In an interview with Funminiyi Philips, Dr Penninah Iutung, Executive Vice-President of the AIDS Healthcare Foundation, reflects on a monumental milestone: providing life-saving HIV care to 2.5 million people worldwide, with over half of them in Africa. From the early days of battling prohibitively expensive treatments to today’s near-epidemic control, Iutung’s insights reveal a tale of resilience, innovation, and unyielding hope. Yet, she cautions that the journey is far from over: stigma, donor fatigue, and hard-to-reach populations pose significant threats to progress. For AHF, the mission continues, bridging gaps, training local health workers, and advocating for sustainable funding to turn the tide on HIV/AIDS.
Could you please share more about what this milestone means to AHL and the communities you serve?
I’ll start briefly by introducing AHF. AIDS Healthcare Foundation is a global, not-for-profit organisation. We operate in 49 countries worldwide. Of those 49 countries, 59 of which are in Africa, we have recently added Ghana to the list. We do work in Nigeria. We’ve been working there. I believe that since 2011, and considering most of our work on the global front, the majority of the 2.5 million patients you’re referring to are from the African region. Of course, you’d be well aware that the epidemic is biggest in Africa compared to anywhere else in the world. The global program began in 2001 in South Africa and was subsequently followed by Uganda.
Then we expanded to the other 15 countries, now that we are in. That was imperative. 2001 was the height of the epidemic in 2000, around early 2000 in most African countries, especially in the East and Southern Africa region, where many patients were dying. That’s where AHF initially focused a lot of its efforts. To address the heart of the problem, we began offering air care at a time when it was not available in public spaces. In both South Africa and Uganda, the programmes started in 2001 and 2002, respectively.
AHF puts the first patients on ARVs through ARV medications that it produces. Those were the first 100 patients in each of those countries. Of course, at that point in time, the cost of the medication was quite high. The cost per patient per year was approximately $5,000 to treat one patient. That cost has come down substantially due to numerous efforts across the board. One is, of course, that more funding is available for ARVs, and more generics are now available. So, the cost is less than $100 for current fast-line regiments. Actually, it’s around $60, just under $70. So that is a remarkable milestone. Now, how did AHF get to this 2.5 million patient mark? From the outset, it was crucial for AHF to collaborate closely with national governments to support patients and ensure their ongoing care and treatment.
To get patients into ARV treatment. Of course, the reason for that is obvious. National governments are responsible for treating their patient populations, but they often lack the necessary infrastructure to do so effectively. And so AHF came forth with the experience that they had had in the US. AHF is a 39-year-old organisation. The experience we already had in the US, providing hospice care and airbag medications that were translatable to the African continent, benefited from that. Initially, we received extensive training. You know, ERB management about the drugs, etc. And so, the collaborations with governments provided us with the opportunity to start providing treatment and care within government facilities and build the capacity of government health workers. Filling key human resource gaps where there was a knowledge gap, whether it was physical HR gaps, support infrastructure, or procurement of equipment to ensure that patients with HIV were receiving quality care.
That is what we’ve continued to do, because our goal is. The mission is to make sure that we achieve HIV control. We are not yet there in multiple locations. We’re not yet there. The training that was being provided to build capacity, yes. So, I said from the beginning that we needed to build capacity. So, we utilise our experience in the US to build the capacity of health workers within the region, enabling them to provide effective treatment and care. Our goal was always that, you know, to build the capacity of the local nationals to be the ones who take responsibility for providing the services, the HIV services. And so, you know, we never brought in expatriates. We always ensured that local nationals took the lead on that. And so, the collaboration with the government, as I mentioned, was not just to build capacity, but also to continue addressing critical human resource gaps. We support infrastructure development because some of the existing care infrastructure is generally in poor condition. We built that because we want to provide a quality service, including equipment and medical supplies. We also procure buffer stocks for drugs and other necessary items.
