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The United Nations Children&#8217;s Fund has called on all governments to protect, sustain and accelerate progress in fighting childhood HIV. UNICEF also says that about 15 per cent of Global Aids-related deaths in children and adolescents occurs in Nigeria. Dr Idris Baba, HIV and AIDS Specialist at UNICEF Nigeria and Dayo Amzat, Managing Director and CEO of Zedcrest Capital joins CNBC Africa’s Kenneth Igbomor for more.

UNICEF: Almost 15% of global AIDS-related deaths in children

UNICEF: Almost 15% of global AIDS-related deaths in children, adolescents occur in Nigeria

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The long term effect of HIV both on a macro and micro economic level has been noted to have an effect on the Gross domestic product (GDP) of countries with high prevalence rates – in fact having a negative effect of between 0.5 and 1.7 per cent on their per capita GDPs. CNBC Africa&#8217;s Arnold Kwizera spoke to Board Chair of Global Fund, Donald Kaberuka for more.

Global Fund Chair Kaberuka assesses the impact of HIV on African economies

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The number of new HIV infections is on the rise in Sub-Saharan Africa (SSA), a step back to previous efforts to curb the virus on the continent. United Nations Population Fund (UNFPA) Regional Director, Mabingue Ngom joins CNBC Africa for more.

UNFPA’s Mabingue Ngom on curbing HIV prevalence in SSA

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Outdated legislation are some of the biggest hindrances in the fight to stop the spread of HIV according to experts at the ongoing Independent Communications Authority of South Africa (ICASA) Conference in Kigali – CNBC Africa&#8217;s Arnold Kwizera caught up with Legal Advisor to Kenya Sex Workers Alliance (KESWA), Munjiru Wanjiru for more.

KESWA’s Wanjiru on how to stop the spread of HIV in Kenya

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Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV and AIDS says a government-driven approach will not make access to healthcare universal to Africans at such a coalition like the African Business Coalition for health is needed. He joins CNBC Africa’s Wole Famurewa to discuss the impact of poor healthcare on quality of life in Africa.

Impact of Africa’s poor healthcare on quality of life

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The One Campaign is calling for strong funding and smart investments to accelerate the fight against HIV over the next four years, as the World marks HIV day on Saturday, the first of December. Innocent Edache, Project Manager, Make Naija Stronger at One Campaign joins CNBC Africa to discuss this development.

