Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.

Reuters NewMedia - Thursday November 15, 2001
Matthew Green

More than six months after African presidents abandoned years of denial to declare the AIDS epidemic an emergency at a meeting in Abuja, Nigeria, health experts say far too little has been done to restrain it.

"There's a lot of talk and many people think there's a lot more talk than action," said Bunmi Makinwa, team leader for U.N. AIDS workers in eastern and southern Africa.

Governments say the main problem is a lack of cash on a continent where many countries have only a handful of dollars to spend per person on health each year.

But critics argue that the problem goes deeper than money, saying the quality of leadership, not poverty, is the key.

A glance at the map reveals striking contrasts -- from apparent successes in Senegal and Uganda where governments acted fast, to a sluggish response from politicians in South Africa.

Unless leaders start keeping their promises to act on AIDS, activists say, there is little hope of rolling back a tide of infection threatening to claim countless more lives.

MEDICINE CUPBOARDS BARE

Leaders say it is small wonder they are struggling when the world's poorest continent is saddled with caring for 70 percent of the world's estimated 36 million HIV/AIDS cases.

Cutting down swathes of teachers, civil servants and farmers, the epidemic is an economic disaster that is eating into government finances, weakening their ability to fight back.

"The biggest issue we have is resources to tackle both the preventative and curative aspects of the problem," said Kenyan Health Minister Sam Ongeri.

Leaders meeting in Abuja in April pledged to raise spending on health, currently about four percent of gross domestic product in Africa. But resources are scarce.

Wars make matters worse. Ethiopia says it spent $3 billion on a two-year conflict with Eritrea, enough to fund a basic AIDS prevention and care scheme for the whole continent for a year.

The United Nations hopes to mobilize billions of dollars in a war chest to fight AIDS in the next few years, but some experts fear that cash alone will not solve the problem.

LEADERSHIP CRUCIAL

Africa's mixed response to the epidemic shows that leadership can make the defining difference.

Activists say South Africa shows how political controversy has blunted the fight in a country with an estimated five million AIDS sufferers, more than any other in the world.

Despite a storm of criticism, President Thabo Mbeki continues to stand by his skepticism about whether HIV causes AIDS, and last month repeated his view that life-prolonging anti-retrovirals are as toxic as the disease they aim to treat.

"We need the president, the minister of health and most cabinet ministers to change their tune to end the confusion," Zackie Achmat, head of the country's leading activist group, Treatment Action Campaign, told Reuters. South Africa is not alone. The continent abounds with governments -- from Zimbabwe to Ivory Coast -- which according to critics have been slow to face up to the disease.

Senegal, in contrast, has managed to cut the infection rate to 1.4 percent from some two percent, a success health workers in the west African state attribute to early government action.

Stigma has played its part. For years African leaders shied away from discussing an epidemic so closely linked to sex and intimacy, delaying the policy response.

A growing vanguard of presidents like Festus Mogae in Botswana and Olusegun Obasanjo in Nigeria have won praise for talking more openly, but many remain reticent.

Kenyan members of parliament burst into a rare peal of laughter at this year's budget speech. The joke? The finance minister had announced a waiver on VAT for condoms.

SLOWLY WAKING UP

Africa's efforts to stem the spread of infection are gaining momentum, following the lead of ambitious programs in places like Uganda and Nigeria, but pitfalls litter the path ahead.

Africa's penury means the vast majority of money spent on AIDS often comes from donors, leaving health ministries prone to feel marginalised in programs dominated by Western experts.

Countries like Tanzania and Botswana are providing drugs to HIV-positive mothers to prevent their children getting infected, but experts say this will do little to shut down the engine of the epidemic -- people having sex without condoms.

Health experts say few governments have directly targeted those most at risk such as sex workers and vulnerable teenage girls -- groups with little political clout.

"Communities can organize themselves, but without political will it just doesn't work," said Marc Aguirre, director at the medical center of the U.S. AIDS charity HOPE in Ivory Coast.

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