Lessons Africa has learnt in 15 years of responding to HIV/AIDS - Introduction

There are now 16 countries in sub-Saharan Africa where over one-tenth of the population aged 15-49 years of age is estimated to be infected with HIV, the virus that causes AIDS. Since the epidemic began in mid - to late 1970s, over 18 million lives have been claimed worldwide by AIDS. Of these, 15 million have been in Africa. Over 24.5 million Africans (including 1.4 million children) are estimated to be living with HIV and around 4 million Africans are acquiring HIV every year.

For most Africans, however, access to even basic care and prevention services is far from adequate. Nor has the general population been mobilised, through awareness and education campaigns about the epidemic, to "own the issue" and therefore act on it. This is especially tragic given that Africa has – as shown by the variety of best practice in HIV/AIDS responses found in most countries of the continent – most of the tools (if not all the resources) needed to turn the epidemic around.

It was for just this reason – the mounting crisis and the paradoxical existence of the means to solve the crisis – that the International Partnership against AIDS in Africa (IPAA) was created. Its purposeis to help governments, civil society, communities, and national and international organisations, work together more effectively. Only through such concerted action can the inherent strengths of African societies be fully mobilised to curtail the spread of HIV, sharply reduce the human suffering it produces, and reverse its rising human, social, and economic impacts.

A development disaster

AIDS is now deadlier than war itself: in 1998, 200,000 Africans died in war but more than 2 million died of AIDS. In fact, the epidemic has become a full-blown development crisis. Its social and economic consequences are felt widely not only in health but in education, industry, agriculture, transport, human resources and the economy in general.

Because of the insidious ways it destabilises already fragile and complex geopolitical systems, AIDS has become a key issue for human security in sub-Saharan Africa. Recognising this, the United Nations Security Council meeting on 10 January 2000 was devoted to the theme "AIDS in Africa" – the first time that Body had dealt with a development issue.

Yet, the worst impacts of the epidemic on the people and entire economies are still to come. If current trends are maintained, 70% of people currently HIV-positive in sub-Saharan Africa will die of AIDS in the next 10 years.

An international partnership

The International Partnership against AIDS in Africa was created in 1999 in recognition of the fact that national AIDS activities in Africa must be expanded dramatically to make an impact on the epidemic, reduce the human suffering it causes, and halt the reversal of human, social and economic development on the continent.

The Partnership proceeds from the vision that within the next decade African nations, with the support of the international community, will be implementing larger-scale, sustained and more effective multi-sectoral national responses to HIV/AIDS. Through collective efforts, promotion and protection of human rights, and promotion of poverty alleviation, countries will:

substantially reduce new HIV infections

provide a continuum of care for those infected and affected by HIV/AIDS

mobilise and support communities, non governmental organisations, the private sector and individuals to counteract the negative impact of the HIV/AIDS epidemic in Africa.

Spotlighting success stories

The Best Practice process is crucial in the framework of the Partnership. Best practices include success stories and lessons learned on how and why things work in different situations and contexts. There are indeed many places where effective responses to the virus have been mounted. On a national scale, the biggest success stories to date are those of Senegal and Uganda, but valuable lessons have been learnt in almost all countries in sub-Saharan Africa.

Obviously, not all best practices can be applied the same way – or at all – from one country to another. Not only does the stage of the epidemic vary from country to country, but each country has to work within the context of its own administrative structure, institutional capacity, and cultural traditions. Best practices are to be learned from and adapted to specific context rather than copied.

In the following chapters, a variety of best practices are presented. They have been divided into groups that exemplify the following sub-themes:

The "social contract"

Getting the AIDS message out more effectively, and following up with action

Mutual reinforcement of AIDS care and prevention

Something for all, and special measures for those at greater risk

Making people less vulnerable to HIV infection

Reducing HIV/AIDS impact on people

Identifying leadership at all levels

The key priority for the IPAA is to be effective at country level, and to enhance the national response within nationally negotiated partnership plans. While governments will naturally be expected to take a lead role in the overall national response, it is clear that the various institutions and groups that make up civil society within a country (non governmental organisations (NGOs) and community-based organisations (CBOs), religious groups and the private sector) will all have to demonstrate leadership as well.

In order to best serve the intended readership of this paper, the technical aspects of the practices described here have been kept brief, and the leadership component has been highlighted. Readers who would like more detailed information will find references for most of the material cited. The majority of the best practices can be found described at greater length on the UNAIDS web site (http://www.unaids.org).

At the beginning of each chapter, a box shows how the chapter’s sub-theme relates to a list of cross-cutting themes developed by the ADF 2000 Technical Advisory Committee to help guide discussions at the Forum.

The accompanying paper "ADF Theme III" moves the focus from the past and present to the present and future.