That’s to ensure that patients receive quality service. And so that has been the journey. Our growth has been that we are growing within the current countries where we are. We continue to support many more government facilities. We continue to expand into new countries because the need remains in Africa, and this has ensured that we have secured collaboration to support all those patients over the years, which has led to our current number. So, the 2.5 million patient number one, around just under 1.4 million, are in Africa. So, yes, most of AHFS’s global support is focused on Africa, although we also cover all other regions worldwide. And that has made a difference. You asked earlier what it means that has made a difference. Number one is the number of lives that have been saved. To ensure that patients get onto ERT. Secondly, it means that we’ve restored families, so parents can live and not have to worry about fewer orphaned children. But it has also made a difference in the communities we work in, restoring individuals.
And a family, you know, has a trickle-down effect in the community. In some of the communities we’ve worked with, I’m based here in Uganda. I remember way back when I started with AHF over 20 years ago, you would go to those communities and you’d see the devastation that you know. HIV AIDS has caused you to see an age gap. So, little children and grandmothers, the older children’s productive age range was basically, you know, we’re not what we’re not were either sick or in a good number had died. So, being able to see that you can go back to those same communities and they are, you know, revived. You know, while people are living normal lives, they’ll be able to get jobs, etc. That’s the impact, some of the effects that I can see we’ve had in those communities. Additionally, I believe our contribution has also been on the development side, as we invest significantly in infrastructure across different countries. That we work with, so we are also contributing to the development of those countries in that way.
How does it feel to have achieved this milestone? And what next for AHF in the global fight against HIV?
So, in terms of how I feel, I think it’s remarkable. I keep telling individuals that for most of us, the job we do is not just a job, but a fulfilment of a purpose. Because what better job would you have than to make a difference in people’s lives? You know, in a tangible way, in a way that they actually appreciate. It feels good to know that we are able to reach so many individuals, and we understand that there’s a ripple effect on families and communities. I believe it’s essential as part of fulfilling our mission as an organisation. It’s good that we are reaching these milestones, but that’s it. What’s next for the future at a critical time like this, where you know we are close to achieving epidemic control? We’ve seen that there’s been a lot of rhetoric about getting there, and you know, the funding was available. However, with those reductions and the many changes that are taking place in the world. There is donor fatigue. You know, fewer donors want to fund HIV and AIDS in particular and health in general.
Our work is still ahead of us as an organisation. You know, we do not want the gains that have been made, not just by us but by other partners as well, to be lost because a lot of effort has gone into various aspects. That’s one of the things; our goal is to ensure that we can preserve the efforts we have made so far and continue to grow. That’s why growth is still important to us. Expand our reach to more countries that need support, visit more facilities that require assistance, and be innovative in how we connect with small populations that are now being tested, such as those across most of Africa. You know, most countries, over 70% of the population, majority of the country, 70% of the population know their HIV status. But then, that pocket of the 30%, how do you convince them to get tested? Because they’re individuals who fall within the 30% who will not want to get tested for one reason or another, whether it’s due to stigma.
It’s not because they do not know about HIV; they do know. But just the decision to get tested is still an issue. So how do you creatively have models that can reach that, you know, reach that last mile of individuals? Because without an HIV test, without knowing your HIV status, you can’t know the right decision to make, you know, do you know for your family, but also for yourself, or just even for your community. So, it’s about being able to reach that last mile, specifically with testing, to ensure we can get there. Additionally, there is a risk of reaching high-risk populations, also known as key populations. Because you have to go to the epicentre of the epidemic, you have to be able to achieve control. Therefore, there are still pockets of key populations where the risk and prevalence remain high. Those are the individuals’ number one priority, focusing on reaching out to peers. Are we taking services closer to them? We’re making it convenient for you to receive treatment and care. So that’s our focus on the prevention side.
Then, on the care and treatment side, when it comes to actual medications, the concept of treatment as prevention needs to be preserved. And because we know that when you treat a large section of the population and their viral load is suppressed, then they are less likely to transmit the infection to the rest of the population. Therefore, to ensure that, despite donor funding, our own governments can also contribute to covering the gap and ensure that air is available. We also engage in some collaboration with the government. We also advocate that we’re built; we started off as a grassroots organisation. That’s part of our history.
