Middle East and North Africa

AU and NEPAD Agency take the lead in transforming the face of health responses in Africa

ADDIS ABABA, 16 July 2012—A roadmap adopted today by African Heads of State and Government charts a new course for the continent’s responses to AIDS, tuberculosis (TB) and malaria. Developed by the African Union Commission (AUC) and the NEPAD Planning and Coordinating Agency (NEPAD Agency), with support from UNAIDS, the Roadmap on Shared Responsibility and Global Solidarity was endorsed at the 19th Summit of the African Union in Addis Ababa, Ethiopia.

“This Roadmap provides a major step forward in our responses to AIDS, TB and malaria,” said Dr Thomas Yayi Boni, Chairperson of African Union and President of Benin. “Through it, we will pursue African solutions reflecting our continent’s dynamism and potential—like local pharmaceutical production. Together we will invest in the future.”  

Structured around three strategic pillars—health governance, diversified financing and access to medicines—the Roadmap offers a set of practical and African-owned solutions to enhance sustainable responses to AIDS, TB and malaria. It defines goals, expected results, roles and responsibilities to hold stakeholders accountable over a three-year time frame, through 2015.

“This Roadmap will act as a driving force for Africa-owned solutions,” said Dr Ibrahim Mayaki, Chief Executive Officer of NEPAD Agency. “Together we must support African leaders to implement it—that means new partnerships, new financing arrangements and new ways to strengthen sustainable African institutions.”

Health governance

The Roadmap emphasizes the importance of robust policy, oversight and accountability frameworks for investments in AIDS, TB and malaria. AIDS Watch Africa—an African advocacy and accountability initiative—will play a key role in measuring progress and holding national, regional, continental and global stakeholders accountable to their commitments on AIDS, TB and malaria.

“AIDS Watch Africa’s vision of shared responsibility and global solidarity marks a radical departure from business as usual,” said UNAIDS Executive Director Michel Sidibé. “I urge all African leaders to urgently take the Roadmap forward and all development partners to get behind these African efforts in the spirit of solidarity and mutual accountability.”

Diversified financing

According to UNAIDS estimates, Africa will require an annual investment of US$ 11-12 billion for its AIDS response in 2015; that same year, the expected funding gap is US$ 3-4 billion. Similarly, resources available for the continent’s TB and malaria responses fall far short of need.

The Roadmap calls on African governments and development partners to fill these funding gaps together, investing their “fair share” based on ability and prior commitments. Countries are encouraged to develop financially viable national plans with clear targets. Development partners are asked to provide long-term, predictable resources and to align their commitments with African priorities.

"Effective fund mobilization and disbursement are critical for our response," said Mr Idriss Déby Itno, President of the Republic of Chad. “This Roadmap should be a roadmap for each Head of State. We must consider this an opportunity to change our approach not just to AIDS but to the development of our Continent.”

Access to medicines

Many African countries depend on external sources to provide life-saving medicines for their populations. In the case of AIDS, more than 80% of HIV drugs dispensed in Africa are imported. A vast majority of HIV medicines keeping Africans alive are paid for through external aid.

The Roadmap establishes a set of priority actions to accelerate access to affordable and quality-assured medicines in Africa. These include: strengthening African drug regulatory systems; ensuring that countries in Africa acquire essential health-related technologies and commodities through South-South cooperation; and removing trade barriers to allow for the emergence of pharmaceutical production hubs within Africa that can serve regional markets.

AU Chair calls for side event on AIDS and shared responsibility

During the Summit of the African Union, Dr Yayi Boni called on African leaders to hold a high-level side event at the September 2012 UN General Assembly focused on AIDS and shared responsibility. Such an event would offer a unique opportunity to present the Roadmap to the global community, he said.

GENEVA, 13 July 2012—United Nations Secretary-General Ban Ki-Moon has appointed Asha-Rose Migiro as his Special Envoy for HIV/AIDS in Africa.  “Ms Migiro’s experience in responding to AIDS as UN Deputy Secretary-General, combined with her many years as an advocate for health and social justice in Africa, make her uniquely qualified for this important role,” said Mr Ban.

Ms Migiro served as the United Nations Deputy Secretary-General from 2007 to 2012. In that role, she was integrally involved in promoting the AIDS response globally and within Africa, with special emphasis on reducing the vulnerability of women and girls and ensuring the rights of people living with HIV.

“I am honoured to accept this appointment at this crucial moment in the African AIDS response,” said Ms Migiro. “A decade ago, HIV in Africa was almost entirely an epidemic of despair. Today, we celebrate progress against AIDS that we never thought possible. Now is the time to take our efforts to a new level––I am committed to the Secretary-General’s vision that the beginning of the end of AIDS in Africa starts now.”

