Has Universal Access to HIV/AIDS Treatment been realized?

Paul Odhiambo*

“The battle against AIDS ought to be everyone’s battle... I too ask pastoral workers to bring to their brothers and sisters affected by AIDS all possible material, moral and spiritual comfort. I urgently ask the world’s scientists and political leaders, moved by the love and respect due to every human person, to use every means available in order to put an end to this scourge,” (Ecclesia in Africa, Pope John Paul II) On December 1, the international community observed the 23rd World AIDS Day.

Since 1988, the World AIDS Day has been commemorated annually in order to increase awareness about the HIV/AIDS endemic. World AIDS Day’ activities are also meant to re-energize the fight against prejudices, discrimination and stigmatization associated with the HIV/ AIDS scourge. In addition, World AIDS Day is an occasion to continue educating the general populace about HIV and AIDS so that the public could play a critical role in the prevention of new infections and also to manage effectively the treatment and care of those infected and to provide necessary support and care to those affected by the AIDS pandemic. The World AIDS Day theme for 2010 was: Universal access and human rights. From time to time, world leaders have acknowledged that the universal access to HIV and AIDS treatment, prevention, care and support are fundamental human rights.

Former Zambian President Dr Kenneth Kaunda (R) is an activist in the anti-HIV/AIDS campaign while Goal 6 of the Millennium Development Goals aims at combating HIV/AIDS, malaria and other diseases, targets 6A and 6B deal with HIV/AIDS pandemic. Target 6B is specifically about the universal access to treatment for HIV/AIDS for all those who need it by 2010.

When the United Nations launched the Millennium Declaration in 2000, the world leaders had a great ambition that infected people would be able to access and afford the HIV/AIDS treatment by 2010. Why hasn’t this target been realized? What are national leaders doing to ensure that people’s rights to access antiretroviral drugs and other medical services are achieved? How are other members of the society responding to the needs of both infected and affected persons? How do churches, other faiths and various organizations working with people living with HIV/AIDS envisage holistic treatment to ensure that the dignity of infected people is upheld?

In the Service of Faith and the Promotion of Justice, December 4, 2010 According to UNAIDS Report (2010), there were 33.3 million people living with HIV at the end of 2009 compared with 26.2 million in 1999. The estimated number of children living with HIV at the end of 2009 was 2.5 million. In sub-Saharan Africa, the estimated number of people living with HIV was 22.5 million in 2009, comprising 68% of the global total. The estimated 1.3 million people who died of HIV/AIDS related ailments last year in sub-Saharan Africa comprised 72% of the global total deaths of 1.8 million.

Southern Africa is the most severely affected region of Africa by the HIV/AIDS epidemic accounting for 11.3 million in 2009. An estimated 34% of HIV infected people globally reside in ten countries in Southern Africa region. Nonetheless, there has been relative decline of HIV prevalence in East Africa since 2000. Between 2004 and 2008, HIV prevalence decreased in Tanzania by 3.4%. In Kenya, HIV prevalence fell from about 16% in the 1990s to 5% in 2006. The HIV prevalence in Uganda has generally stabilized at between 6.5% and 7.0%. On the other hand, the HIV incidence in Rwanda has been estimated at 3% since 2005.

The enhancement of HIV treatment in the last few years has had positive progress in reducing HIV prevalence in a number of countries. According to 2010 UNAIDS Report 37% of adult and children living with HIV were under antiretroviral therapy in Eastern and Southern African regions by the end of 2009 compared to only 2% seven years ago. In Kenya, AIDS-related deaths decreased by 29% between 2002 and 2007. An estimated 370,000 children contracted HIV during the pre-natal and breastfeeding in 2009. This is a decline compared to 500,000 children who contracted HIV in 2001. It has been observed that access to services aimed at halting mother- to-child transmission has contributed considerably to the decline of HIV prevalence among the newborns.

Though statistics have shown that concerted efforts in the last two decades have led to considerable prevention of new infections and improved HIV treatment, care and support, national governments and other stakeholders must remain vigilant to avoid “complex epidemic of complacency and AIDS fatigue” (Kelly, 2010).

Due to complacency, increases in HIV incidence among the youth have been observed in developed countries where the HIV prevalence had been low. Michael J. Kelly observes that complacency might lead to denial that HIV/AIDS needs exceptional response in low prevalence country because the government in such country might not see the need to mobilize special information, awareness-raising and protective measures to combat HIV/AIDS. A success in controlling new infections and adequate provision of HIV treatment in a high prevalence country can also lead to complacency if stakeholders are “satisfied” with the gains made in containing the HIV/AIDS pandemic hence they are “reluctant” to sustain an aggressive campaign to reduce further or eliminate altogether the HIV/AIDS scourge. It is, therefore, critical that all efforts against HIV/AIDS must be concerted so that complacency does not undermine the gains achieved against the debilitating disease.