So, the advocacy is very strong for us. Therefore, advocating for our governments and partners to have more innovative streams of funding that are being made available is crucial for this last mile. So those are some of the areas we are focusing on ensuring the treatment remains a priority, ensuring that people get tested and linked into care, but also for the population that is on treatment right now, we want to make sure that they are retained in care because if treatment is going on, You must stay on treatment in order for you to prevent transmission of HIV. But when people get lost to care for various reasons, you know they’re fatigued from taking the ARV medication, you know, because of stigma, loss of finance, the various reasons patients sometimes leave care. Patients rarely follow a straight-line journey; their treatment journey is often a series of on-and-off events. We want to ensure that patients are fully supported to stay in care. If they leave care, we stay in touch with them, provide them with relevant information to help them make an informed decision, and occasionally offer them additional services. So, those are some of the areas we want to focus on, as part of our quest for epidemic control.
Can you share some specific success stories or testimony from clients who have benefited from AHF services?
I have some young children I started with. They were around six. Most of them are between six and eight years of age, but now they’re in their 30s, married with children, and employed; they’re living a normal life. So, for me, that’s very gratifying. Sometimes when I go back to the facility where I used to see them, they’re still in treatment and care with us. That’s a success story because we’ve been able to save them. They grew up as orphans. Most of them grew up with their grandparents, but now that they’re adults, they’ve attended school, completed their education, and are making a positive impact in the communities they’re in. We do have a number of them who are actually part of our youth advocates.
So, they are the ones now who are the champions for the other young people, telling them about the dangers of HIV and AIDS, but also helping those, you know, if you get infected with HIV and AIDS, these are the things that you can do. These are the things you can do to prevent yourself from getting HIV. These are things you can do. So, they are actually the best advocates, as I think you’re well aware. Gen Z’s younger people listen to each other. So, it’s better. They tend to listen to each other more when we use those peer networks and so on.
Those have been part of the success stories. But then we do have very many where you know patients who came to us and were, you know, basically on the deathbed many years down the line, they built new families. For us, and I think for me as a doctor, there’s nothing more gratifying than being able to see that, you know, you’re able to work with someone because chronic care is a journey. It’s a lifelong journey, and being able to see that is really gratifying. It’s different from treating malaria because you treat malaria, they get well, and they go. So, with this, it’s a journey that involves working with patients, and for most of the patients we’ve worked with, we’ve walked that journey with them on and off.
How has AHF contributed to the remarkable increase in life expectancy in countries like Malawi?
I can’t attribute that solely to AHF, because, as I said, it’s a collective effort. However, that story of Malawi is no different from many other African countries. If you examine the life expectancy of many countries, you will notice that it is around. Most of them were around in the 50s, 60s, you know, at one point, 50s, 60s, and maybe even 70s, before the AIDS scourge. However, when you examine the space, especially between around 1990 and around 2005, that’s when the life expectancy in most countries declined for the general population. And that’s because the ARVs were not available. That’s when the scourge was taking, you know, taking so many lives and so many people were dying. Life expectancy was just, you know, reduced. So, Malawi is just one of those countries where, I think, it’s very well documented, and the information around that has been making a difference, but it’s similar to other countries. So, our contribution, if you look at it, is that we are able to support services for HIV patients in those particular areas. Countries test people specifically, link them to care, and put them on treatment.
What are some of the biggest challenges AHF still faces in achieving global HIV control, and how do you plan to address them?
The biggest challenge, as I mentioned, is the values held by small pockets of the population that have not been tested. Sometimes they’re tested, but they do not want to start ARV treatment. You cannot achieve epidemic control if people do not know their HIV status. So, we will always strive towards the goal, but then we’ll never really reach it. The biggest challenge is that there’s a population that has not been tested. Another challenge is the high-risk populations. The prevalence remains high among key populations. You know, sex workers, you know, gay men, and in some other countries, there are different key populations. For instance, the prevalence of fisherfolk is quite high, sometimes reaching about 20 per cent, or 15% in various countries.
