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ORIGINAL FRENCH ARTICLE: Afrique : recul global de l’espérance de vie

by Jean Chatain

Global Life Expectancy Recedes in Africa

Death is the Sole Winner in Africa

Translated Wednesday 10 December 2008, by Isabelle Métral

The world epidemic is stabilizing no doubt, but at unacceptably high levels, and indeed, in sub-Saharan Africa, the levels are most unacceptable.

“Robust HIV funding will be needed for decades. In low-income countries, international donors will need to provide most of the financing for HIV in the coming years.” The warning issued by UNAIDS (the HIV and AIDS UN joint program) in its 2008 report is clear enough: the financing of the struggle against the epidemic should in no way be allowed to suffer from the financial crisis.

A health disaster is sure to follow if the progress made in many countries in their fight against the epidemic, and above all, the six fold increase in financing for HIV programs in low- or middle-income countries between 2001 and 2007, which is beginning to bear fruit, are allowed to relax if only slightly. The world epidemic is stabilizing no doubt, but at unacceptably high levels, and indeed, in sub-Saharan Africa, the levels are most unacceptable.

22 million Africans are HIV-positive

These findings lead the UN organization to make the following statement in the conclusion to its report: “International donors must generate the funding needed to ensure universal access to HIV prevention, treatment, care and support, but they must also substantially raise all kinds of public development aid.”

In 2005 only five OECD member countries invested at least 0.7% of their GDI in development aid as pledged in the Declaration of Commitment on HIV/AIDS and in other international agreements. France is not among them. And yet the estimate for recently HIV-infected people in Africa is 1.9 million (between 1.6 and 2.1 million), which brings the total number of people living with HIV to 22 million, namely two thirds of the global number (estimated at 33 millions), and three quarters of AIDS deaths in the year 2007.

The extent of the pandemic varies from one region to the next. It is relatively limited in several West African countries with a prevalence rate of less than 2% among adults (with the notable exception of Nigeria, the African country with the largest population), and in Central Africa, as well as in the Horn of Africa, while the prevalence rate is 5% or above in seven other Central or East African countries (Cameroon, Gabon, Malawi, Mozambique, Uganda, Central Africa and Tanzania). But the rates are as high as 15% in seven countries in Southern Africa (South Africa, Botswana, Lesotho, Namibia, Swaziland, Zambia and Zimbabwe). In South Africa alone, the estimate for HIV-infected people is 5.7 million, which makes it the most highly contaminated country in the world. The total number of AIDS deaths soared by 90% between 1995 and 2001, with a more than three fold increase for females aged 20 to 39, and a two fold increase for males aged 30 to 44. The 2006 HIV-prevalence rate among adults is at 26% in near-by Swaziland, a global, all-time high.

The demographic impact is already a horror story in countries with the highest prevalence rates. Life expectancy at birth has collapsed spectacularly: while it is under 50 for Southern Africa as a whole, the figure is now under 40 in Zimbabwe, despite the effective implementation (according to the UNAIDS report) of programs for pregnant women: the prevalence rate among the anti-natal clinics’ practice having declined from 26% in 2002 to 18% in 2006. In Lesotho, the new-born and infants are the worst hit groups, together with the 30 to 50 age group

The causes of the “omnipresence of the disease” (as UNAIDS was prompt to put it) are to be sought in a set of mutually-bracing factors: poverty, social instability and its corollaries, like family break-ups, war situations (as in Burundi where the epidemic has flared up among displaced populations), women’s inferior status, the population’s mobility (labour migration patterns are important) – and, of course, the inaccessibility of treatment as a result of soaring prices: the vast majority of infected Africans have never had access to AZT, the oldest antiretroviral drug, which makes it possible to reduce mother-to-infant transmission in considerable proportions.

All these multiplying evils account for the parallel emergence of new infections (Ebola, Lassa), and worse still, the parallel resurgence of traditional diseases, first among which are malaria (a million deaths a year, 90% of which in Africa) and TB, which, together with Aids, forms what WHO has called “an infernal pair”.

TB treatments are insufficient

WHO predicted several years ago already that between 2000 and 2010 the number of TB cases in Africa was likely to double. The reasons for that estimate were the propagation of HIV and the inadequacy of the funding for short TB treatment schemes called DOTS. In 1999, the 2004 UNAIDS report noted, two thirds of the estimated 2 million new TB cases had been previously infected by HIV. The report predicted a doubling of that number by 2010 (four million new cases annually). A slowing down in demographic growth is always liable to turn into negative trends.

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