Official Bank Sites Related Information August 16, 2006—In some ways, Burkina Faso is typical of many African countries struggling against HIV. In the last two decades, the virus spread from high-risk groups such as gold miners, truckers, and commercial sex workers to the general population, so that today, about 140,000 adults 15 and older are living with HIV, according to the Joint United Nations Programme on HIV/AIDS As in many countries, a large number of people could barely afford to be tested, let alone pay for treatment. But lately there is cause for hope. The 2006 United Nations Report on the Global AIDS Epidemic found that the proportion of people living with HIV in urban areas recently declined by more than 25 percent. The national average is now about 2.3 percent of the population, down from 7.2 percent in 1997, and among the lowest in Sub-Saharan Africa. And life-prolonging antiretroviral (ARV) drugs are becoming more widely available as donors and organizations help the national government and its partners in the AIDS fight pay for and administer them. The World Health Organization announced August 16 that the number of people receiving HIV antiretroviral therapy in sub-Saharan Africa has surpassed 1 million for the first time, a ten-fold increase in treatment access in the region since December 2003. WHO estimates that 63 percent of people on ART in low- and middle-income countries today are African, compared with 25 percent in late 2003. Although sub-Saharan Africa has the greatest number of people on treatment, and the second-highest rate of treatment coverage among those who need it, the region still accounts for 70 percent of the global unmet treatment need, says WHO. Once, fewer than 1,000 people in Burkina Faso could get AIDS drugs. Some paid for them directly. Some drugs were provided by non-governmental organizations or networks of people living with HIV. Some were donated by people in richer nations and distributed informally. Today, 24 percent of people living with HIV are receiving antiretroviral therapy, according to UNAIDS. Some 850 are receiving antiretroviral therapy (ART) through what’s called the MAP project. The Bank and its partners designed the Multi-Country HIV/AIDS Program (MAP) for Africa, which has made available an initial amount of US$1 billion to scale up national HIV/AIDS efforts and to support sub-regional (multi-country) HIV/AIDS initiatives. About 400 of these ART patients are part of a research study monitoring resistance to the drugs and treatment failure. An additional 7,000 people will be receiving treatment through the 2-year-old Treatment Acceleration Program (TAP), a partnership among World Bank, Economic Commission for Africa (ECA) and the WHO. Thousands more are getting ARV drugs from other programs, such as those funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. A pilot project, TAP is providing a total of US$60 million to fund ART in three countries—Burkina Faso, Mozambique, and Ghana—in anticipation of providing ART to thousands more. In Burkina Faso, US$18 million from TAP is funding the drugs and assisting clinics run by non-governmental organizations and networks of people living with HIV. The funding is also going to strengthen 21 of the country's 54 small district hospitals that serve small rural communities by training doctors and nurses in counseling and follow-up, says Timothy Johnston, a World Bank human development specialist who spent three years working on health projects in Burkina Faso. The World Bank is also collaborating with WHO and local research institutes to monitor and evaluate the national treatment program. The effort involves measuring the determinants of successful ART treatment, as well as overall benefits of ART to individuals and the country. By the time the pilot project is completed in 2007, the Burkina Faso Ministry of Health plans to access pooled donor funds to pay for ART over the long term. The World Bank recently approved a new $47.7 million Health Sector Support and Multisectoral AIDS Project, which will support the pooled donor health fund as well as HIV/AIDS prevention efforts. While the cost of the most commonly used ART has declined dramatically in the last five years, people can develop resistance to these drugs and require much more expensive treatment. The first line of ART costs about $300 a year per patient in Burkina Faso. If the first line drugs don't work or stop working, the second line of treatment is more costly—about two or three times as much. The third line of drugs is currently too expensive to be affordable, Johnston says. Over 90 percent of people receiving ART in Burkina Faso's TAP are on the cheaper first line drugs, he says. He says non-governmental organizations (NGOs) and the HIV community will play a key role in the success of the program, because, with only 400 doctors for 12 million people, doctors are too overworked to follow up regularly with patients and make sure they are taking their medicine. "People need to know that they have to take the medicine every day—they can't miss a day. That's why the involvement of these NGOs and associations is so important." NGOs visit the family of the patient and make sure the patient is taking the medicine, and provide psychosocial support for the patients and the families, who are often very poor. If patients fail to take ART regularly, "you're going to very rapidly start to have treatment failure and resistance rates going up," says Johnston. The results of ART so far are so good that people who thought HIV was a death sentence can live healthier, even normal, lives, and their friends find it hard to believe they still have HIV, says Johnston. Now the challenge is making sure the general population understands the new medicine is not a cure, so people remain vigilant against the disease, he adds. "We still need to work on prevention," Johnston says. "There's a real risk we could experience an upsurge in new infections that would undercut everything we've done with treatment." |
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