin, warning that such belief threatened the little gains achieved in the battle against the scourge.
The fear, according to a top ICASA source, was that the new thinking threatened to obscure the quest for safe sex as the solution to the increasing infections. “Let’s not talk about that, you know what it all means: controversy. We do not want that,” he said. But he conceded that it was a critical issue that could change the approach to the HIV/Aids strategy in the developing world.
According to Lilian Salerno, needle reuse and other unsafe practices contributed to “as much as 30 per cent of new Aids cases, not the mere 2.5 per cent acknowledged” by the WHO.
The rate of infection in sub-Saharan Africa ranges between 8 per cent, in Uganda, to close to 40 per cent in southern African nations of Botswana, Zimbabwe, Zambia and Malawi. In the developed world where medical treatment is considered safe and where the first cases were discovered about three decades ago, the infection rate is reportedly 0.5 per cent.
Sub-Saharan Africa is the most devastated. It hosts 70 per cent of new infections worldwide.
The exponential increase in HIV/Aids incidence in the region is unprecedented, and is now considered a holocaust of biblical proportions. Yet the world saw the problem burgeon.
In 1983, less than a million Africans were infected, 10 years later an estimated 11 million had succumbed to the virus. In the last 20 years, about 30 million sub-Saharan Africans have been infected, while 14 million have already died from related complications.
Hardly all. By 1999, Africa had 12.4 million children orphaned by Aids. Zambia has the highest concentration of Aids orphans – by 1999, more than half of all Zambian children had lost at least a parent.
The holocaust threatens to reduce the continent’s life expectancy by 20 years, from 64 to 44 years. (In fact, Aids has reduced average life expectancy in Zambia by about 20 years, from 56 to 37, according to US Census Bureau).
Aids will impact heavily on all spheres of industry and socio-political life, leading to widespread poverty and unprecedented suffering.
Researchers argue that with between $75 million and $100 million a year, the entire continent could be supplied with safe syringes. A needle distribution network would be the best way to combat the scourge, they argue.
Even with the substantial drop in the prices of antiretrovirals, Africa’s Aids bill is beyond imagination. Every HIV/Aids case requires $20 a month for ARVs and a further $150 for lab investigations every three months, according to the ICASA chairman, Dr D. Owili. “It is a lot of money, a lot of money,” he laments.
According to estimates by the global anti-Aids programme UNAids, about $950 million went into fighting Aids in sub-Saharan Africa last year, a figure that is far less than the requisite $2 billion for basic prevention and treatment services.
“There is still too much talking and not enough doing,” said UNAids director Michel Sidibe at the opening of the ICASA on Sunday. “If words and paper commitments alone could prevent HIV infection and stave off the deadly effects of Aids, we would reach the Millennium Development Goal of halting and reversing the spread of the epidemic by 2015,” he said.
What disturbed a number of speakers, including UN secretary general’s representative Steven Lewis, was that the world, in particular the rich nations, spent $200 billion in countering terrorism while they could hardly raise the $5 billion necessary to reverse the HIV/Aids pandemic.
At the moment, only 80,000 people living with Aids are on ARV treatment, out of the 4.5 million that require the treatment, according to Matshidiso Moeti, HIV/Aids adviser at the WHO regional office for Africa.
Yet from the myriad speeches delivered at the conference, it was obvious that the controversy was being pushed to the back burner deliberately. It hardly featured in UNAids’ three major challenges in confronting HIV/Aids.
Dr Owili may have hazily set the tone at the opening ceremony on Monday when he said the meeting would “bring out the latest knowledge on the subject (of challenges to access and care) and to share the most current information on the HIV/Aids and STIs.” Yet by Wednesday, speakers were still wary of the subject.
In inaugurating the meeting, Kenya’s President Mwai Kibaki said: “The choices we make today as individuals will determine how effective the fight against the HIV/Aids pandemic will be.” However, there was no mention in his speech about the unsafe health care, or that Africa had found itself in a Catch-22 situation.
Dwindling donor support has ensured that Sub-Saharan African governments ill-afford investing in health care. Most hospitals in the region lack the requisite drugs and equipment to combat the malignant HIV/Aids.
In fact, Aids will make Africa poorer, not because of the expected loss of manpower, but because donors are focused on controlling the scourge rather than supporting the economies of the so-called countries in transition as has been the case in the past.
A publication, World Development Report 2004: Making Services Work for Poor People, released on Tuesday by World Bank Kenya country director Makhtar Diop, gives an insight into how the pandemic has ravaged African economies and threatened the survival of the continent.