Ms Migiro served as Tanzania’s Minister of Foreign Affairs and International Cooperation from 2006 to 2007—the first woman to hold that position since the country’s independence. She was previously the Minister for Community Development, Gender and Children for five years. Prior to Government service, she pursued a career in academia, and, served as a member of Tanzania’s Law Reform Commission in 1997 and as a member of the United Nations Committee on the Elimination of Discrimination against Women in 2000.

“I look forward to working closely with Ms Migiro in helping African countries reduce their AIDS dependency and provide universal access to HIV prevention, treatment, care and support services,” said UNAIDS Executive Director Michel Sidibé. “Her experience and leadership will promote African ownership of the AIDS response at the highest levels and reduce the inequities of people affected by AIDS in the continent.”

Africa remains the continent most affected by HIV. In 2010, about 68% of all people living with HIV resided in sub-Saharan Africa. The region also accounted for 70% of all new HIV infections worldwide.

Dubai, 29 June 2010 - At a high-level policy dialogue organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and the World Bank, senior officials from government, donor agencies, development partners and civil society today launched a consensus statement calling for an accelerated regional response to the HIV epidemic in the Middle East and North Africa.

The statement reaffirmed the goal of universal access to HIV prevention, treatment care and support—a commitment enshrined in the 2006 Political Declaration on HIV/AIDS. While recognizing recent gains, the statement outlined a number of key recommendations to bolster the HIV response in the region. These include:

• wider access to HIV prevention;
• free and equal access to antiretroviral treatment and care for all in need;
• improved data and surveillance on the HIV epidemic, particularly for populations at high risk of HIV infection; 
• increased domestic and external funding for the AIDS response;
• the elimination of stigma and discrimination against people living with HIV;
• the removal of political and legal barriers that block an effective AIDS response; and
• the involvement of civil society and people living with HIV in the AIDS response.

The two-day policy dialogue, held under the patronage of HH Sheikh Maktoum Bin Mohammed Bin Rashid Al Maktoum, Deputy Ruler of Dubai, in collaboration with Dubai Police, cast a rare spotlight on an epidemic that is seldom highlighted in the region.

Addressing conference participants, Lt General Dhahi Khalfan Tamim, Commander-in-Chief of Dubai Police, emphasized the importance of a coordinated HIV response. “AIDS knows no boundaries or limits, and has no nationality,” he said. “Unifying the efforts of all stakeholders involved is crucial to halt the spread of AIDS in the region.”

HIV remains a highly stigmatized health condition in the region. In many settings, stigma and discrimination are preventing affected communities from accessing the HIV services they need. “I am here today to ensure that the voices of all those affected by HIV are heard,” said Egyptian actor Mr Amr Waked, a UNAIDS Regional Goodwill Ambassador who attended the meeting. “Social stigma and discrimination in this region must be urgently addressed.”

In his opening remarks, Mr Tim Martineau, UNAIDS Director of Programme Effectiveness and Country Support, noted that focusing resources on key populations—such as injecting drug users, men who have sex with men and sex workers—can change the course of the epidemic in the region. “Universal access goals are achievable if we want them to be,” he said. “We can break the trajectory of the epidemic in this region through strong leadership, a focus on human rights and effective health systems.”

Based on UNAIDS estimates, about 412 000 people were living with HIV in the region at the end of 2008, up from about 270 000 in 2001. However, to date, a lack of reliable data has hindered a clear understanding of HIV dynamics and trends in the region. “The Middle East and North Africa stands as the only region where knowledge of the epidemic continues to be very limited, inaccessible, and subject to much controversy,” said Akiko Maeda, Manager for Health, Nutrition and the Population Sector in the Human Development Department at the World Bank.

According to a new report developed by the World Bank, WHO and UNAIDS, the region has low HIV prevalence in the general population, with the exception of Djibouti, Somalia, and southern Sudan. Most HIV infections occur in key populations at high risk of infection. The report, entitled “Characterizing the HIV Epidemic in the Middle East and North Africa,” is the most comprehensive scientific synthesis of HIV spread in the region since the beginning of the epidemic.

Though all countries in the region are providing antiretroviral medications free of charge, most are falling far short of the goal of universal access to treatment. At the end of 2008, only 14% of the estimated 68 000 in need of treatment were accessing it. “Most people living with HIV do not know their HIV status,” said Dr Jaouad Mahjour, Director of the Division of Communicable Disease Control in WHO’s Eastern Mediterranean Region. “This remains the biggest challenge to expanding antiretroviral therapy in the region. Wider access to voluntary and confidential HIV testing and counselling tailored to the needs of most-at-risk populations is critical.”