One campaign calls for strong HIV funding

<figure><img decoding="async" src="https://images.theconversation.com/files/241212/original/file-20181018-67188-12rs5mq.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="File 20181018 67188 12rs5mq.jpg?ixlib=rb 1.1" /><figcaption>The WHO recommends HIV viral load testing to monitor people on ARVs. 
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<a href="https://theconversation.com/profiles/glenda-gray-111201">By Glenda Gray</a>, <a href="http://theconversation.com/institutions/south-african-medical-research-council-1976">South African Medical Research Council</a>
A United Nations <a href="http://www.unaids.org/en/resources/909090">initiative</a> backed by global experts has set its sights on an ambitious programme to bring an end to the AIDS epidemic by 2030.
The 90-90-90 strategy aims to do this by reaching three targets: 90% of all people with HIV must know their status, 90% of those diagnosed with HIV must receive antiretroviral therapy, and 90% of people receiving antiretroviral therapy must be virally suppressed. When a person is <a href="http://www.who.int/hiv/mediacentre/news/viral-supression-hiv-transmission/en/">virally suppressed</a> it means the virus in their blood is undetectable. The last goal is informed by <a href="https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30183-2/fulltext#%20">evidence</a> that people with a suppressed viral load are less likely to transmit HIV to others.
But a couple of steps still need to be taken before these goals can be met. The first is large scale community based HIV testing that aims to get people tested on an annual basis at the very least. The second is linking testing to care. This is critical because it addresses the gap between a person being diagnosed with HIV to when they start antiretroviral therapy.
The third step is the close monitoring of people taking antiretroviral medication. The World Health Organisation (WHO) recommends <a href="http://apps.who.int/iris/bitstream/handle/10665/255702/9789241512633-eng.pdf?sequence=1">viral load testing</a> as the primary method of monitoring people on antiretroviral therapy. Viral load is the measure of the amount of HIV in a person’s blood and is used as a measure of how well a person is responding to HIV treatment. The lower the viral load the better the health outcomes.
WHO guidelines advise that all patients on antiretroviral therapy receive a viral load test at six months and 12 months, and annually thereafter if the patient is stable. But very few patients receive that level of care.
The main barrier is the time it takes to get test results back from laboratories that are often situated great distances from clinics. One way round the problem is to enable viral load testing to take place at primary health care level – what’s known as point-of-care viral load testing. This would be a game changer. Results would be known immediately and health workers could intervene swiftly by evaluating antiretroviral treatments in real time. This would, in turn, improve treatment outcomes.
But achieving this requires innovation. A new approach is being piloted. The idea is to test if point-of-care viral load monitoring is in reach.
<h2>Testing</h2>
Monitoring the viral loads of people on antiretroviral therapy is an essential part of HIV management. Viral load testing helps doctors determine if a person is taking their medication as prescribed. It also helps to determine if patients are on the correct combination of antiretroviral drugs.
It’s a key part of the arsenal against HIV because research shows that people who are virally suppressed are less likely to pass on the virus to someone else. That makes it a key factor in breaking the cycle of transmission.
The most efficient way of doing this is through point-of-care testing sites. These are based within the community so that patients don’t have to travel long distances to get tests done as well as to receive treatment. This new model is being piloted with the aim of providing convenient access to care for patients.
Currently nearly all viral load testing is conducted in centralised and <a href="http://www.nhls.ac.za/?page=hiv_pcr&amp;id=61">designated laboratories</a>. This means that there can be lags in getting results back to the field. Patients can wait for weeks.
Laboratory based viral load testing is also expensive. Point-of-care testing is also cheaper than lab-based viral loads: health care workers could do the test rather than highly paid technicians.
Small steps have been made in the direction of enabling viral load monitoring to be done at point of care.
But additional equipment is also needed. Pilots evaluating point-of-care viral load testing are ongoing. A pilot is being run using a portable testing machine – the m-PIMA HIV1/2 – that fits on a desk top and can provide an accurate reading of viral load in under 70 minutes.
The machine is being tested to establish whether it meets WHO standards. Once it is given the stamp of approval by the WHO, ministries of health can start the implementation at all sites.
<h2>Closing the gap</h2>
All countries still struggling to bring the HIV pandemic under control are focused on achieving the 90-90-90 goals.
South Africa, which still has the <a href="http://www.unaids.org/en/regionscountries/countries/southafrica">biggest HIV epidemic in the world</a>, with 7.9 million people living with <a href="http://www.hsrc.ac.za/uploads/pageContent/9234/SABSSMV_Impact_Assessment_Summary_ZA_ADS_cleared_PDFA4.pdf">HIV</a>, is no exception, and is making significant progress.
It is edging closer to the target of having 90% of people with HIV <a href="http://www.hsrc.ac.za/uploads/pageContent/9234/SABSSMV_Impact_Assessment_Summary_ZA_ADS_cleared_PDFA4.pdf">knowing their status</a>. And it’s made significant progress on the second target that 90% of people with HIV should be on treatment.
But it has some way to go on the third. While the country is on track to meet the goal that 90% of people on treatment be virally suppressed, it’s advances on this front haven’t been uniform. Some regions of the country still lag behind others. Being able to roll out point of care testing would go a long way in helping close these gaps.<img loading="lazy" decoding="async" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/104432/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" />
<a href="https://theconversation.com/profiles/glenda-gray-111201">Glenda Gray</a>, Research Professor, Perinatal HIV Research Unit and President, <a href="http://theconversation.com/institutions/south-african-medical-research-council-1976">South African Medical Research Council</a>
This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-innovation-can-help-end-the-aids-epidemic-by-2030-104432">original article</a>.

Innovation can assist in the end of the AIDS epidemic by 2030, here’s how

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CNBC Africa is joined by Nqobile Ndlovu from the African Society for Laboratory Medicine with the outcomes of this year&#8217;s International AIDS Conference which was held in Amsterdam. One of these developments includes the first ever price ceiling agreement which could guarantee access and proper healthcare for East and Sub-Saharan Africa.