That population, we cannot, is a core population. That’s where most of the infections are occurring. To achieve epidemic control, you must be able to treat that core population and the bridging population. The bridging population is, you know, the clients, for instance, of sex workers, and that’s important. So that’s a big challenge, the means of getting to that population, and for African settings, and many laws that are against, you know, gay people and all that, that further stigmatise them as a public health measure. When you have such laws, you cannot effectively reach that population with the health services they need, and so they often go underground. Therefore, you must be extremely innovative to deliver services to them. So, our policies to get services to the gay population, to the high-risk populations like sex workers and other populations, have to also take into mind the public health approach because without getting the services there, there will always be pockets of new infections coming up.
That’s one aspect, and that’s one challenge. Another challenge is the issue of care and treatment, where retention is currently a problem. As I said, not all patients walk; some do, but not all walk a straight-line journey with you. Due to life circumstances, people often move. We found the most important cause of patients getting lost to care and getting off ARV medications is that they are moving for socioeconomic reasons. So, they are relocating for work, for you know, you name it, you know, for family reasons, and you name it. And so, they get lost along the way. They’re not linked to another facility. And so, when someone is not on ARV medications for a very long time, their viral load increases, and we are more likely to transmit the infection.
That’s another significant challenge for us: overcoming retention barriers. So, being able to bring patients back, ensure they’re taken care of, and then, in various ways, also being able to provide services to patients more quickly is also important. As I mentioned, one of the common reasons is that patients move frequently, either migrating within the country or relocating to another region. And so, how do we establish collective policies within the different regional economic blocks or within various countries to ensure a smooth handover?
Patients should be able to access their medications wherever they are, ensuring that we can continue their treatment. So that’s another challenge. Retention continues to be a challenge. And now, in this day and age, the reality is that more resources are needed. AHF cannot say it’s only 2.5 million patients. They are across the world. I mean, across even just Africa, there are about 2/3 of 39.9 million, or about 23 million patients, whom we need to take care of in quantity. So, we still have the burden of ensuring that we attend to and maintain continuity of care. So, the issue of financing health and financing HIV and AIDS is very critical. So that’s an ongoing challenge. As I said, part of that is we are bringing our resources and contributing to it, but it’s not enough. Therefore, we need to ensure that our own governments can also bridge the gap and allocate more resources due to donor flight.
How will AHF continue to expand access to care and dismantle barriers in the global fight against HIV?
It’s one step at a time. So, yeah, that’s what we do – take it. Therefore, our strategic focus is to target countries where the need remains significant, and this need, as we assess it, varies from country to country. For instance, in some countries, the overall prevalence is low. Many patients are already familiar with ART, and it may be necessary to identify those at the highest risk of complications. Perhaps it’s just a key population that we need to address. That’s where our strategic focus lies, as we aim to address the root of the problem. There are many in places where, for instance, the government is paying for ARVs. Let me provide an example of the Eswatini government covering the costs of ARVs, which are distributed through the country’s regular healthcare system. Our goal now is to support the national government and provide training.
We have the expertise and a lot of experience. How can we continue to support them by mentoring and training government health workers to take on more of that responsibility? That’s the gap we’ve noticed. A lot of the donor funding was previously siloed, and now government health workers have to take responsibility for providing care and treatment, but they lack the experience with these patients and the ART. So, being able to strategically. You know, support those particular areas, but in some other countries, just because of donor flight and the disease burden is much higher, you know, it’s important that we are supporting the actual delivery of the care, you know, providing always support in terms of human resource support and all the others I talked about earlier on. To deliver the service.
The other aspect is retention. As I said, the government’s retention is intensive, very intense. To track a patient back into care, follow them, and continue to call them is not straightforward, and you must make consistent efforts in that direction. So, those are some of the things that AHF continues to invest in, plugging in those gaps and strategically growing, depending on the country’s needs. No Donna flight has been ongoing for the last five years. I think you know most countries have been told. To get their sustainability plan in order.
