In Africa, HIV still creates far too many orphans

[3 October 2007 - 09h51]
[mis à jour le 3 October 2007 à 11h28]

With 14% of the general population HIV positive – infected with the AIDS virus – Malawi is not the country in Africa most seriously affected by this pandemic. But it does provide a good illustration of the disparities affecting the population where AIDS is concerned. Disparities that mainly exist between men and women: according to the Malawi National AIDS Commission, in 2005, 58% of those infected with HIV were female!

As Malawi UNICEF representative Aida Girma explains, the situation is even more worrying among young people. “Among 15 to 24-year olds, the incidence of HIV contamination is in fact 4 times higher among young women (9%) than among young men (2%).” Which means that although the infection rate is considerably lower than the national average among boys – no higher than 4% – the same is not true of girls.

And there is something of even greater concern. As the UNICEF representative points out, “in 2004, according to UNAIDS, more than 20% of pregnant women in the 15-24 age group were contaminated by HIV”. So there are some marked differences in the effect of the HIV epidemic in this small southern African country. It’s true to say that after an increase between 1995 and 1999 when the incidence of HIV exceeded 20%, there has been a relative easing off. But only a third of the 170,000 patients whose condition warranted the use of antiretroviral treatment actually received it.

Today the country has 1,000,000 inhabitants who are either HIV positive or suffering from AIDS, of whom around half live in towns, although the country is mainly rural. Women account for around 60% of these cases, and children for 8%. And every year, more than 100,000 HIV positive women give birth to a child who is in danger of becoming contaminated during birth. A few years ago, the WHO estimated that 800,000 children were contaminated in this way at birth by their HIV positive mother!

Thanks to the donation of the antiretroviral drug Viramune by its manufacturer, the setting up of mother-to-child AIDS transmission prevention programmes in 50 countries has proved a real success. To such an extent that UNICEF, the IPPF and the Boehringer-Ingelheim laboratories have just celebrated the treatment of the millionth mother, here in Lilongwe (Malawi). In 6 years this strategy has saved hundreds of thousands of children. But insufficient access to the treatment by those affected – and hence by mothers-to-be – has had an unexpected, dramatic and undesirable effect: of the million children orphaned for a variety of reasons in Malawi, over 500,000 are what are known as “AIDS orphans”. And in 2004, there were 14 million such orphans in the world according to figures published that year by the WHO on World AIDS Day.

In Malawi, 13 millions inhabitants of which... a million orphans

There has certainly been genuine progress. “In the 4 years from 2002 to 2006, the number of screening and prevention advisory centres in Malawi has risen from 70 to 350 and the number of patients still alive and being treated with antiretroviral drugs has leapt from 4,000 to 66,000”, Aida Girma informs us. It is also encouraging to note that treatment observance in developing countries is generally identical to that in rich countries … or even better in some cases!

Today, however, with a population below 13 million, Malawi still has as many as a million orphans and a million people living with HIV. A fact that literally thwarts any hope of development! In a country where international agencies estimate the health budget at less than 43 euros per head per year, this situation is producing dramatic consequences. Although it may be improving, access to basic HIV drugs still falls far short of what is needed. Cotrimoxazole coverage in Malawi, for example, is described as “very insufficient by Aida Girma. Yet, back in April 2000, the WHO and UNAIDS welcomed the international consensus on its preventive use against certain opportunistic infections in those infected with HIV!

So what is to be done? Co-development programmes run by international agencies – such as UNICEF and the European Commission – need to be strengthened but also individual efforts by manufacturers need to be coordinated, as Dr Michael Rabbow, head of HIV policy at Boehringer Ingelheim laboratories points out. Many companies have put a great deal of effort – over many years – into humanitarian programmes aimed at developing countries. But they have done so in a disparate way and the implementation of concerted plans aimed at both treating patients and preventing mother-to-child transmission for example, are today cruelly lacking. So here is a recommendation for the international lobbies that could be far more productive than the inopportune proceedings begun in 2001 in Pretoria against a South African initiative to produce generic anti-AIDS drugs…

Source : from our special correspondent in Lilongwe; WHO Core Health Indicators 2007; UNICEF 2007

>> Cet article est aussi disponible en français

>> Cet article est aussi disponible en arabe

© 1996-2012 Destination Santé SAS - All Rights Reserved. No information contained on this server can be reproduced or retransmitted without prior written consent of Destination Santé. Offenders will be prosecuted in consideration of articles L 122-4 and L 335-3 of the Code of Intellectual Property, allowing up to two years' imprisonment and a 150,000 euros fine.