Key takeaways from the 2018 International AIDS Conference

Griffins Manguro | Ghent University
The World Health Organisation (WHO) has clear markers on the road to controlling the global HIV/AIDS pandemic. By 2020, about nine out of every ten people should know their HIV status. Nine out of ten HIV positive people should be on antiretroviral treatment (ARVs) and the virus should not be detectable in their blood.
<div id="attachment_91118" style="width: 1034px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-91118" class="wp-image-91118 size-full" src="http://cnbc.africa/wp-content/uploads/2017/03/Drugs-Wikimedia.jpg" alt="" width="1024" height="761" />Photo: Wikimedia.</div>
And by 2030, the WHO says, there should be no new infections, no AIDS-related deaths and no stigma or discrimination related to the virus.
These are all good goals and important ways to measure how countries are progressing. In Kenya, where I live and conduct my research, there has been some progress, but more must be done. We see progress in reducing new infections among adults, providing preventive medication and providing oral self-testing for HIV.
But more must be done to reduce new infections among adolescent girls and young women, female sex workers and men who have sex with men.
<h2>Fewer new infections, more people on treatment</h2>
Kenya’s latest HIV progress report shows that new infections are dropping.
There were 40% more people on antiretroviral treatment in 2017 than there were four years ago. Antiretroviral treatment prevents the virus from multiplying and prolongs the lives of HIV positive people. It also lowers the risk of transmission from HIV positive to HIV negative people.
Currently, 66% of the 1.5 million people living with HIV in Kenya are on antiretroviral treatment. The goal is to have at least 90% on treatment by 2020.
This strategy is based on WHO recommendations, which call for a person to start treatment immediately after testing positive. Previously it was recommended that people start ARVs only after their CD4 cells (blood cells which fight infection) dropped below 500 cells per cubic millimetre of blood.
<h2>HIV self-testing strategy</h2>
One of the biggest changes in Kenya’s strategy this year was the introduction of guidelines for oral HIV self-testing.
People can test themselves for HIV using their saliva. In most African countries, self-testing is mostly used for research. Kenya is the first country to introduce a plan to make it available nationally. The aim is to increase the number of people getting tested and link those who are HIV positive to care and treatment.
The self-testing kits became available in public and private health facilities and in some pharmacies countrywide from July and could be bought at subsidised prices. They will help fill a gap in HIV testing. The number of Kenyan adults who have ever tested for HIV has grown between 2008 and 2016, from roughly a quarter of adults to more than half.
But certain populations, such as men who have sex with men, sex workers and adolescents, have low testing rates. This is mostly because they may experience stigma and discrimination when seeking routine HIV services.
Self-testing is a way to avoid stigma and discrimination and boost people’s links to care.
But the process has some problems, including the absence of counselling before and after testing. Without good counselling, people who test positive may not seek treatment and care. This can be solved by community health volunteers following up at people’s homes. They already support family planning, maternal health and child health and can help people who use the kit and test positive.
<h2>Preventive medicine</h2>
Kenya also launched guidelines on the use of pre-exposure prophylaxis (PrEP). This comes in several forms, including vaginal rings and gels. The most common is a tablet taken daily.
PrEP is given to people in high-risk groups who are HIV negative to prevent them from contracting the virus. They may be in relationships where one partner is infected with HIV and the other is not. Others at high risk are male and female sex workers.
Kenya and South Africa are the only countries in Africa that offer this type of treatment as part of a national HIV prevention strategy.
<h2>On alert for infections among youth</h2>
Kenya also started paying more attention to young people. More than half of the world’s new HIV infections are in the group aged between 15 and 24.
In Kenya, too, 51% of new adult HIV infections were in this age group by 2016 – a steep increase from 29% in 2013. It is also the only age group in Kenya that has recorded an increase in new infections. This is because young people tend to have little knowledge about the virus and the behaviours that increase their chances of infection.
People in this age group often have sex while under the influence of alcohol, which can result in poor decisions. Girls in this age group also have transactional sex with older men.
<h2>Looking ahead</h2>
Kenya has made great strides against HIV and in providing care to all HIV infected people. But more work is needed.<img loading="lazy" decoding="async" src="https://counter.theconversation.com/content/88850/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" />The country must step up its efforts to get more men tested. It will also be important to get more adolescents and young girls to adopt HIV prevention methods, and to reduce stigma and discrimination among sex workers and men who have sex with men.
This article was originally published on The Conversation.

Kenya’s HIV progress report: good progress, but also big gaps

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More than 35 years after HIV was first identified, an estimated 78 million people around the world have become infected with the virus and 35 million people have died of AIDS-related illnesses. South Africa has borne the brunt of the epidemic.

HIV-Aids still seen as an African disease 35 years on – Michael Mol

NEW YORK (Thomson Reuters Foundation) &#8211; U.S. President Donald Trump’s plan to cut foreign aid supporting HIV/AIDS treatment could cost 9 million years of lost life in South Africa and Ivory Coast, according to a global study released on Monday.
In the first study to measure the impact of cuts in global investment in HIV care in terms of health and costs, scientists found sky-rocketing deaths in the African nations would far outweigh savings.
South Africa has the highest prevalence of HIV worldwide, with 19 percent of its adult population carrying the virus in 2015, according to UNAIDS, with a total of 7 million HIV-infected people.
Ivory Coast counted 460,000 HIV-infected people in that same year.
Trump’s proposed budget for 2018, made public in May, envisions cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) program, a cornerstone of U.S. global health assistance, which supports HIV/AIDS treatment, testing and counseling for millions of people worldwide.
Under Trump’s budget, which pursues his “America First” world view, PEPFAR funding would be $5 billion per year compared to about $6 billion annually now, the U.S. State Department has said. No patient currently receiving antiretroviral therapy, a treatment for HIV, through PEPFAR funds will lose that treatment, officials have said.
Should the cuts keep South Africans and Ivorians from receiving antiretroviral drugs, an additional 1.8 million HIV-infected people would die over the next 10 years, 11 researchers in America, Europe and Africa concluded, using mathematical models.
The combined deaths amount to nearly 9 million years of life lost, the scientists calculated, in what they said was the first effort to put figures on the proposed cuts.
The researchers measured expected savings over the next decade, whose small scale they said raised efficacy and ethical questions. In South Africa, it would amount to some $900 per year of life lost, compared to $600 to $900 in Ivory Coast.
“We leave it to readers to draw their own conclusions about whether imposing such trade-offs on vulnerable populations accurately reﬂects how donor countries value life in recipient nations,” the researchers wrote in Annals of Internal Medicine.
Savings would eventually dry up over the decade, they found, due to higher costs tied to the spread of HIV amid scaled back screening and care.
&#8220;Would the relatively small savings realized by currently proposed budget reductions be worth these large humanitarian costs?&#8221; said lead author Rochelle Walensky, a professor of medicine at Harvard Medical School.
&#8220;Over the past decade and a half we&#8217;ve spent considerable money to save lives in these and other African nations.&#8221;
Some 90 percent of Ivory Coast&#8217;s funding for HIV care and prevention depends on international aid, while South Africa self-finances most of its HIV expenditures, according to U.S. government figures.
<div class="Attribution_attribution_o4ojT" data-reactid="47">
Reporting by Sebastien Malo @sebastienmalo, Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, trafficking, property rights, climate change and resilience.
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Trump’s HIV aid cuts to cost millions of lives in South Africa, Ivory Coast

