Guinea Bissau

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

To support the capacity of countries to integrate human rights in their Fast-Track approaches to HIV programming, UNAIDS and the Alliance Nationale Contre le Sida (ANCS) Senegal held a three-day capacity building workshop in Dakar, Senegal from 22 to 24 June 2015.

The workshop highlighted the continued political, legal, cultural, social, and programmatic challenges that hinder efforts to address the HIV epidemic. Participants pointed out that existing programmes to address these challenges in Western and Central African countries remain largely insufficient and inadequate.

According to participants, human rights, gender equality and the involvement of people living with HIV and key populations are often cited in HIV planning documents. Yet, they are rarely translated into specific human rights programmes. And where these programmes are included in the national HIV planning documents, they are not addressed at the costing and budgeting phase, there are little metrics to track progress, and when implemented, these programmes are often not evaluated or taken to scale.

Participants

The workshop brought together more than 50 participants from 10 countries across Western and Central Africa including Burkina Faso, Cameroun, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Guinea Bissau, Mali, Nigeria and Senegal.

Participants included decision makers and technical experts involved in HIV strategic planning at country level, officials from national AIDS commissions, Ministries of Health and Justice, people living with HIV and other key populations and community-based organizations. A wide range of technical and other partners including UNDP, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Office of the High Commissioner for Human Rights, the International HIV/AIDS Alliance and the Technical Support Facility for west and central Africa also participated in the workshop.

This workshop was the seventh and last in the series of regional workshops held since 2011, with support from the Ford Foundation.  

Key messages

• Participants stressed the importance of the workshop in highlighting approaches and tools for ensuring the inclusion of programmes to advance human rights and gender equality.

• The workshop led to the elaboration by each country team of a national action plan with specific commitments to integrate human rights and gender programmes in their national AIDS response that clearly spells out partners and timelines for its implementation.

• The meeting concluded with the development and endorsement of the “Dakar Declaration on scaling up the HIV response, realizing the human rights and full access to services for everyone in West and Central Africa” in which participants committed to specific actions in their respective countries to advance evidence-informed and rights-based programmes in national HIV responses.  

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

While touring the DREAM project in Conakry, UNAIDS Executive Director Michel Sidibé (centre) met an HIV-positive couple who gave birth to two HIV-negative babies. Photo credit: Mamadou Cellou Diallo/UNAIDS

President Alpha Condé and the First Lady, Ms Djene Kaba Condé, will participate in this year’s UN General Assembly High Level Meeting on AIDS. The announcement came during a two-day official visit by UNAIDS Executive Director Michel Sidibé to the West African nation of Guinea Conakry.

The High Level Meeting, from 8-10 June 2011, is widely seen as an important opportunity to revitalize the global AIDS movement and achieve the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“I commend President Condé for his commitment and leadership on HIV,” said Mr Sidibé, after a meeting with Guinea’s Head of State on Thursday. “His presence at the High Level Meeting will be critical to advancing the AIDS response here in Guinea, and globally,” he added.

Over the past decade, Guinea has made significant strides in its national response to HIV. Between 2001 and 2009, Guinea saw a 25% reduction in its rate of new HIV infections. Coverage of antiretroviral treatment in the country reached 40% in 2009, up from just 3% in 2004. Furthermore, HIV prevalence in Guinea has remained relatively low since 2006, at about 1% of the adult population.

In his discussions with President Condé, the UNAIDS Executive Director underscored the importance of shared responsibility around AIDS funding. “Ninety six per cent of the AIDS treatment in Guinea is currently funded through external sources. This situation is unsustainable,” said Mr Sidibé, adding that both domestic and international AIDS investments must increase. President Condé committed in his meeting with Mr Sidibé to creating a national fund for the purchase of antiretroviral drugs and said that his government would maintain current HIV investments.

UNAIDS announces US $60 000 grant to a foundation run by the First Lady

In a meeting on Thursday with the First Lady of Guinea, Mr Sidibé said that vertical transmission of HIV was a pressing concern for UNAIDS in Guinea. In 2009, only 17% of pregnant women living with HIV in Guinea were able to access services to prevent new HIV infections among children. That same year, just 10% of pregnant women were tested for HIV.

During the meeting, Mr Sidibé said that UNAIDS, with funds received from Cooperation française, would grant US $60 000 to a national foundation created by the First Lady focused on maternal and child health. The grant is earmarked specifically for stopping new HIV infections among children in Guinea.

Preventing vertical transmission of HIV in Conakry

Earlier in the day, Mr Sidibé visited a project in Conakry, the capital city of Guinea, that provides mothers with a complete package of services to prevent new HIV infections among children. Established in 2002, the DREAM project offers HIV prevention and treatment services as well as psychosocial and nutritional support, advanced laboratory analysis, and health education. All services are provided free of charge.

The DREAM project, supported by the Community of St Egidio (a religious association), UNICEF and UNAIDS, has two centres in Conakry and operates a mobile clinic that brings health services directly to women in the region. With support from UNAIDS, a third centre will soon be opened in Dubreka, 50 kilometres from Conakry.

Since 2006, more than 3600 people living with HIV have received antiretroviral treatment at the two centres. More than 800 mothers enrolled in the programme have given birth to HIV-negative babies.

While touring the DREAM project, Mr Sidibé met Fatoumata Sylla and Naby Bangoura, an HIV-positive couple who gave birth to two HIV-negative babies. Fatoumata received antiretroviral prophylaxis during her pregnancy; she now works at the DREAM programme and shares her experience with other women. Fatoumata told Mr Sidibé that while many women continue to receive free services through the DREAM project, some are turned away as the centre does not have sufficient funding to meet patient demand.

The DREAM project, headquartered in Italy, is working in nine other countries across Africa, including Mozambique, Malawi, Tanzania, Kenya, Guinea Bissau, Cameroon, Democratic Republic of Congo, Angola and Nigeria.

“West Africa HIV/AIDS epidemiology and response synthesis”

On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.

The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.

Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.

The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.

The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.

“Know your epidemic. Know your response”

The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.

Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.

The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.