So, it had already started. It’s not like it’s something that, you know, happened this January. No, it had already started. But I think because the funding was still flowing, our governments also relaxed. Until, you know, it was still a particular stop. No, we’re no longer doing this. So that’s the, you know, that that happened. But that said, I think what we’ve seen is that at the beginning it was expected that, you know, all of a sudden, there’ll be no treatment available. There has been a flight, but certain core aspects of the programme remain unchanged. The most important one is care and treatment. The drugs are still being procured. I think there’s no country where, unless for clinics that have closed, standalone clinics have closed, but through government support systems. In government health facilities, the drugs are still available. We’ve also seen, fortunately enough, that a number of governments have picked up the pace. I know Nigeria was one of those governments right at the beginning when the stop-work orders came in; the government said, ‘Okay, we are going to fill in the gap’. I think they set aside a particular amount of money. Several governments have actually been doing so. They’re increasing their national budgets for health.
So, some effort is being made. I believe that as a civil society organisation, one of the things we ensure is that governments are working on the issue where they have committed to increasing donor funding. You know, we’re asking, have you increased funding for health? We are asking, OK, what is that going to happen? Is the money actually available? So, it’s also keeping them accountable to make sure that funding for health remains a priority. Unfortunately, I think the drive for Africa to support its own health budget is not only being undertaken, but is also being taken up by the AU. So, even at the level of the AU, there’s a significant push to ensure that we, as Africans and African governments, take responsibility for our own health as part of our own sovereignty. In terms of timing, where the pieces are falling into place, we need to ensure that we prioritise our own sovereignty and not compromise our health management and the well-being of our residents. The two donors are in a position where the timing is right.
Could you elaborate on AHF’s advocacy initiative and its contributions to policy reform and equitable access to HIV services?
Some of it is historical, some of it is ongoing. We are, we are always, it’s just a matter of one piece of advocacy over another. As I mentioned earlier, the annual cost of treating a patient was $ 5,000. That would never have been sustainable. But because it was also because those drugs were mostly, you know, from branded drugs, the original pharmaceutical companies, no generics were being produced in India, and so AHF, there was no way we were going to get treatment to thousands of people who needed it. You know, especially in Africa, at that price, no one could afford it, not even donors. So, part of what we knew was important was to enhance our advocacy around drug pricing. We did that for very many years. We continue to do it for various drugs that come up and are too expensive on the market.
If you go to our website on drug pricing, our advocacy around drug pricing has been very key because we cannot talk about equitable access to care without making sure that the drugs are cheap enough to be affordable. For various reasons, whether it’s donors or our governments, we need to afford it; therefore, drug pricing is one of our core advocacy areas. Depending on which drug now comes to market, if we think it’s too pricey, so drug pricing is a big issue for us to make sure that the drug prices are lowered, they’re affordable, they’re more generics that can be, and be made available, you know, especially for the global South. So, drug pricing is a key factor that has played a big role in making services more equitable. And then over the years, as well, you know, part of the history was that there was a point in time where, of course, it all depended on the research that was coming out at a particular point in time, where not everyone who tested HIV positive was being put on treatment. You know it depended on your CD4 count, which had to be above 500. You know then if it was less than 500, you know you are placed on treatment, or at one point, much earlier, you were only started on treatment.
If your CD4 counts are less than 200, you know it is a measure of your immunological status. Now, you are aware of the amount of research that has become available while governments were taking their time to adjust their policies. We started advocating for it. We observed that one of our primary methods of advocacy was to make treatment available to everyone. Over time, we saw that most governments and advocates have adopted this stance. It’s not just at a local level, it’s all the way, you know, to the Geneva, to the international level. So, the government started changing the treatment guidelines to ensure that treatment was made available to all. The other one was just a model of testing. I think that historically, you may be too young to remember. Still, in the past, at the beginning of the epidemic, most of it was a VCT approach, a voluntary counselling and testing approach, where it depended on the individual to take the initiative to go and get tested at a health facility. Now, with a dreaded disease that takes up a lot more courage and effort for an individual to go and get tested.
As you know, you need to spend a lot of time counselling the person and a lot of time. There was no way that approach was going to get to the millions of people who needed testing. We began by conducting mass testing campaigns, which is where we are now. Instead of a voluntary approach, we were being proactive, going out to communities and ensuring you know who we are so that you can increase the convenience factor. So, take the services there so a patient doesn’t have to pay for transportation to go to a health facility. So, taking the services there, offering it right there, you know, with rapid tests, and making sure the person knows their HIV status if they’re positive, supporting them to get linked to a facility. With the evidence we presented, we successfully lobbied all the way to the WHO for the treatment and testing guidelines to be revised.