When Kato was called into his manager&#8217;s office, the Ugandan driver assumed he would be sent on an errand, not be ordered to take an HIV test and lose his job when it came back positive, leading him to sue his Chinese employer for unfair dismissal.
Kato, 45, is one of two HIV-positive workers who went to court in June to demand compensation from their former employer, China Communications Construction Company (CCCC), in Uganda&#8217;s second high-profile AIDS discrimination case in two years.
&#8220;(My manager) said: &#8216;If you don&#8217;t go for this test, you&#8217;ll be fired&#8217;,&#8221; said Kato, a father of three who declined to give his full name for fear of stigma.
&#8220;We had to go along with it because we were afraid of losing our jobs,&#8221; he said, describing how half a dozen employees were ferried to a clinic in the Ugandan capital, Kampala, to have their blood tested.
Uganda&#8217;s high court will hear the case on Aug. 16, in which the two plaintiffs are asking for 400 million Uganda shillings ($110,000) in compensation, after efforts to reach an out-of-court settlement failed.
The day after his results came back in March 2016, Kato said, his manager asked him to sign a resignation letter.
CCCC, one of the world&#8217;s largest businesses with a focus on infrastructure projects, denied the allegations.
&#8220;No employee has ever been coerced to take a medical check-up,&#8221; it said in court documents.
&#8220;Medical check-ups undertaken by the plaintiffs, if at all, were not calculated to determine their employment, but for their own health benefit.&#8221;
A lawyer for CCCC, which has three major road contracts with Uganda&#8217;s government, and a spokesman for the Uganda National Roads Authority declined to comment as the case is in court.
CCCC&#8217;s administration manager in Uganda, Hao Yunfeng, said in emailed comments that the company offers staff free, voluntary HIV tests.
<h3 data-reactid="54">Privacy</h3>
The other plaintiff, a 27-year-old woman who asked to be identified as Alen, said she was fired after eight months cleaning at CCCC on a monthly salary of 300,000 Uganda shillings ($83).
&#8220;You&#8217;re not supposed to treat people like that,&#8221; said Alen, who has been unable to find another full-time job since she was fired and struggles to support her six-month-old baby.
&#8220;For them, it&#8217;s as if HIV is like flu.&#8221;
CCCC said in its court submissions that Alen stopped coming to work after being warned about her performance.
Both plaintiffs are also suing for infringement of the right to privacy, saying that the clinic shared their test results with their managers, not them.
Eight other employees said, in affidavits supporting Kato and Alen, that their managers also forced them to take HIV tests, which proved negative.
Some 1.5 million of Uganda&#8217;s 40 million people are HIV positive and stigma is rife, with parliament in 2014 criminalizing the intentional transmission of the disease.
Kato&#8217;s lawyer, Stephen Tumwesigye, said in emailed comments that the case highlights &#8220;glaring human rights violations that are perpetrated unabated&#8221; by Ugandan government contractors.
&#8220;We hope that in presenting this case before the court, many Ugandans will come out to report such violations,&#8221; he said.
A kitchen worker employed by China&#8217;s Sinohydro Corporation, which is building a dam on the River Nile, lost an HIV discrimination case in 2016 when the Ugandan court ruled that its decision to transfer her to another department was legal.

