Cote d'Ivoire

African ministers and other leaders at the opening of the Annual Meeting of the ECA Conference of African Ministers of Finance, Planning and Economic Development and AU Conference of Ministers of Economy and Finance in Abidjan, Cote d’Ivoire, 25 March 2013.
Credit: UNAIDS/Basil Zoma.

African Ministers of Finance and other leaders have agreed that the continent needs to shift from a reliance on exports of primary commodities to greater industrialization in order to accelerate the continent’s development. 800 ministers, experts and representatives of the United Nations met at the Annual Meeting of the Economic Commission for Africa (ECA) Conference of African Ministers of Finance, Planning and Economic Development and Africa Union (AU) Conference of Ministers of Economy and Finance. The conference on ”Industrialization for an Emerging Africa.” opened in Abidjan, Cote d’Ivoire on 25 March.

The President of Côte d’Ivoire, Alassane Ouattara, who chaired the opening ceremony, said that "political stability, the stability of the macroeconomic framework and infrastructure quality are necessary for the industrialization of African countries." He also noted that his country has chosen to industrialize and diversify its economy.

Africa has experienced remarkable growth in recent years. Conference speakers pointed to the continent’s growth rate of 5% in 2012 compared to 2% for the global economy.

The Chairperson of the African Union Commission Nkosazana Dlamini Zuma said, “Industrialization is not a luxury for the region but a necessity,” and pointed out that “in spite of significant progress in some areas, challenges and opportunities remain.”

Some of the challenges include a number of non-tariff barriers to trade. The Executive Secretary of the United Nations ECA, Carlos Lopes also pointed to “the chronic instability that characterizes the African continent in contrast to Asia.” He said, “There is no doubt that Africa requires structural transformation and not structural adjustment. Industrialization is absolutely indispensable to this objective.”

UNAIDS Executive Director, Michel Sidibé participating at the Annual Meeting of the ECA Conference of African Ministers of Finance, Planning and Economic Development and AU Conference of Ministers of Economy and Finance in Abidjan, Cote d’Ivoire, 25 March 2013.
Credit: UNAIDS/Basil Zoma.

UNAIDS Executive Director, Michel Sidibé participated in the conference and he stressed that Africa has a unique opportunity to develop its pharmaceutical industry. Currently Africa is highly dependent on foreign medicines, importing 70% of its drugs. Mr Sidibé said, “Africa must change its approach, its paradigm and production strategy.”

Africa imports 80% of antiretroviral medicines. This heavy reliance on external markets represents a serious health risk to Africa, as evidence suggests that many leading Asian pharmaceutical companies are shifting their focus to the more lucrative markets of the West to be replaced by companies who may not have the same quality credentials. Local production can result in many benefits including: greater product quality assurance, shorter supply chains and fewer stock-outs and the production of drugs for diseases that affect Africa that the rest of the world does not supply.

Mr Sidibé said that to encourage the development of a pharmaceutical industry in Africa the next step was to equip public and private stakeholders with key strategic information to attract funding. A new partnership among the African Union Commission, UNAIDS and other partners is seeking to redress this gap in strategic information through the establishment of the Pharmaceutical Market Data Initiative.

The annual meeting continues until 26 March.

UNAIDS Executive Director Michel Sidibé (left) met with the President Alassane Ouattara of Côte d’Ivoire on 27 February in Abidjan.

Meeting on 27 February with President Alassane Ouattara of Côte d’Ivoire, UNAIDS Executive Director Michel Sidibé noted with concern that the country relies heavily on external aid to finance its national AIDS response—a trend seen in many countries across Africa.

Approximately 87% of HIV investments in Côte d’Ivoire are financed through external sources. A vast majority of HIV medicines used in the country are imported. The Government of Côte d’Ivoire recently reported a funding gap of approximately
US $20 million for its national HIV programme.