So now that it’s changed, instead of calling it voluntary VCT, it is now called HIV counselling and testing, under which there are various approaches. VCT is still an option. Those who know want to on their own, it’s fine, but at a health facility, anyone going in there, if there are symptoms, everyone is being offered an HIV test. So, now that one was called PITCT, where the provider takes the initiative to offer the test and encourages people to get tested. We use various approaches. Still, the policy issue at that time was that we could influence the change in policies from a VCT approach to a more comprehensive HIV counselling and testing model, which was broader and provided more opportunities for people to get tested quickly. It also included other features, such as rapid tests that provide quick results. Imagine staying there and you’re not sure for three weeks or three months, and you’re waiting for an HIV test. So those are some of the key policy changes we’ve seen.
How does AHF work with governments, civil society partners, and other stakeholders to advance equity and ensure no one is left behind?
So, with the government, mostly as I said, it’s on the policy front. So, if we identify policies that affect access to HIV services and those policies, then that’s where our advocacy begins. These are the policies that have been created so far, but they’re standing in the way of patients receiving services equitably. Therefore, policy identification varies across different countries. And with that, we don’t usually do it alone. Sometimes we have, but we also bring together other civil society partners. You know, so that we can form, let’s say, a coalition and involve the government as well, so that we work as a bridge between what we are hearing in the community and the government. Level and with the policy makers.
So, it will not only be the government, but also legislative makers, such as members of parliament, with whom we engage in these discussions. As you know, advocacy is not limited to a single channel; sometimes, you need to use multiple channels to achieve a goal. I’ll give you an example: for instance, when it came to COVID-19, these are lessons we’ve learned from supporting the response to Ebola in Sierra Leone, where we also work.
In 2015, one of the things we learned was that, as you know, at that point in time, much as we’re an HIV and AIDS provider, we realised very quickly that we had to be playing a role in the global public health field. So, through our global public health initiatives, when COVID-19 came round. One of the key things we wanted to ensure was equitable access to vaccines. You are well aware of what happened in Africa and the consequences that followed, as the global North hoarded the vaccines, making them inaccessible to us. So AHF started a campaign called VAW, Vaccinate Our World.
Basically the campaign was to alert, you know, the various leaders at various levels because we did this around all the across the globe was that you cannot vaccinate yourselves only in the north with an infectious disease and think that in a global world that is easy to get around, you know it’s easy to go from one place to another that you are actually protecting yourselves. There is a reasonable thing to do, which is to ensure that everyone is vaccinated, and to provide equitable access to the vaccine in the global South as well. So, it’s various campaigns like that that we’ve done. However, the first step is to ensure that we identify the key players in our advocacy and participate with other society members.
What does this milestone mean to you personally? How do you envision AHF working in Africa, and what contributions will it make to the global HIV response? And what are some key successes you’ve seen in your region?
It’s very gratifying. I’ve been doing this work for the last 24 years, since I graduated. At the time I graduated, the epidemic was at its height around 2000. So, at that point in time, there were no ARVs available. I was already working at the mission hospital before I joined AHF, and I knew at that point that the 100-bed capacity I had for inpatients was for adult males. Ninety-five per cent of those patients have HIV, and if I didn’t see them the next month or two months down the line, I knew they were dead.
So, to be a new doctor at that time, passionate about, you know, delivering services, and just to feel handicapped. That you couldn’t reach the patients with their biggest need, that was very, you know, it made me feel a little depressed at that point in time. In 2004, when I joined AHF, it had already established a presence in Uganda. They were the first organisation to provide free ARV medications in public health settings. So, when I joined at that time and these drugs, it was like a magic bullet to see that this patient who started with a CD4 count of only 10, three months down the line, they were being brought in in a wheelbarrow, and three months down the line, they’re now up and about. So, to come from a point where a handful of patients were dealing with it to over 1.3 million in Africa, plus 1.4 million in Africa here. That, for me, is a big achievement, not just for myself, but on behalf of all those patients I’ve been managing. So, it’s very gratifying.