Ugandan employees take Chinese firm to court in HIV workplace battle

By Daniel Wesangula
Kenya is the first African country to start using a generic version of the latest AIDS drug that can improve and prolong the lives of tens of thousands of people who suffer severe side effects and resistance to other treatments.
A generic of Dolutegravir (DTG), first approved in the United States in 2013, is being given to 20,000 patients in Kenya before being rolled out in Nigeria and Uganda later this year, with the backing of the health agency UNITAID.
DTG is the drug of choice for people with HIV in high-income countries who have never taken antiretroviral therapy before and for those who have developed resistance to other treatment.
&#8220;I had constant nightmares and no appetite,&#8221; said Nairobi resident Doughtiest Ogutu, who started taking the drug this year because of her resistance to other treatments.
&#8220;My appetite has come back&#8230; My body is working well with it.&#8221;
Ogutu, who has been living with HIV for 15 years, said her viral load &#8211; the amount of HIV in her blood &#8211; has fallen tenfold from 450,000 to 40,000 since she started on DTG.
Sub-Saharan Africa has been at the epicenter of the HIV epidemic for decades and home to nearly three quarters of all people with HIV/AIDS.
UNAIDS aims for 90 percent of people diagnosed with HIV to receive antiretroviral treatment by 2020.
The brand name version of DTG is Tivicay, produced by ViiV Healthcare, which is majority-owned by GlaxoSmithKline.
About 15 percent of HIV patients are resistant, which means the medicines do not work on them, said Sylvia Ojoo, Kenya country director for the University of Maryland School of Medicine, who is monitoring the introduction of DTG.
UNITAID works to bring medicines to market quickly and to reduce manufacturing costs by allowing generic companies to access patents for a small royalty and produce them cheaply for the developing world.
Kenya, with one of the world&#8217;s largest HIV positive populations, has made great strides in addressing HIV in its public medical facilities.
&#8220;The health systems we have in place allow for rapid deployment,&#8221; said Ojoo. &#8220;It makes it relatively easy to introduce new interventions.&#8221;
About 1.5 million Kenyans are HIV positive, with more than two-thirds on treatment, said Martin Sirengo, head of Kenya&#8217;s National AIDS and STI Control Program.
The number of new infections in Kenya has almost halved over the last decade to 80,000 a year, he said, thanks to increased testing, treatment and awareness.
(Reporting by Daniel Wesangula, Editing by Katy Migiro and Ellen Wulfhorst. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, trafficking, property rights and climate change.

Kenyans are first in Africa to get generic of latest AIDS drug

Katharine Houreld | NAIROBI
The U.S. government has suspended $21 million in direct aid to Kenya&#8217;s Ministry of Health amid concern over corruption, the embassy said on Tuesday, giving emphasis to an issue that is a growing liability for the government before August elections.
Support for HIV drugs and other health programs outside the ministry would continue, the embassy said, adding that the United States invests more than $650 million on health in Kenya annually.
&#8220;We took this step because of ongoing concern about reports of corruption and weak accounting procedures at the Ministry,&#8221; the statement from the embassy said. &#8220;We are working with the Ministry on ways to improve accounting and internal controls.&#8221;
The announcement adds weight to a rising number of scandals plaguing the government of President Uhuru Kenyatta, who is seeking a second and final five-year term in presidential, parliamentary and local elections on Aug. 8.
The so-called Afya House scandal, named after the building housing the Ministry of Health, was based on an audit report leaked to Kenyan media in October.
The audit showed the ministry could not account for 5 billion Kenyan shillings ($49 million) and funds meant for free maternity care had been diverted, newspapers reported.
Officials at Kenya&#8217;s anti-corruption commission did not return calls seeking comment on Tuesday, but the ministry of health issued a statement.
&#8220;The ministry has been raising matters raised in the internal audit investigations following the Quality Assurance audit by the National Treasury,&#8221; the statement said.
&#8220;Other autonomous institutions &#8230; are undertaking independent investigations.&#8221;
Last year, Kenya&#8217;s anti-graft chief told Reuters that a third of its state budget &#8211; the equivalent of about $6 billion &#8211; was lost to corruption every year.
The government disputed the figure, blaming poor paperwork. In October, Kenyatta infuriated voters by telling them he could not tackle corruption because his &#8220;hands were tied&#8221;. He criticised the judiciary and other agencies for not doing more about the problem.
Kenyan doctors and nurses say the corruption means that hospitals are often left without basic equipment, from drugs to gloves. Kenyan doctors in public hospitals went on strike from December to March, demanding a pay increase and improved working conditions.
($1 = 103.1000 Kenyan shillings)
(Editing by Larry King)
&nbsp;