To bridge the HIV resource gap, Mr Sidibé urged President Ouattara and his government to explore more diversified sources of financing such as low-interest loans from the African Development Bank and taxes on the use of mobile phones.“Côte d’Ivoire needs home-grown solutions for a sustainable response to the national HIV epidemic,” said the UNAIDS Executive Director, while meeting with President Ouattara in Abidjan.

A call for the local production of HIV drugs

By manufacturing antiretroviral drugs within Africa, Côte d’Ivoire and neighboring countries across the region could avoid drug shortages and benefit from lower drug prices, said Mr Sidibé. The UNAIDS Executive Director also spoke of an urgent need for a single African drug regulatory agency to ensure the faster roll-out of quality-assured HIV medicines to the African population.

Stating that increased domestic financing for HIV is a “national priority,” President Ouattara said that his government would seek innovative funding solutions to reduce its dependency on external aid. He pledged to use his platform as President of the Economic Community of West African States (ECOWAS) to mobilize other African leaders to catalyze the local production of antiretroviral medicines.

Progress in the national response

Mr Sidibé commended the Government of Côte d’Ivoire for the more than four-fold increase in access to HIV treatment over the past five years—from approximately 18 500 to more than 75 000 people. He urged President Ouattara to build on these gains and close the remaining treatment gap of 150 000 people.

The UNAIDS Executive Director praised the Government of Côte d’Ivoire for its efforts to reduce new HIV infections among children: As of end-2011, 54% of HIV-positive pregnant women in the country were able to access services that prevent HIV transmission from mother to child. Mr Sidibé called on the leadership of Côte d’Ivoire to champion the UNAIDS vision of “Zero new HIV infections in children.”

Remaining challenges

During his meeting with President Ouattara, Mr Sidibé noted that the dynamic flow of migrants between Côte d’Ivoire and neighboring countries poses a major challenge to the HIV response in West Africa. A failure to contain the HIV epidemic in Côte d’Ivoire would have negative consequences across the region, he warned. An estimated 3.4% of the population in Côte d’Ivoire is living with HIV—the second highest national HIV prevalence in West Africa.

The UNAIDS Executive Director spoke of the importance of addressing the widespread stigma and discrimination against people living with and affected by HIV. He said that reaching minority and vulnerable groups in Côte d’Ivoire with HIV services would be critical to reversing the epidemic—particularly men who have sex with men, sex workers and people who use drugs.

“West Africa HIV/AIDS epidemiology and response synthesis”

On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.

The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.

Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.

The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.

The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.

“Know your epidemic. Know your response”

The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.

Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.

The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.

This story was first published on UNFPA.org

SAN PEDRO, Côte d’Ivoire

Midwife Odette Koffi-Brou.
Photo: Jane Hahn/Panos/UNFPA

“I’m here because I have four children,” explains a 48-year-old sex worker, who asked that her name not be used. Today she is being tested for HIV at a mobile health clinic, run by the volunteers of the Association for the Promotion of Mother, Child and Family Health (APROSAM) which is supported by the United Nations Population Fund (UNFPA).

After her husband died in an accident, she ran away from her home in Nigeria rather than marry his younger brother as is the custom in her region. With no means to support her children, or pay for their school fees, she turned to sex work to ensure her family’s survival. She earns as little as $2 per client and sends the money to her sister in Abidjan, where her children live.

Midwife Odette Koffi-Brou helped create APROSAM to serve the health needs of the residents of Bardot, one of the largest shantytowns in West Africa. Bardot is home to 80 per cent of San Pedro’s 160,000 residents. Each of its 24 districts is served by two APROSAM volunteers.

For Koffi-Brou, people who engage in sex work should not be stigmatized, but should be treated like any other client in need of health services.

“It’s not our role to talk them out of prostitution,” Koffi-Brou says. “Our role is to sensitize them and protect them against HIV.”

In Bardot, the majority of HIV infections are sexually transmitted or associated with parent-to-child transmission. HIV vulnerability, like poor sexual and reproductive health generally, is exacerbated by social drivers including poverty, gender inequality and social marginalization.

