Number of people living with HIV/AIDS in Africa to outpace treatment resources by 2020, IOM report finds

The number of people living with HIV/AIDS in Africa is projected to greatly outpace treatment resources by the end of the decade, according to a report released Monday by the Institute of Medicine (IOM), Reuters reports (Fox, 11/29).

"In 2008, more than 33 million people globally had HIV/AIDS, 67 percent of whom were in Africa. In addition, more than 90 percent of the 2.7 million new infections reported that year occurred in Africa, and only half of Africans who should have received ART according to World Health Organization guidelines then in place were treated," according to a National Academy of Sciences press release. "By 2020, the number of infected people in Africa will grow to over 30 million," the report found (11/29).

"Only about 12 million of those 30 million will be eligible for antiretroviral therapy (ART) paid for, in part, by the President's Emergency Plan for AIDS Relief (PEPFAR) and other international efforts; and of those eligible, a little more than half - 7 million - will be likely to receive treatment, according to the report," the Hill's "Healthwatch" blog adds (Pecquet, 11/29).

"Because treatment will only reach a fraction of those who need it … preventing new infections should be the central tenet of any long term response to HIV/AIDS in Africa," Thomas Quinn, a co-chair of the 12-member committee that wrote the report, said on Monday at a press conference in Washington, Nature's "The Great Beyond" blog writes. "Quinn, who directs the Center for Global Health at Johns Hopkins University in Baltimore, Maryland, added that, by the committee's conservative projections, the number of people living with [HIV/AIDS] in sub-Saharan Africa will reach an 'astounding' 70 million by 2050, unless intervening forces come into play," according to the blog.

The report "recommends that both the United States and individual African nations develop ten-year strategic 'roadmaps' for combating AIDS, and that these prioritize prevention. It also urges long-term capacity building to produce the institutions and health workforce in Africa equipped to tackle the epidemic," the blog notes (Wadman, 11/29).

"The lack of trained health care workers … is [already] impacting many African nations' abilities to provide care," the National Academy of Sciences press release states. "In addition, the global financial crisis presents significant challenges to the U.S. and other donor nations in maintaining current levels of support for treatment and prevention in the region, making it essential that African governments take up their share of the responsibility."

"It's going to take careful long-term planning to build adequate work-force and infrastructure capacities for HIV/AIDS prevention and treatment programs in Africa," Quinn said, according to the release. "It is absolutely critical that more coordinated efforts between the U.S. and African governments be negotiated and formalized now to enable better planning that will reduce the impact of the HIV pandemic in the future," he added (11/29).

"'HIV/AIDS is a mosaic of epidemics in Africa,' which will require approaches tailored to local circumstances, [said] David Serwadda … of Makerere University in Kampala, Uganda, and the other co-chair of the committee," MedPage Today writes. "A key element of that tailoring, he said, will be shared responsibility between local governments and donor nations, such as the U.S. Such responsibility could be spelled out in negotiated aid contracts that would link cash to specified milestones," the news service writes (Smith, 11/29).

Among several recommendations, the committee also suggested "[t]he Office of the Global AIDS Coordinator … emphasize a more binding, negotiated contract approach at the country level whereby additive donor resources are provided largely as matching funds for partner countries' investments of their own domestic resources in health. African countries should establish a negotiated contract with U.S. agencies that includes programmatic targets and delineates each partner's responsibilities and expectations," according to an IOM report brief.

Meanwhile, for the long-term fight against HIV/AIDS, the committee recommends, "African governments and international donors should, first, assess and plan for meeting national health workforce requirements. Second, they should better utilize existing capacity within African institutions. Third, the United States and other donors should fund African leadership and management development. Fourth, donors should increase funding for and participation in partnerships designed to build African capacity to address the epidemic," the brief notes (11/29).

A Reuters factbox summarizes global HIV/AIDS statistics (Fox, 11/29).