U.S. suspends aid to Kenyan health ministry over corruption concerns

As part of his proposed first budget, US President Donald Trump has threatened to cut US aid <a href="https://www.theatlantic.com/politics/archive/2017/04/what-trumps-foreign-aid-budget-means-to-the-rest-of-the-world/521553/">to levels not seen</a> since the 1970s and 1990s. This could have a devastating effect on healthcare in Africa. Alex Ezeh spoke to The Conversation Africa about Trump’s decision and what it means.
How important is US aid been to health?
It’s impossible to overstate the historic importance of US development assistance to Africa. The US provides aid to more than 100 countries to support global peace, security, development efforts and to provide humanitarian relief. Foreign assistance is run through more than 20 different US government agencies. In 2017 alone it planned to spend US$36.6 billion.
The US also contributes to various international organisations such as the Global Fund, which aims to end AIDS, tuberculosis and malaria as epidemics, as well as the United Nations aid agencies, for example. The reality is that these donations have made a significant impact.
Health is particularly vulnerable. For instance, the Global Fund and the US president’s Emergency Plan for AIDS Relief (commonly known as PEPFAR) have jointly turned the tide on the epidemic of HIV/AIDS – in sub-Saharan Africa as well as the rest of the world.
Since it was created in 2002 the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria has contributed to saving an estimated <a href="https://www.theglobalfund.org/en/impact/">22 million lives worldwide</a>. Its greatest impact has been in sub-Saharan Africa, which shoulders the world’s highest burdens of the three diseases.
The Global Fund has invested some US$30 billion over the past 15 years, about 65% of which has been directed to the continent. Even so, the epidemics continue to take an unacceptably high toll in terms of health and economic development.
What big funding programmes could face the chop?
The US has historically contributed one-third of the Global Fund’s budget, which flows to countries with high disease burden of HIV/AIDS, tuberculosis, and/or malaria, and the least ability to pay for services and health commodities for prevention, diagnosis and care. In August 2016 the US government said it would contribute up to US$4.3 billion to the Global Fund.
If the US doesn’t follow through on its pledge, one possible scenario is that other countries may step up more, including national governments in low and middle-income countries. But this may affect other development priorities as funds get shifted from other important programs to cover the huge shortfall.
In terms of big funding programmes at stake, the US has already announced that it’s withdrawing <a href="http://www.bbc.com/news/world-us-canada-39487617">US$32 million in funding</a> from the UN Population Fund which directs money to family planning.
The dramatic declines in maternal and child mortality since 1990 cannot continue without sustained investment in maternal and child health, of which family planning is a crucial element.
We know that when women are able to plan and space their children, it protects their lives and those of their children. Given the projected doubling of Africa’s population to 2.5 billion by 2050 and 4.4 billion by 2100, and the commitment of African governments to fast track investments in human capital to achieve the demographic dividend, now is the time to increase investments in family planning programmes in the region.
The US’s contribution amounts to just over 3% of the UN Population Fund’s total annual budget, so the immediate programmatic impact may be offset by other countries increasing their annual contributions, which has started to take place. For example, in March 2017 Sweden announced a US$22 million increase. The country is considered a top funder to the programme. The longer-term impact, however, could be more pervasive.
How can gaps in health financing be filled?
There’s evidence that aid has stifled domestic investment in health and other social sectors including education, and infrastructure. This must change.
There’s a critical need to meet the demand for full health funding. Donor aid helps, but countries on the continent must contribute more money, and must continue to increase funding more rapidly in coming years.
If aid is cut there’s an opportunity for African countries to make good on their pledges to increase domestic financing for health. (This is true regardless of what the US decides).
The Abuja Declaration, now 16 years old, saw African Union countries commit to dedicating 15% of their national budgets to health. Very few have met this target, and unfortunately, in some countries it’s difficult to know for sure whether funding has gone up or down due to poor quality data.
One thing is for sure: this is a rapidly shifting global health development landscape. Now is the time to explore innovative financing mechanisms and partnerships with traditional and non-traditional donors, and also for citizens of African countries and donor countries alike to hold their national decision-makers to account in honouring their commitments.

How Trump’s proposed US aid cuts will affect healthcare in Africa

By Yasin Kakande
Thomson Reuters Foundation
Seven-year-old Esther Agutti weighs 7 kilos &#8211; a third of the weight of the average child her age.
She has been in hospital in Katakwi, eastern Uganda, for three days. She was painfully thin when she was admitted and had diarrhoea and vomiting, said Loyce Akelo, a senior doctor.
Esther&#8217;s family, who are farmers, have been hit hard by the drought that has scorched East Africa. They have had to ration the little food they have to survive &#8211; but this is particularly dangerous for Esther, who, like her parents, is HIV-positive.
Esther is receiving anti-retroviral (ARV) treatment &#8211; which slows the development of HIV and holds off its progression into AIDS. But crucial to the proper functioning of these drugs is good nutrition, doctors say.
<blockquote>&#8220;The hospital has received 232 children, more than half of all the children on HIV medication in the district. They lack food and have been malnourished since the start of this year,&#8221; Akelo told the Thomson Reuters Foundation in Katakwi.</blockquote>
&#8220;It is important that someone with HIV first takes a meal before taking on drugs.&#8221;
Poor nutrition can affect the absorption of the drugs in the body or leave the body less able to tolerate the medication.
Akelo said the hospital is giving Esther meals to help her take her drugs but the arrangement is just temporary and she will soon be sent home.
Esther&#8217;s father, Moses Agutti, said the family was hoping to receive government food handouts but they weren&#8217;t yet being distributed in his village.
&#8220;We have been to the county offices and officials there have promised us that there will be food relief coming though they are not sure of when,&#8221; he said.
&#8220;I am struggling to get some food for the family from the garden. It&#8217;s not enough because of the drought.&#8221;
In December, Uganda&#8217;s President Yoweri Museveni announced he was redirecting funds budgeted for roads to provide relief food to areas affected by drought and hunger.
DYING
A poor rainy season has led to extensive drought across East Africa, destroying crops and killing livestock. Uganda&#8217;s neighbour Kenya has already declared a national disaster, with the Red Cross estimating 2.7 million people are in need of food aid as a result of lack of rains.
In Uganda, the worst affected districts are in the north and east, where district authorities have warned the drought may disrupt ARV treatment as HIV-positive children and their elder relatives are hungry and unable to take the drugs.
Walter Elakas, a district head in Katakwi, said parents of HIV-positive children are struggling to give their children a meal before midday.
David Tumwesigye, an official at the Ministry of Gender Labour and Social Development, said in a news conference last month 11.7 million Ugandan children are on the verge of dying of hunger and pneumonia due to lack of food and proper housing: that means about six in 10 children are starving.
&#8220;The situation has been worsened by the dry spell that has hit the country hard and if action is not taken many children are likely to die or have permanent effects on their health,&#8221; he said.
ADULTS TOO
An estimated 1.5 million people live with HIV/AIDS in Uganda, of whom nearly 100,000 are children under 15, according to UNAIDS.
The effects of drought are also felt by adults living with the virus.
In Acholi village on the outskirts of Moroto town in northern Uganda, Teddy Adwin, a 30-year-old mother who was HIV-positive, was still being mourned a week after her death.
Her sister, Mary Akol, who also lives with HIV, said Teddy was one of four in their family who had died during the drought.
&#8220;I feel dizzy after taking the drugs without having a good meal,&#8221; Akol said. &#8220;The medicine we take becomes toxic to the body whenever we miss a meal.&#8221;
Mariko Ingodi, an HIV-positive army veteran in Acholi, said doctors had warned him that he would die if he continued taking ARV drugs without food.
&#8220;Many of us have stopped taking the drugs as we can go three days without eating; we have resorted to eating the leaves of wild trees,&#8221; he said.
(Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women&#8217;s rights, trafficking, resilience and climate change. Visit news.trust.org)
&nbsp;

