Analytical summary - HIV/AIDS
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Two thirds of all people living with HIV and AIDS live in sub-Saharan Africa. Encouragingly, new infection rates are now dropping, due to scaling-up of antiretroviral therapy treatment and more effective preventive interventions.
Forty-four out of the 46 countries of the WHO African Region have policies in place, while 38 have policies on HIV testing and counselling. However, the human resources needed to deliver on these policies fall short of requirements. This shortfall is in the region of 1.5 million throughout Africa, leading to increasing use of task shifting. This strategy is now used by 33 countries and is seen as successful in scaling-up the rate of antiretroviral therapy delivery (see figure).
The present antiretroviral coverage rate is 53% regionally, with an increase of 1 million people treated compared with the previous year. There has also been a significant increase in treatment facilities. This is of utmost importance as WHO has lowered the recommended cell count level at which antiretroviral therapy should be commenced. The benefits of this strategy are expected to outweigh increased logistical and cost challenges in terms of people reached and treated.
However, although the treatment of pregnant women to interrupt mother-to-child transmission has increased by 23% since 2008, nearly half of all HIV-positive pregnant women still do not have access to antiretroviral therapy. Also, only a small fraction of tuberculosis cases coinfected with HIV/AIDS are currently being reached, for reasons thought to be connected with effective programme delivery capacities.
Health workers in African health facilities are greatly at risk. Although policies on post-exposure prophylaxis are in place in almost all African countries, implementation remains low. However, information outreach to populations has been successful, although it is thought that efforts still need to be increased. Men still report higher rates of condom use than women.
Surveillance systems require strengthening. Only just over half of African countries have fully functional sero-surveillance systems, although these are mainly in countries with high disease burdens. The remaining countries have poor surveillance capacity, lacking the ability to appropriately track the epidemic. Deficiency in this fundamental area impacts on the potential benefits of all other health system efforts to address the HIV/AIDS pandemic.