LSE alumnus Waiswa Nkwanga argues that although significant progress has been made in the fight against HIV/AIDS, science and ARV treatment are not sufficient to eradicate the epidemic in poor countries that lack strong and effective healthcare systems.

Indications that AIDS is on the retreat is everywhere: the rate of new HIV infections has declined by more than 50 percent in 25 low and middle-income countries mostly in Africa while AIDS-related deaths have dropped by more than 25 percent between 2005 and 2011 worldwide. The number of people on HIV medication has increased by 59 percent in the last two years, resulting in 96 percent reduction in transmission rates.

Namulondo would walk 12km to pick up her drugs
New Vision

That was the good news from the United Nations Programme on HIV/AIDS (UNAIDS) report released late last month.  It suggests that AIDS is on the retreat because of the increase in access to antiretroviral (ARV) medication.

This week, US Secretary of State Hillary Clinton added more optimism by affirming that an AIDS-free generation is almost here: “We know we can get there, because now we know the route we need to take. It requires all of us to put a variety of scientifically-proven prevention tools to work in concert with each other,” she said in her keynote speech at the International Aids Conference in Washington DC.

But the picture is not as rosy in Africa as the report suggests and scientific breakthrough is only one of several tools needed to eradicate AIDS.

True, HIV prevalence has declined in many African countries as a result of increased access to treatment. But the fact remains that Africa is home to 23.5 million of the 34 million people living with HIV worldwide.

Even more disturbing is that some countries that had been successful in reducing HIV prevalence such as Uganda seem to be going backwards. Once considered a success story in the fight against HIV/AIDS, prevalence rates in Uganda dropped from 18 percent between 1989 and 1992 to 6.1 percent in 2002, but has been climbing in recent years standing at 7.3 percent in 2011.

There are several factors behind the rise in HIV prevalence in Uganda, including the decline in public awareness and risky sexual behaviour. But arguably a major feature and shortcoming of the global fight against AIDS is its rather blind focus on ARV provisioning and scientific research. Virtually no attention has been given to the crumbling healthcare system in Uganda and across the African continent—and the way in which it has undermined HIV prevention and treatment.

This is a great contradiction because an effective healthcare system is a necessary condition to the long-term health of everyone including AIDS patients. Indeed, despite significant increases in access to ARV, millions of people still lack access to health clinics where they can get tested for the disease or collect medicine.

Consider Rachel Namulondo, the seventeen-year-old Ugandan girl who contracted the disease when she was just eight from her HIV-positive aunt whom she was looking after..  Before she died in April this year, she used to walk twelve kilometres to pick her ARVs from Kamuli Main Hospital in Kamuli district because there were no health clinics near her home. Frequently, she walked on an empty stomach, which further weakened her strength to fight the disease.

Additionally, there is a severe deficit of medical practitioners on the continent. The 2009 World Health Statistics showed that there was just 1 physician and 7 nurses/midwifes per 10,000 persons in Uganda and only 2 and 11 in Africa. This compares unfavourably with 14 doctors and 10 nurses/midwives in China, 23 and 128 in the UK and 38 and 162 in Norway.

Across the board, healthcare is getting worse, not better, in Africa. According to the 2012 World Malaria Report, eighty-one percent (174 million) of all malaria cases and ninety-one percent of malaria deaths worldwide occurred in Africa. At the same time, reports on cholera show that between 2010 and 2011, outbreaks in Africa rose by 65 percent, according to UNICEF.  The disease has recently been reported in at least fourteen African countries. Marburg and Ebola have also resurged in places like Uganda and the DRC.

There is no doubt that HIV is starting to retreat in Africa. Infection rates are going down, treatment is more accessible, and victims live longer. But the fact remains that the absence of a strong and effective healthcare system makes it much more difficult to control or eradicate AIDS in Africa.

What does this mean for the fight against AIDS? The international community can keep pursuing a narrow path that focuses on prevention through ARV provisioning. But what good does it do to save someone from AIDS only for them to succumb to typhoid or hunger? It wasn’t HIV that killed Rachel at seventeen—a broken healthcare system did. A more holistic approach is desperately needed.