For Ugandan children, hunger and HIV make a deadly mix

November 2016 marked the 25th anniversary of the death of rock star Freddie Mercury, ‘The Great Pretender.’ Back then the stigma of an AIDS death was such that not enough was made of the horror that is the slow and painful death from AIDS (even if you have all the money in the world!) Only now do we see internet documentaries on the terrible end of Freddie.
Watch them! Feel them! Know them!
<img loading="lazy" decoding="async" src="/media/19341554/aids_graph_1_27feb2017_600x310.jpg" width="600" height="310" alt="Aids Graph 1_27Feb 2017"/>﻿
South Africa’s AIDS death rate may have declined from just below 50% to 28% today. But there are still 150 000 AIDS related deaths per annum. And nearly all are the poorest of the poor.
Before the national budget the topic of ‘sugar tax’ was trending. Are we bonkers? Concentrating on raising less than R1-billion in the context of a national budget of R1,4 trillion.
Yes! We are all The Great Pretenders.
New HIV infections are still sitting at around 330 000 per annum.
<img loading="lazy" decoding="async" src="/media/19341561/aids_graph_2_27feb2017_600x256.jpg" width="600" height="256" alt="Aids Graph 2_27Feb 2017"/>﻿
With effect from the 1st of September 2016: all  HIV positive children, adolescents and adults regardless of the CD4 count will be offered ART (Anti Retroviral Treatment), prioritizing those with a CD4 of less than 350. That must be a very cold comfort to an HIV victim. They should be asking ‘how did this ever happen to me?’
And that’s not the end of the problem.
Rock star economist Thomas Pikkety tells us that a 1% real economic growth rate is OK. But goes on to qualify that with ‘so long as that’s 1% above the population growth rate. So lets graph it.
<img loading="lazy" decoding="async" src="/media/19341568/aids_graph_3_27feb2017_595x300.jpg" width="595" height="300" alt="Aids Graph 3_27Feb 2017"/>﻿
South Africa is going nowhere slowly!
On 15 February 2017 the World Bank reported on the state of the  South African Economy to parliament&#8217;s <a href="http://link.email.dynect.net/link.php?DynEngagement=true&amp;H=Kcx6DL4Dm6j8l5b8EGQG5sD79SAgq9f7Q5QkowEJ0Fx2l%2Bl%2BX2VFbW8DCwKpdCyuc5%2BOEfVv8EiLojP%2FsV1%2BmnPQMyAy%2BkvCz0Sl53G6wMTQf7muJDXs0w%3D%3D&amp;G=0&amp;R=https%3A%2F%2Fpmg.org.za%2Fcommittee%2F61%2F&amp;I=20170223062401.000001753155%40mail6-23-ewr&amp;X=MHwxMDQ2NzU4OjU4YWU3ZmZhOWRjODYyNWE4YTI4OTdhMTs%3D&amp;S=sYABwP1mxp9XqYAfwwObDMJNjS8APWWqSf-95el1bEM">Standing Committee on Appropriations</a>.
<ul>
<li>The National Development Plan (NDP) targets six percent unemployment rate by 2030. To achieve this will require 600 000 new jobs annually from 2012 to 2030. However, on average since 2012, South Africa has been able to make only 250 000 jobs annually.</li>
<li>As a consequence of population growth and youth entering the labour market, unemployment has remained very high, particularly for unskilled and semi-skilled workers, and for new entrants such as woman and the youth.</li>
</ul>
Is anybody out there listening?
Of course this now all gets caught up in a massive blame game. The primary target is JZ as SA has made no progress under his regime. Let alone all the other scandals.
But the problem is not all of JZ’s making.
Yes, South Africa’s past pre-1994 will always be with us.
But we had a chance to make great progress post-1994!
<img loading="lazy" decoding="async" src="/media/19341575/aids_graph_4_27feb2017_600x321.jpg" width="600" height="321" alt="Aids Graph 4_27Feb 2017"/>﻿
Before the financial crisis of 2008/9 South Africa was growing faster than its population and there was a real decline in national debt. We were on the right trajectory.
President Mbeki and then Finance Minister, Trevor Manuel, basked in the glory of it all. If they ever gazed into the future they saw f&#8212; all! They did nothing to accelerate growth rates that may have helped South Africa really grow. Mbeki also shunned the HIV/AIDS pandemic leaving us with 7 million HIV infections today.
To be kind Mbeki and Manuel were the patron saints of Great Pretenders.
For the last five years South Africa has achieved little more than struggle to contain the fantastic debt trajectory established between 2009 and 2012.
If South Africa is ever to be ‘ Free at last! Free at Last’ it is going to take a superhuman effort from all of us.
Every one of us can make a contribution instead of procrastinating and playing the blame game. As Kipling put it so many years ago when he wrote for his beloved son. 
If you can fill the unforgiving minute     With sixty seconds’ worth of distance run,    Yours is the Earth and everything that’s in it,        And—which is more—you’ll be a Man, my son! 
Now shove that in your pipe and smoke it! And see the numbers to the 2017/18 national budget work per the <a href="http://link.email.dynect.net/link.php?DynEngagement=true&amp;H=Kcx6DL4Dm6j8l5b8EGQG5sD79SAgq9f7Q5QkowEJ0Fx2l%2Bl%2BX2VFbW8DCwKpdCyuc5%2BOEfVv8EiLojP%2FsV1%2BmnPQMyAy%2BkvCz0Sl53G6wMTQf7muJDXs0w%3D%3D&amp;G=0&amp;R=https%3A%2F%2Fwww.youtube.com%2Fembed%2FhBHGpKWb2Vo%3Frel%3D0%26modestbranding%3D1&amp;I=20170223062401.000001753155%40mail6-23-ewr&amp;X=MHwxMDQ2NzU4OjU4YWU3ZmZhOWRjODYyNWE4YTI4OTdhMTs%3D&amp;S=0jAxebfTEgPSXtEt7ed0z0xnWtuWVNmGomfqy9sUp7w">VIDEO</a> .
Have a bottle of anti-diarrhetic ﻿handy! This is frightening stuff.
 
