South African Press Association (Johannesburg) - July 31, 2003

The report, which comes ahead of an international Aids conference in Durban, says donor governments should increase spending on HIV prevention to 0.02 percent of their national gross domestic product.

In sub-Saharan Africa about 29 million people, including three million children under the age of 15, are currently living with HIV/Aids. According to UNAids one in every 11 adults in the region is infected with the virus.

In 2002 alone, 3,5-million people in the region contracted HIV, accounting for 70 percent of the world's new infections.

Extrapolating from estimates by UNAids, the group estimates that spending on HIV prevention services in the region in 2002 from all sources amounted to US927-million.

A figure of US1,5-billion annually will be needed by 2005, and US1,65-billion by 2007 for prevention programmes to be brought to scale.

The majority of HIV transmission in sub-Saharan Africa stems mainly from heterosexual behaviour.

The report says that although Uganda, Senegal, Zambia and other African countries have made enormous strides against the epidemic, many people at the highest risk of infection cannot obtain the support needed to change their behaviour to avoid exposure to HIV.

Only eight percent of youths out of school and a more than one third of school-going youths have access to prevention programmes.

Fewer than one in 12 sex workers and their clients are currently targeted by behavioural programmes.

It says current donor contributions are sufficient to provide roughly three condoms per year for every adult man in the region.

Fewer than one in three people at risk have access to programmes which supply condoms. An additional 1,9 billion condoms will be needed to raise all countries to the average procurement level of the six African countries that use the most condoms.

The report says sub-Saharan Africa accounts for roughly 90 percent of the 800,000 infants who acquire HIV each year.

Prevention of mother-to-child-transmission programmes should be a priority in the region, however, it is estimated that 99 percent of women who require such services do no have access.

Many countries in sub-Saharan Africa have a high prevalence of sexually transmitted diseases, accelerating the spread of HIV. It cites rural South Africa saying nearly nine percent of adults have syphilis and almost one in 20 has gonorrhoea.

Only 14 percent of people in need of services to counter sexually transmitted diseases in the region can obtain them.

The document says only six percent of people who want HIV counselling and testing in Africa have access to it.

"With an estimated 29 million people currently living with HIV/Aids, it is likely that the vast majority are unaware they are infected."

Forty-three percent of people at risk are reached by mass media awareness programmes and more than 800,000 infections annually are due to the use of intravenous equipment which is not sterilised during mass vaccination campaigns.

Available interventions and technologies are highly effective in reducing transmission rates. However, prevention strategies will be optimally successful if the region addresses the social and economic conditions that accentuate vulnerability to HIV.

"Limited educational opportunities for girls, for example, are directly correlated with higher teen pregnancy rates and earlier initiation of sexual activity.

"Where a woman's economic security depends on a man, she may be less able to negotiate condom use during sex," the report says.

"From a societal standpoint, countries that are too poor to support even a minimal healthcare infrastructure are unlikely to have the wherewithal to provide VCT (voluntary counselling and testing), STD diagnosis and treatment, or PMTCT."

From a global view, the report says increased spending for prevention should occur in the context of a dramatic, comprehensive scaling up for all HIV/Aids efforts.

Annual spending on treatment for opportunistic infections should increase to US2,6-billion by 2005, while annual outlays on antiretroviral treatment should grow to US1,9-billion. Programmes to support Aids orphans will require at least US1-billion annually.

Because prevention efforts currently fall short of what is needed in every region of the developing world, prevention must be a central priority.

In addition to funding prevention interventions themselves, donors should, in collaboration with multilateral agencies, provide extensive additional support to build long-term human capacity and infrastructure.

The report says development assistance and policy reforms should address social and economic conditions that increase the rapid spread of HIV/Aids.

Research into new prevention strategies and technologies should be strengthened and accelerated, and a sustained effort needs to be made in improving data collection on the epidemic.

-- The group which complied the report comprises Aids experts, researchers and programme leaders from across the globe. It was jointly convened by the Bill and Melinda Gates Foundation and the Henry J Kaiser Family Foundation.

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