Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility
HIV/AIDS is a catastrophe globally, but nowhere more so than in sub-Saharan Africa, which in 2009 accounted for 68 percent of cases worldwide and 69 percent of new infections. The magnitude of the epidemic in Africa is further amplified by a region that lacks sufficient resources to meet the need for life-saving antiretroviral therapy (ART) and is home to those who need it the most. According to the World Health Organization’s most recent guidelines, just 36 percent of Africans needing ART are receiving it, and the need for treatment is expected to increase exponentially over the next decade.
In this context, the Institute of Medicine (IOM) tasked a committee of experts to recommend affordable, sustainable strategies that both African nations and the United States can implement to address the long-term burden of HIV/AIDS. The committee concludes that the burden of morbidity and mortality in Africa cannot be alleviated through treatment alone. Treatment can reach only a fraction of those who need it, and its costs are unsustainable. Greater emphasis must be placed on preventing new infections.
Strategies to Build Capacity to Tackle HIV/AIDS in Africa
The IOM committee identified strategies for both African nations and the United States to build African capacity—including human, scientific, technological, organizational, institutional, and/or resource capabilities—to prevent, treat, and care for HIV/AIDS.
For African nations, the focus is to strengthen health care systems by making the most of existing capacities, such as health care workers on the ground and local institutions. Some of the committee’s recommended strategies include:
- making use of management and support staff from outside the clinical health sector to free up time for health care providers to perform clinical work;
- delegating tasks of health professionals, when appropriate, to health workers with less- specialized training;
- tapping the potential of modern information and communications technology, such as smart phones and distance learning; and
- forming partnerships between developing countries and creating regional collaborations to exchange technical assistance.
For the United States, strategies focus on supporting partnerships—particularly institutional partnerships—so Africa can move forward independently toward a sustainable and healthier future. Partnerships include collaborations between the public and private sectors, with faith-based organizations, and between the militaries of the United States and African nations, as well as academic partnerships.
Ethical Decision Making for HIV/AIDS in Africa
If the burden of HIV/AIDS does in fact reach the projected levels, it will confront decision makers with tough choices about who receives life-saving treatment and who does not. Capabilities need to be expanded to enable professionals overseeing HIV/AIDS policies, programs, and resource allocation to receive ethical training and to carry out their responsibilities within the structures needed to ensure transparency and accountability in these life-altering decisions.