Dire situation: downtown Antananarivo, Madagascar's capital. The number of AIDS infections and deaths is rapidly increasing in this country. ©UNAIDS 2024.
Over the past two decades, the world has made significant gains in the fight against HIV.
At the beginning of the pandemic 40 years ago, there was no cure for HIV, but as medicines become more widely available, more people are living healthy lives. Currently, 29.8 million (76%) of the 39 million people infected with HIV worldwide are on treatment (7.7 million in 2010).
Most people (93%) who are treated are virally suppressed and cannot transmit the virus to others. However, gains against the HIV pandemic are fragile in many low-income countries where international and domestic funding is lacking and many people are still waiting for treatment.
In Eastern and Southern Africa, the region most affected by the AIDS pandemic, with more than 20 million people living with HIV, many countries are lagging in their efforts to prevent and treat HIV.
In Madagascar and South Sudan, AIDS continues to claim lives due to a combination of problems, including a lack of domestic and international funding.
This tragic situation also poses a direct threat to global efforts to end AIDS by 2030, in line with the United Nations Sustainable Development Agenda.
For example, Madagascar has recorded a 151% increase in new HIV infections since 2010 and a 279% increase in AIDS-related deaths over the same period. Moreover, of the estimated 70,000 people living with HIV in Madagascar, only 18% will receive treatment in 2022, and 3,200 people will die from AIDS-related illnesses.
Madagascar, one of the poorest countries in the region, has also been hit by a series of natural disasters, including a chronic drought in the south and a series of cyclones, as the country recovers economically and develops an effective HIV response. It's becoming difficult to work on. response.
According to the World Bank, natural disasters cost a country 1% of its gross domestic product each year, taking away resources that could be devoted to strengthening essential health services.
Malagasy authorities are similarly concerned about the country's HIV status. “The number of new HIV infections is increasing in Madagascar,” said Dr. Ribomalala Rakotnavarona, head of the Ministry of Public Health's Preventive Medicine Department.
Compounding the problem of rising new infections is the lack of reliable data due to weak systematic surveillance systems and out-of-stock HIV test kits in some clinics and other health facilities. As a result, authorities are unable to grasp the overall picture.
Rakotnavarona says the number of new HIV infections continues to rise. “We have been seeing this for several years. But… Madagascar has not conducted a national seroprevalence survey. The last one was in 2008, and at that time HIV infection rates were still It was less than 1%.”
The United Nations is concerned that Madagascar has failed to strengthen its HIV prevention and treatment efforts and that the pandemic could have a negative impact on the country's development agenda. HIV particularly affects young people, especially young women and girls.
“Young people are the workforce of tomorrow. If that group is affected by HIV and we do nothing about it, it will become an economic problem for us tomorrow. Dr. Issa Sanogo, UN Resident Coordinator for Madagascar, because its workforce will be affected by HIV, thereby reducing productivity and increasing morbidity. said this:
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A lack of funding also threatens to derail South Sudan's HIV response. Although the number of new HIV infections in the country is leveling off, HIV prevention is in jeopardy due to a lack of funding to end the pandemic. An estimated 160,000 people are living with HIV in South Sudan.
People who inject drugs remain particularly vulnerable to HIV infection, and drug use has been identified as one of the biggest causes of new HIV infections in Indian Ocean countries such as Madagascar, Mauritius and Seychelles.
However, some Indian Ocean countries have demonstrated the value of well-funded harm reduction programs in the past, such as clean needle and syringe programs and opioid agonist maintenance therapy.
The United Nations Joint Program on HIV/AIDS (UNAIDS), the global leader in the fight against AIDS, is working with countries like Madagascar to identify gaps and strengthen the HIV response to prevent new infections and AIDS-related deaths. ing.
For example, the increase in new infections in countries like Madagascar is in stark contrast to the downward trend in Botswana, where the number of new HIV infections has fallen by 66% since 2010 and the number of AIDS-related infections has fallen by 36%. It is. Deaths (number)
However, Botswana has benefited from significant investments in the HIV response over the years. As a result, the country, like Eswatini, Rwanda and Zimbabwe, is on the path to eliminating AIDS through strong HIV prevention and treatment interventions.
To step up efforts to end AIDS as a public health threat by 2030, at the recent World Bank Spring Meetings in Washington, UNAIDS urged global financial leaders to called for ensuring increased sustainable investment in the global response. threat.
Robert Shivambu is UNAIDS' Global Communications Officer, leading and inspiring the world to achieve our shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.