Combatting HIV/AIDS in Sub-Saharan Africa -- Investing in Health Can Make the Difference

Globalization is a powerful driver for development and the generation of wealth. But even as the world becomes more interconnected, hundreds of millions of women, men and children are still confined to extreme poverty, hunger, illiteracy and disease. One of the most devastating infectious diseases of this era is HIV/AIDS, which is killing more than 2 million people annually.

Sub-Saharan Africa continues to bear the heaviest burden. According to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS), the region is home to more than two thirds of all people living with HIV worldwide. Africa symbolizes the consequences of insufficient investments in health, which have enabled HIV to grow into a global pandemic.

During the last several years, however, we are beginning to see signs of a turnaround. A tenfold growth in investments to tackle AIDS since 2000 has begun to yield results. Through the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States President's Emergency Plan for AIDS Relief (PEPFAR), well over 2 million people are receiving AIDS treatment. The number of people in Africa with access to antiretroviral (ARV) treatment has increased eightfold. And in some countries, the rates of new HIV infections have decreased as investments in prevention and treatment have taken effect.

Those who are getting well are able to care for their children, return to work and lead meaningful, productive lives. Eventually, societies hobbled by severe declines in human capital due to illness and death will be able to translate these gains into economic growth, since healthy populations live longer and are therefore more productive. A study by Yale University's Economic Growth Center, for example, showed a 20-per-cent increase in labour force participation and a 35-per-cent increase in hours worked among AIDS patients in western Kenya within six months of starting treatment with antiretroviral drugs.

In addition, investment in HIV prevention and treatment gives countries the opportunity to begin thinking about how the building blocks of sustainable social protection can be put in place, such as health insurance. Rwanda provides an inspirational example in the form of community-based health insurance schemes that use international aid as seed money to pay health insurance premiums for the poor. The rationale is that health insurance, properly implemented, gives people better financial access to health services, contributes to sustainability and, on current evidence, increases utilization of health facilities.

The money used for AIDS prevention and treatment programmes is also having an effect on health systems. Malawi had lost half of its health workers in the 1990s due to emigration and AIDS mortality. Investments by the Global Fund, the United Kingdom's Department for International Development and the World Bank are giving the country the means to fund an emergency human-resource strategy and provide training for health-care workers. Together with the roll-out of ARV treatment to health workers, this is investing in the very people who will sustain the fight against AIDS.

Ethiopia provides another example of how funds for AIDS programmes are contributing to better health care for all. Financing from the Global Fund, PEPFAR, the World Bank and the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization) is paying for the training of 30,000 community workers, who will provide a wide range of services for patients in rural areas, including treatment for AIDS, tuberculosis and malaria, as well as maternal health and immunization.

Medical solutions alone will not succeed in beating the virus. Stigma and discrimination against people living with HIV must be fought in schools, on factory floors, in the media and legislatures. Responses must include treatment and prevention, notably by helping the most vulnerable groups to protect themselves. By working to fight diseases like AIDS, tuberculosis and malaria, we can contribute to fighting poverty, promote social development and increase equity in health care. That is globalization with a human face. That is globalization that will benefit all.