I have mixed feelings about ICASA 2011. I believe that the gains in the fight against the HIV/AIDS epidemic were a cause for celebration while the challenge of sustaining the gains was a matter of serious concern.
When I attended the previous ICASA in Dakar, Senegal, the mantra was ‘Know your epidemic and know your response’. This time, the focus is more on country ownership, scaling up the interventions that are believed to ensure sustaining the gains.
The times have changed; there is a talk of European recession looming on the economic horizon. Ironically, not many people think of Africa as a bread basket anymore. During the final pre conference dates, The Economist published an interesting article in its December 3 edition depicting Africa as a ‘rising’ continent.
In my view the following are some of the highlights of ICASA 2011:
I would like to start by commenting on the presentations on treatment as prevention. This is an important milestone for those working in the area of prevention. The discourses and global plans on elimination of mother to child transmission of HIV is another important success which, according to one presenter, is a model of translation of policy into practice. It has been also noted that there is a lesson from countries like Botswana in this regard. However, the coverage of Pediatric ARV treatment is embarrassingly low. Combination prevention is also given more emphasis in this ICASA than in the previous ones.
There is also concern about data on hidden epidemics among IDUs and MSMs. There is not enough statistics in these areas and they are shrouded by legal and policy complexities in many African countries. I have heard in one of the presentations that as the economy of African countries grows, we may see the epidemics in IDUs in the future.
It has been noted that TB-HIV coinfection management has been improved significantly this time around and a new policy will be coming early in 2012.
ICASA 2011 also will be remembered by ‘fund the fund activists’. During my attendance, I was trying to read between the lines around the decision of Global Fund board meeting in Accra, Ghana. In the midst of my confusion, I listened to a presentation by the deputy Executive Director of Global Fund who said, ‘We are here to exist’.The other interesting yet controversial presentation was made by Stephen Lewis. He lamented that despite logical arguments for working interventions in treatment, prevention countless lives were lost to the Epidemics because of inaction. He sternly rebuked the West describing the attack on the Global Fund as “the latest blow in a long list of betrayals on the part of the donor countries, in this instance the Europeans in particular”.
Time will show how Africa responds and where donors will stand in this critical juncture in history.
Abiy Hiruye (MD, MPH)