Professor Matthew Lester,  BCom (Rhodes) CA(SA) H Dip Tax Laws (Wits), is an Associate Professor at Rhodes Business School. In 2001, he was the winner of the Vice-Chancellor&#8217;s award for distinguished teaching. Apart from teaching at Rhodes, Matthew lectures to a wide range of South Africans on taxation and money matters. He also writes the weekly column ‘Tax Talk’ in the SundayTimes.﻿

HIV

UNICEF: Almost 15% of global AIDS-related deaths in children, adolescents occur in Nigeria

Global Fund Chair Kaberuka assesses the impact of HIV on African economies

UNFPA’s Mabingue Ngom on curbing HIV prevalence in SSA

KESWA’s Wanjiru on how to stop the spread of HIV in Kenya

Impact of Africa’s poor healthcare on quality of life

One campaign calls for strong HIV funding

Innovation can assist in the end of the AIDS epidemic by 2030, here’s how

Key takeaways from the 2018 International AIDS Conference

Kenya’s HIV progress report: good progress, but also big gaps

HIV-Aids still seen as an African disease 35 years on – Michael Mol

Trump’s HIV aid cuts to cost millions of lives in South Africa, Ivory Coast

Ugandan employees take Chinese firm to court in HIV workplace battle

Kenyans are first in Africa to get generic of latest AIDS drug

U.S. suspends aid to Kenyan health ministry over corruption concerns

How Trump’s proposed US aid cuts will affect healthcare in Africa

For Ugandan children, hunger and HIV make a deadly mix

Op-Ed: Budget 2017/18 – "The Great Pretenders?"

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Advertise With Us

HIV

UNICEF: Almost 15% of global AIDS-related deaths in children, adolescents occur in Nigeria

Global Fund Chair Kaberuka assesses the impact of HIV on African economies

UNFPA’s Mabingue Ngom on curbing HIV prevalence in SSA

KESWA’s Wanjiru on how to stop the spread of HIV in Kenya

Impact of Africa’s poor healthcare on quality of life

One campaign calls for strong HIV funding

Innovation can assist in the end of the AIDS epidemic by 2030, here’s how

Key takeaways from the 2018 International AIDS Conference

Kenya’s HIV progress report: good progress, but also big gaps

HIV-Aids still seen as an African disease 35 years on – Michael Mol

Trump’s HIV aid cuts to cost millions of lives in South Africa, Ivory Coast

Ugandan employees take Chinese firm to court in HIV workplace battle

Kenyans are first in Africa to get generic of latest AIDS drug

U.S. suspends aid to Kenyan health ministry over corruption concerns

How Trump’s proposed US aid cuts will affect healthcare in Africa

For Ugandan children, hunger and HIV make a deadly mix

Op-Ed: Budget 2017/18 – "The Great Pretenders?"

News Tips

Advertise With Us

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