Consultation on Prevention of HIV Infections in the African Region Brazzaville, Congo


Dear Dr. Samba, Emeritus Regional Director,
Your Excellency the Minister of Health of Health of Mauritania,
My Lord the Archbishop of Luanda,
Distinguished Participants,
Dear AFRO Directors and colleagues,

It is my greatest pleasure to welcome you all to the Regional Office of WHO for Africa, here in Brazzaville. I am gratified to see you at this “Consultation on Prevention of HIV Infections in the African Region” as I must concede that my letters of invitation to you only went out a couple of weeks ago. I sincerely thank you for making time to participate in this very important consultation. I hope that your flights to Brazzaville were not too demanding and that you are fully prepared to share your rich experience and deep knowledge in HIV prevention with us during these two days.

Ladies and Gentlemen, the HIV/AIDS epidemic in Africa has reached a stage where we need to step back and review what we have been doing to stop new infections. Each year, about 3 million new HIV infections occur in the region, with 50% of newly infected individuals being young people aged between 15 and 24 years. Sadly, the rate of HIV infections among young people is growing in Africa. The escalating risk is especially evident among young women and girls who make-up to two-thirds of the young people living with HIV/AIDS in the Region.

HIV/AIDS has resulted in significant increases in child and adult mortality, and reductions in life expectancies in several countries. More than 13 million children have been orphaned by HIV/AIDS and left in need of love, care and support. The epidemic has impacted negatively on household resources and is deepening household poverty. The medical expenses of affected households are increasing and the income of care-givers is being lost. HIV/AIDS has imposed severe shock on national health systems. On the whole, HIV/AIDS is impacting negatively on sustainable human development in sub-Saharan Africa.

Countries in the African Region have been implementing prevention interventions over the years. The effectiveness of these interventions have been demonstrated in many successful projects. However, success on a large scale has been demonstrated in only a few countries. In these countries, the rates of new HIV infections have stabilized or have been declining. However, in the majority of African countries, new HIV infections are on the increase, indicating that HIV prevention efforts have not been adequate.

Ladies and Gentlemen, we must all concede that countries and international partners and donors have not been inactive over the years. There has been increasing political commitment and engagement in the fight against HIV/AIDS at the national, regional and international levels. Substantial resources have been allocated to national HIV/AIDS programmes by governments, and through multinational channels like the Global Fund to fight AIDS, TB and Malaria and the World Bank Multi-Country HIV/AIDS Programme. (Bilateral assistance from the Organization for Economic Cooperation and Development countries has increased.) The involvement of the private sector and civil society organizations has also been substantial. But as we all know, despite these advances, the response to the epidemic seems to be inadequate, at least as far as prevention is concerned.

Ladies and Gentlemen, I have convened this consultation because we need to squarely address this unacceptable situation. This consultation needs to critically review the key challenges and means to overcome obstacles in the implementation of the available effective interventions in order to reach significant coverage. We need to come up with possible new approaches within both the broad multi-sectoral response and specific health systems actions.

There are several critical issues that need to be addressed. I will just highlight a few. HIV/AIDS is associated with poverty and social vulnerability. The epidemic is often concentrated in marginalized populations and among people driven by economic need. Economic need may drive women to take up sex work, and to enter or remain in risky relationships that are associated with sexual violence. Inter-generational sexual relations between young girls and older men, one of the factors fuelling the epidemic, have become a normal practice. Lack of economic opportunities also promotes migration and has a disrupting effect on families.

One of the greatest barriers to HIV prevention in Africa has been the deplorable state of health systems in countries. Critical prevention measures, including the treatment of sexually transmitted infections and ensuring safe blood transfusion and injections, depend on functioning health systems. Health systems in several of our countries are weak and dysfunctional, and even too expensive for a larger portion of the population. Besides the lack of resources, there is an acute shortage of skilled health care workers.

Ladies and Gentlemen, these issues raise several questions. What specific actions can we take to re-invigorate HIV prevention to order to bring a sense of urgency and to elicit global and country support? How can HIV prevention be better resourced, scaled up and operationally addressed within the multi-sectoral response, while ensuring the appropriate health sector contribution? How can we better advocate for, and promote country efforts to address the underlying factors like poverty, gender disparity, sexual violence and other factors fueling HIV transmission? What are the concrete actions we need to take to ensure that interventions targeting vulnerable groups like sex workers, mobile populations, and others, in both low and high prevalence countries are expanded? And what do we expect WHO to do in supporting all these efforts?

Since assuming office as Regional Director in February 2005, I have declared HIV/AIDS as one of my top priorities. I am fully committed to the 3 by 5 Initiative, an initiative that seeks to scale-up access of people living with HIV/AIDS to anti-retroviral therapy. You are all witnesses to how the 3 by 5 initiative has galvanized the whole world into recognizing that it is morally indefensible to allow millions of People Living with HIV/AIDS to die, while effective medicines to turn HIV/AIDS into a chronic disease exist. Member States have scaled up their treatment programmes and the number of people on ARVs in the region has trebled in just 1 year. Even though this still represents only 8% of the people in need of ART in the Region, the scale up has been significant and is commendable. In order to sustain the benefits of progress with treatment access, prevention efforts must expand and have more impact. The same sense of urgency needs to be brought to bear on HIV prevention. I expect that this consultation will be the first step in our efforts to reemphasize HIV prevention in the African Region. I assure you of WHO AFRO’s commitment to finding the resources and improving our capacity to provide more support to Member States’ prevention programmes, especially through health systems.

I believe that there are several opportunities out there that we need to take advantage of. Political commitment and engagement in the fight against HIV/AIDS at the national, regional and international levels is increasing. Substantial financial resources are now available. Member States and their international development partners, through the Millennium Development Goals, and the African Union through the New Partnership for Africa’s Development (NEPAD), are all making efforts to place HIV prevention and control at the centre of Africa’s development. We cannot miss these opportunities.

Ladies and Gentlemen, I am very confident that we will have very fruitful deliberations on how we can scale-up HIV prevention during these two days of the consultation. I once again welcome you to the WHO Regional Office for Africa and I thank you very much for accepting my invitation.
I wish you all a very productive meeting.
Thank you.