[afro-nets] Strengthening Health Systems to Fight HIV

[Megan Gaydos <megangaydos@yahoo.com>]

Strengthening Health Systems to Fight HIV
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Wash Post op-ed by WHO Director Jim Kim

How to Turn the Corner On AIDS

By Jim Yong Kim

A new U.N. report shows that the global AIDS epidemic has been
cutting a broad and destructive path, causing 3 million deaths
in the past year alone, or 60,000 a week. Nearly half of the 40
million people living with HIV-AIDS are women, and more than 2
million are children. Infection rates are rising in nearly every
region of the world.

Why, then, in the face of numbers such as these, are some public
health officials, myself included, optimistic that the epidemic
can be stopped? Because there is a growing body of evidence that
public health approaches such as pairing HIV treatment and pre-
vention and strengthening health care delivery systems in poor
countries can help not only slow HIV-AIDS but also make long-
needed breakthroughs in reducing the impact of diseases such as
malaria and tuberculosis that enslave the developing world.

The good news is hard to find in the new U.N. report, but it's
there. While the number of AIDS deaths continues to rise, the
rate of increase is slowing, probably because a growing percent-
age of people in need now have access to HIV treatment. The
World Health Organization reports that between 250,000 and
350,000 deaths were averted last year because of expanded access
to treatment. More governments are moving to reduce the global
HIV death rate by strengthening the health systems that deliver
AIDS care. But this effort is proceeding at a maddeningly slow
pace that must be stepped up.

Expanding access to treatment is only half the picture, however.
The other critical and equally difficult challenge is reducing
new HIV infections, which reached 5 million last year. This is
no easy task, considering that the United States, with all of
its education and technology, has not been able to reduce HIV
infection rates in more than 10 years. When you consider that,
globally, fewer than one in five people at risk of HIV infection
has any access to HIV prevention information, it becomes clear
that a new approach is required.

That approach must go beyond AIDS awareness billboards, absti-
nence education and condom demonstrations. All these have their
place, but none has produced the sustained reductions in HIV in-
fections needed to tip this epidemic. The approach that excites
public health advocates, and that seems increasingly achievable,
is building and strengthening health care systems in the devel-
oping world so they can deliver both HIV treatment and preven-
tion, including voluntary counseling and testing.

Before treatment became available in the developing world, gov-
ernments had little reason to invest in HIV testing, and indi-
viduals had no reason to know their status. Today, however, ac-
cess to treatment is driving new interest in HIV prevention and
testing among governments and individuals. In one region of
South Africa, demand for voluntary HIV testing and counseling
increased by 1,200 percent when treatment became available. The
interest and excitement created by the growing availability of
HIV care must be marshaled to support the building of health
care systems that provide not only HIV services but also educa-
tion and testing for other diseases that facilitate HIV trans-
mission and exacerbate AIDS, such as malaria, TB and sexually
transmitted infections.

Creating basic health care in poor countries is challenging but
far from impossible. The World Health Organization and national
governments have developed service delivery models that work
with reduced numbers of trained health care workers and without
expensive equipment or diagnostic tests. There is increasingly
compelling evidence that more good can be done with a limited
health system than was thought possible.

Governments in some of the world's poorest nations, seeing the
potential to improve their health care systems, are becoming
more willing to invest the resources and political will needed
to manage their HIV epidemics and other health crises. Take Le-
sotho, a small, southern African nation of 2 million people,
where about one in three adults is HIV-positive. Lesotho will
soon offer HIV counseling and testing to every citizen, within a
framework that protects confidentiality and provides access to
care. Nearby Swaziland, where four of 10 adults are infected,
provides HIV treatment to more than half its citizens in need,
an enormous undertaking that other nations must emulate. The
Swazi government aims to deliver quality HIV-AIDS prevention,
treatment and care services in 80 percent of health care facili-
ties by the end of 2007.

It would be inaccurate to say that we are close to turning back
this epidemic. Current efforts to provide HIV treatment, inten-
sify prevention and strengthen health services are scattered and
lack the pace and rhythm needed to make a global impact. If we
coordinate efforts, however, to strengthen the health care sys-
tems that can holistically address prevention and treatment of
HIV-AIDS and the other debilitating diseases of the developing
world, there is reason to believe that we can turn a corner on
this and other epidemics.

The writer is director of the HIV-AIDS Department at the World
Health Organization.