In West Africa, progress on family planning but millions not treated for HIV

Women gather for the launch of the national family planning campaign in a low-income neighborhood of Bamako, Mali in April.

This was originally published on Global Health TV on April 26, 2016.

BAMAKO, Mali — Last year, there were several reports of how West Africa, after decades of seriously lagging behind the rest of the world (and Africa) in family planning, was finally starting to embrace it. IntraHealth International covered this topic extensively on its Vital blog, and I wrote about my own views of family planning in Mali here at Global Health TV.

Senegal, in particular, emerged as a family planning leader in West Africa and provided hope for the rest of the region. The three main reasons for Senegal’s success were strong political will, better coordination and collaboration and innovative approaches, according to Babacar Gueye, IntraHealth country director in Senegal.

New programs here in Mali, like Keneya Jemu Kan (USAID Communications et Promotion de la Santé, in the Bambara language), are making a major push to increase health indicators beyond the anemic progress of the past three decades. For example, the percentage of married women using any modern method of family planning in Mali has only increased from 1.3% in 1987 to 9.9% in 2013, and Keneya Jemu Kan is working to bend that rate upwards. (Full disclosure: I work as a consultant for Keneya Jemu Kan).

But a disturbing new report from Médecins Sans Frontières (MSF), or Doctors Without Borders, claims that similar progress is not being made in HIV/AIDS. On the contrary, MSF claims that millions of people in West and Central Africa are being left out of the global HIV response despite globally agreed goals to curb HIV by 2020, and is calling on the international community to develop and implement an urgent plan to scale up antiretroviral treatment for countries where critical medicines reach fewer than one-third of the population in need.

The 25 countries that make up West and Central Africa account for one in five new HIV infections globally, one in four AIDS-related deaths and nearly half of all children born with HIV. MSF points out that the region has a low HIV prevalence, with 2.3% of the population infected with HIV, but that is three times the worldwide prevalence of 0.8%, and pockets of the region have prevalence over 5%.

HIV prevalence in West and Central Africa is lower than Eastern and Southern Africa. This lower prevalence has led to “poor knowledge of the disease among the general population, political leaders and health workers” and less funding by international donors.

“The converging trend of international agencies to focus on high-burden countries and HIV hotspots in sub-Saharan Africa risks overlooking the importance of closing the treatment gap in regions with low antiretroviral coverage, said Dr. Eric Goemaere, MSF’s HIV referent. “The continuous neglect of the region is a tragic, strategic mistake. Leaving the virus unchecked to do its deadly work in West and Central Africa jeopardizes the goal of curbing HIV/AIDS worldwide.”

Pape Gaye, president and CEO of IntraHealth and a native of Senegal, says that the problems cited by MSF are another example of why the international community needs to mobilize to help countries strengthen their health systems.

“The difficulties experienced by Ebola-affected countries to address the disease and the inabilities of countries to protect and sustain gains, including recent ones in family planning and reproductive health, point to the need for more attention to health systems strengthening,” said Gaye. “The region of West and Central Africa is poised to enter a new era of growth and prosperity but the momentum will dramatically slow down or vanish unless coordinated effort is made to rid the region of HIV/AIDS. This is not the time to continue erratic and fragmented interventions which produce results such as those described in the MSF report.”

The Ouagadougou Partnership, an initiative of nine French-speaking West African countries to promote family planning started in 2011, set a goal of reaching one million new family planning users in these nine historically under-performing countries by 2015. At their annual meeting in December 2015, members of the Partnership celebrated the achievement of this goal.

MSF is now calling for the same kind of urgent call to arms to address HIV/AIDS and a plan to achieve progress, much as the Ouagadougou Partnership did to address family planning. If we can do it for family planning, we should be able to do it for HIV/AIDS and thereby ensure that West and Central Africa do not thwart our efforts to achieve an AIDS-free generation.