Bringing services directly to the people

Instead of trying to get people living in poverty to visit a doctor’s office, the clinic delivers services directly to their doors in the heart of the shantytown.

Inside the mobile clinic, a pristine reception area leads to the examination room with gleaming medical equipment. The clinic is clean, bright and very professional and is serviced by one doctor, one counsellor and a technician.

Dr. Pascal Attobrat is a volunteer doctor working for the mobile clinic. “We see how AIDS has invaded this population. It is very important to teach the population about how to prevent and treat this disease,” he explains. “Everybody is involved with this disease.”

“The mobile clinic plays a very important role,” said Philippe Delanne, the Côte d’Ivoire Representative for UNFPA, the United Nations Population Fund. “With its trained personnel and volunteers, it can reach multiple towns and villages targeting sex workers, internally displaced persons and those made vulnerable by the crisis in Côte d'Ivoire who might otherwise not have access to health services.”

Staying healthy and positive

Local villagers come out to greet the
UNFPA team's arrival outside of a new
extension of the Bardot Center in
San Pedro. Photo: Jane Hahn/Panos/UNFPA

Clinic volunteer Theodore Magui is HIV-positive. He is happy to be an example showing that you can be living with HIV and still in good health. When clients see a healthy person living with the virus that they also carry, they feel more comfortable in confiding in him.

Knowing your HIV status is empowering, Theodore insists. “When you live in ignorance and fall sick, it’s not good,” he says. “It’s better to have the test, know your status and get the medicine you need.

Stemming the spread of the disease

APROSAM volunteers also visit the homes of those living with the virus to offer support, prevent mother-to-child transmission and provide counselling about treatment.

HIV-positive volunteer Eloise Tohsede threads her way through the maze of shanty shacks. Tonight Eloise is visiting 32-year-old Cecile, whose baby girl was born five days earlier. Cecile’s partner left her when she tested positive for HIV. Her young son also tested positive for the virus, but she doesn’t know yet if her infant has contracted the disease. Eloise urges Cecile to seek treatment using her status certificate, which will enable her to get low-cost medication.

“I’m telling my sisters, ‘You are not alone. Your life can continue. You can take medicine and have hope,’” says Eloise, her smile lighting up the dim room. “If you take your medicine and continue to see a doctor, you can live a long time.”

Community-based AIDS response

UNFPA recognizes that a community-based approach, like that of APROSAM, is essential when responding to the AIDS epidemic and stemming its spread. UNAIDS supports this approach.

“Community-based initiatives are an extremely important part of a multisectoral national response to the AIDS epidemic as they can reach populations who are in real need and who otherwise have no means of access,” said UNAIDS Country Coordinator Cote d’Ivoire, Aoua Paul Diallo Diawara.

“Reaching people with the HIV services they need most is a critical step and a vital step towards achieving universal access to HIV prevention, treatment and care.”

UNFPA is funding the completion of a new maternity clinic in neighbouring Zimbabwe, mirroring the successful Bardot model. The equipped centre, which will offer HIV testing and treatment as well as other maternal and reproductive health services, will cost about $80,000 to complete.

The President of Côte d’Ivoire, His Excellency
Laurent Gbagbo (middle), is leading the drive to
mobilize resources for the implementation of the
county’s national AIDS plan.

The President of Côte d’Ivoire, His Excellency Laurent Gbagbo, is leading the drive to mobilize resources for the implementation of the county’s national AIDS plan.

At a roundtable meeting held in Abidjan at the beginning of May, President Laurent Gbagbo and Prime Minister Guillaume Soro welcomed members of the Government, heads of key departments of the public and private sector, civil society groups including networks of people living with HIV, religious leaders and non-governmental organizations to discuss strategy and action to ensure full funding for the implementation of the 2006-2010 National Strategic Plan. High–level representative of the United Nations system and development partners, and the Director of the UNAIDS Regional Support Team for West and Central Africa also attended on the invitation of the Government of Côte d’Ivoire. 