The treatment of HIV/AIDS cannot be complete without good nutrition. According to Mombe (2008), nutritional therapy can contribute to the overall well being of HIV/AIDS patients. Good nutrition helps the body to fight HIV by ensuring a better quality of life for patients and their families. Similarly, Kelly (2010) observes that nutritional interventions should go hand in hand with the provision of antiretroviral drugs. It is an open secret that malnutrition makes people living with HIV/AIDS more vulnerable to opportunistic infections. The government and other stakeholders should ensure that people living with the HIV/AIDS get adequate nutritional care and support.

While new constitutions in our countries incorporate economic and social rights in their respective Bill of Rights, the realization of these rights is still elusive to many people in developing countries. Accessibility to clean and adequate water and adequate food is still a nightmare to a substantial number of people living with HIV/AIDS.

Universal access to treatment, care and support may not be realized wholly if nutritional therapy is inadequate. It has also been observed that people living with HIV/AIDS need emotional, psychological and spiritual support as they undergo medical treatment (Kenya Episcopal Conference Catholic Secretariat Commission for Education, 2005). HIV/AIDS patients often experience fear, anger, anguish, loneliness, stigma, discrimination, rejection, judgemental attitudes, hostility and the like.

Kelly (2010) observes that stigma and discrimination are powerful forces that can demean HIV/AIDS patients hence making it difficult to deal effectively with the disease. Though efforts have been made to mitigate these challenges through counselling… In the Service of Faith and the Promotion of Justice December 2010 5 selling, home-based care and spiritual accompaniment from religious people, health workers and other members of the community, a lot has to be done so that the dignity of people living with HIV/AIDS is respected.

Since every human being is created in God’s image and like, all persons have worth and dignity rooted simply in who they are, not what they do or what they have achieved (Overberg, 2003).

In their Pastoral Letter entitled: The AIDS pandemic and Its Impact on Our People (1999), the Catholic bishops in Kenya emphasized that all Christians should overcome any prejudice they feel towards AIDS patients. They reiterated that people should not look down upon those who suffer from HIV/AIDS. In addition, the Church leaders extended their support to “all valid and ethical scientific efforts to find ways of controlling the disease...” stressing that these efforts should ensure that the dignity of human person is respected.

Orobator (2005) observes that the Church, as a community of faith, is appropriately suited to offer spiritual and pastoral response to the people who have been infected and affected by HIV/AIDS. He underlines that the challenges facing people living with HIV/AIDS call for not only medical intervention but also spiritual and pastoral response that could include “direct counselling and... sacramental ministries.”

Orobator further submits that the care for HIV/AIDS patients is manifested in a variety of ministries within the Church. Other studies have also shown that spiritual support offers a great source of comfort and strength to people living with HIV/AIDS (Machyo, 2002).

For the universal access to treatment, care and support to be realized, organizations working on the HIV/AIDS prevalence and all other people of goodwill should show their solidarity with those living with HIV/ AIDS by ensuring that they are able to access spiritual support and pastoral case. According to Overberg (2003) solidarity leads to immediate care, education and to changing social structures.

Our solidarity with the AIDS patients should encompass all aspects of their treatment and the provision of their basic needs. It is important to note that many people living with HIV/AIDS are still not accessing ART due to several factors.

Even where a considerable number of people in Africa get HIV treatment, there are concerns about the finan…In the Service of Faith and the Promotion of Justice December 62010.. Cial sustainability of antiretroviral treatment programmes since they tend to rely on external aid (Kelly, 2010).

If the world powers could pay more attention to the promotion of human development and protection of life, then more resources could still be channelled towards the Global Fund to Fight AIDS, Tuberculosis and Malaria despite the economic crisis experienced in the last few years. The Church, other faiths, social movements, NGOs, private sector, social justice activists must continue with the campaign for integral treatment so that more people can access and afford ART and other services. Indeed the following message of the bishops is still valid today: Ways should be found to make medicines which lessen the impact of the disease and which lengthen life and improve its quality available and affordable to the poorer countries of the world.

We call upon pharmaceutical companies to match their right to compensation with the great human need and the scant resources available to our people (Kenya Episcopal Conference, 1999).

The whole world must unite and sustain the fight against the HIV/AIDS pandemic. International institutions that make decisions affecting lives of people across the globe should ensure that their policies are pro-poor people who often lack resources to access and afford basic needs. It is critical that national governments and other actors engaged in the fight against HIV/AIDS devise mechanisms, strategies and approaches that aim at holistic treatment of HIV/AIDS patients.

More efforts are still needed towards prevention of new infections. Universal access to treatment, prevention, support and care is possible if we all stand up and take measures that inspired by our respect for human life and dignity!

*The writer is the Programme Coordinator (Media Community and Voice) at Jesuit Hakimani Centre, Kenya.

Views expressed in this section do not necessarily represent the opinions of CISA.