Even though I’ve moved into leadership and management positions, my goal remains focused, which helps me stay grounded. That, you know, these are lives, actual patients, you know, these are lives of people that you’ve helped. So, stay focused, because there are still many more like you. So, personally, that’s very gratifying. What was the second one?
The second question is, how do you see AHF work in Africa, contributing to the global HIV response?
One is that there are many lessons other parts of the world can learn from Africa, given the numerous success stories in the HIV response on the continent. For instance, the epicenter of new infections is currently not Africa. It’s in Eastern Europe. It is located in Eastern Europe, specifically in Russia. That’s where the number of new infections is actually rising compared to Russia, other small countries in Eastern Europe, and Africa. So, there are many lessons that the world can learn from Africa. So that we can share what we have done in Africa, the models we have used with the rest of the world, I think, is one of the things that Africa can share with the rest of the world.
We will always do that when you bring all the other global programs together during meetings. So sharing, being able to share our experiences and the models that we’ve used with the rest of the world, and so Africa can teach people along, but also because we have the largest epidemic in the world, if we are to achieve epidemic control, it has to take place here in Africa. The rest of the world, the infections and pockets, particular pockets, people who inject drugs, maybe gay men, sex workers, it’s in particular core populations. It’s not as there. I think only Russia and Ukraine have a generalised epidemic, but in most other countries, there may be more new infections, although they are concentrated in particular pockets. However, in Africa, the epidemic is widespread. So, if you are going to achieve epidemic control, the resources still have to be prioritised in Africa.
And so, whether it’s from donor support or our governments, that’s a national priority, and increasingly, we should view health as a matter of national development. Because if nations are not healthy, we already know what happened when we didn’t have these areas. If the nations are not healthy, then we can also not achieve our development goals. Health needs to be viewed as a matter of national security for every country in the world.
What are some key successes you’ve seen in your region?
Number one key success, I think, is that South Africa has a miracle to have in large numbers, if it’s 7 million people, I think, just over seven million people living with HIV and AIDS. Seeing that the government can take responsibility for purchasing all the ARVs is a commitment. We want more from most of our governments. But there have also been other success stories. So, that commitment, I would say, is a success, given that they are continuing to do so.
The other one would be in a place like Zimbabwe as well. You know, that’s a country where, when they had so many sanctions against them, they had an epidemic, of course, like most of the other southern African countries, very many people living with HIV and AIDS, they started building their own resources to finance the HIV aspects. So, they started by putting in place a tax, which to date remains an income tax. I think it’s about 3% of income tax, which finances their HIV residents. So, in a way, that makes it more sustainable. So, I think that for me, Zimbabwe is another of those success stories.
The other one is Eswatini, as well as Botswana. Those have been able to achieve epidemic control. When we talk about the 9595 goals, they are actually achieving epidemic control. And the reason I can confidently say that is that, within our own program nowadays, it’s becoming increasingly difficult. To find an HIV positive person, they really look, they take outreaches, they go, they make the clinic open until 9:00 p.m. It’s so difficult to find an HIV positive person. So that’s the success story. So, it’s possible within Africa. Then, as you just mentioned, we should also consider the life expectancy in Malawi. We increased by close to 20 years. That’s a miracle. That’s a success story right then. Then the other one for me is also Rwanda. Rwanda is another of those success stories, not just on the HIV front, when I look at their overall health response.
The Rwandan government has put in place a national community-based health insurance scheme that ensures everyone has health coverage. It’s a tiered approach that gives opportunities for those who can afford it at a higher level. I think that’s its 4-tiered structure, with four tiers. If you can afford to pay for your health insurance, you pay, and the government will offer the services. At the third level, you pay and receive a range of services.
Now, in the lower levels 211, which is usually about 30% of the population. Those are the ones that the government subsidises. It’s been one of the success stories, which I think most governments have attended a number of meetings with the AU, and they’re actually asking everyone to look at the Rwanda model for health financing because it has ensured that many more people are covered. We have the opportunity to share many of those experiences as Africans, and the honour is truly ours.