The 2006-2010 National Strategic Plan contains clear targets for scaling up towards universal access to HIV prevention, treatment, care and support. It was developed in collaboration with a number of partners and its total cost amounts to US$577 million.

In addition to domestic funding for AIDS from the government itself, financial and technical support for AIDS in Cote d’Ivoire is provided by the President’s Emergency Fund for AIDS Relief (PEPFAR), the Global Fund, the World Bank and the UN system.

The 2006-2010 National Strategic Plan contains
clear targets for scaling up towards universal access
to HIV prevention, treatment, care and support.

Addressing participants of the roundtable meeting, the President and the Prime Minister emphasized AIDS as “the major challenge for the country’s development” and called for extensive social mobilization and the involvement of all sectors, particularly the civil society and the networks of people living with HIV. They also stressed the important role of public/private partnerships in the national response.

The leaders appealed to partners to harmonize approaches and to strengthen support, especially at this crucial post conflict period, while committing themselves to ensure transparency and accountability with regard to resources management.

The UNAIDS Director of the Regional Support Team for West and Central Africa Dr Bekele Grunitzky had an audience with the President in the presence of the Minister in charge of AIDS the representatives of WFP, UNICEF, WHO and the UNAIDS Country Coordinator. Speaking on behalf of UNAIDS Executive Director Dr Peter Piot, Dr Bekele Grunitzky expressed thanks and appreciation to President Gbagbo and his government for maintaining their commitment to address AIDS. “We congratulate the President and the country on the progress made towards peace, a prerequisite for the development of the country and the scaling up of the AIDS response,” she said.

“We also applaud the government for their evident commitment and leadership on AIDS. UNAIDS and its cosponsors are fully committed to support Côte d’Ivoire throughout the implementation of the National Strategic Plan,” she added.

An estimated 750,000 people are living with HIV in Côte d’Ivoire, over half of whom are women over the age of 15 (400,000). At the end of 2005, HIV prevalence among adults aged 15 – 49 stood at 7.1%.

GENEVA, 14 April 2011—UNAIDS expresses continued concern over reported disruptions in access to HIV prevention, treatment and care services in Côte d’Ivoire, even as the country moves towards peace and reconciliation.

Côte d’Ivoire has the highest HIV prevalence in West Africa, estimated at 3.4% of the adult population. More than 70 000 people in Côte d’Ivoire were on antiretroviral treatment when the electoral crisis began in late 2010. Interruptions in treatment access can have serious health consequences for people living with HIV.

“We know that conflict and civil unrest can increase a person’s vulnerability to HIV infection and threaten the health of those on antiretroviral treatment,” said UNAIDS Executive Director Michel Sidibé. “In this time of transition, I urge authorities and civil society organizations in Côte d’Ivoire to urgently restore HIV prevention and treatment services for people living with HIV,” he added.

UNAIDS looks forward to working with President Alassane Ouattara, his government and partners in the coming months to restore basic health and AIDS services to all in need.

GENEVA, 22 March 2011—UNAIDS expresses concern over reported disruptions in access to HIV prevention, treatment, care and support in Côte d’Ivoire. Amid the escalating hostilities across the country, many health care facilities have closed down and essential drugs, including antiretroviral medicines, are in short supply.

“Even in times of political instability, countries and the international community must ensure the continuity of essential health services for all people in need,” said UNAIDS Executive Director Michel Sidibé. “We know, for example, that interruptions in antiretroviral treatment can have serious health consequences.”

Côte d’Ivoire has the highest HIV prevalence in West Africa, estimated at 3.4% of the adult population. At the end of 2009, more than 72 000 people in the country were receiving antiretroviral treatment.

UNAIDS calls on the international community for solidarity in ensuring the continuity of basic health and AIDS services.