A Tentative (Mixed) Public Health Victory: The Slow Retrenchment of HIV-AIDS

This is from the Economist, on the state of the fight against HIV-AIDS.

The next UN target is that, by 2020, 90% of those infected should have been diagnosed and know their status, 90% of those so diagnosed should be on ARVs, and 90% of those on ARVs should have suppressed viral loads. That is ambitious, but history suggests those in the field will rise to the challenge.

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The blue line is testament to George W. Bush’s No. 1 foreign policy success: PEPFAR.

But we should count our chickens just yet. The trends in the graph above are not uniform across the globe. As I noted in a previous post, there is quite a bit of heterogeneity both across and within countries. For example, in East Africa, Uganda is lagging Kenya and Tanzania in the quest to tame the virus (see below).

On a different note, this is yet another data point to suggest that Yoweri Museveni has hit the inflection point, and from now on all his machinations to stay in power will wipe out the achievements of his first 20 years in power.

The Continuing Deterioration of Uganda Under Museveni: The Case of HIV & AIDS

In the 1990s Uganda was typically considered to be one of the success stories in the management of the AIDS epidemic in SSA. However, as is shown below, since the early 2000s Uganda has significantly lagged its regional peers (Kenya and Tanzania) in the fight against HIV/AIDS. New infections are declining in Kenya and Tanzania but increasing in Uganda. HIV prevalence also appears to be increasing in Uganda, while either declining or keeping steady in Tanzania and Kenya. Lastly, of the three countries, the rate of decline in AIDS-related deaths has been slowest in Uganda.

It’s not clear to me why the HIV/AIDS situation has deteriorated in Uganda since the late 1990s relative to its neighbors. After all, the three countries have been receiving cash from PEPFAR since 2004 (which explains the decline in AIDS related mortality in the mid-2000s after the use of ARTs became widespread).

My hunch is that this is a reflection of Yoweri Museveni’s gradual loss of control of the state institutions that he has worked hard to build since 1986. It is also probably related to the manner in which Museveni chose to deal with the advent of competitive politics in Uganda after the end of the no-party “movement” era. His strategy has come to be defined by a willingness to basically buy off anyone and everyone — at the expense of state institutions and specific government agencies.

Consider this:

The OIG auditors identified stock-outs of key medicines, particularly those to treat HIV, in 70% of 50 health facilities visited which could result in treatment disruption for patients. Furthermore, 54% of the health facilities visited had accumulated expired medicines. 68% of facilities reported stock-outs of anti-malaria medicines and test kits and 64% of the facilities reported stock-outs of tuberculosis medicines of between one week and three months.

The OIG concluded that the supply chain system does not effectively distribute and account for medicines financed by the Global Fund. There were reported cases of theft, including 40 cartons of artemisinin-based combination therapies; an unexplained difference of US$21.4 million between recorded and actual stocks at the central warehouse; and a difference of US$1.9 million between commodities received and actually dispensed to patients from January 2014 to June 2015 in eight high-volume facilities visited by the auditors.

Screen Shot 2016-03-05 at 9.20.11 AMUganda’s post civil war economic recovery may have been impressive (see graph), but it should no longer be something for Museveni to hang his hat on. It is clear that the longer Museveni stays in office, the more he is going to undo his very own achievements in the earlier years of his three-decade rule.

 

 

UN reports gains in the global fight against AIDS

There is more good news in the area of public health. A couple of days ago I posted on the decline of human mortality rates in the tropics. Now the UN agency for HIV/AIDS, UNAIDS, reports that HIV infection rates, especially of the mother-to-child variety, are on a downward trend.

The New York Times reports:

New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.

The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.

Adding that:

Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.

obama is coming to Africa

US President Barack Obama is scheduled to visit Accra, Ghana in July of this year. Mr. Obama will hold talks with his Ghanaian host Mr. Atta Mills, the President of Ghana. Accompanying Mr. Obama will be his wife Michelle. This will be the Obama’s first trip to Sub-Saharan Africa since Barack Obama, the son of a Kenyan, was elected president of the United States.

It is my hope that besides the expected fanfare that will greet the Obama’s in Accra there will be a sober discussion of the problems afflicting millions of Sub-Saharan Africans – from poverty, to aids, to conflicts to poor governance. I hope that the US president will be as candid as is diplomatically permissible in telling African leaders to style up and realize that the region will continue to remain the global backwater if they do not stop their kleptocratic ways.

I also hope that the president will talk frankly about US commitment to improving living conditions in Africa by allowing for more free trade between the Continent and America (and please do something about the farm subsidies that are killing Global South farmers, Mr. President). President Obama will also most certainly continue former president Bush’s generosity to Africa in tackling AIDS, TB and Malaria through PEPFAR – although minus Mr. Bush’s crazy (religious??) objection to the use of contraceptives in the fight against HIV/AIDS.

I dare say in advance, Akwaba Mr. and Mrs. Obama.