HIV is a cunning, adaptable and formidable foe that requires highly innovative counterattacks in an era characterized by drying up wells of donor financial support, an expert has said.

Prof Nana Poku, the Executive Director for Health, Economics and Research Division (HEARD) at the University of KwaZulu-Natal who is also the newly-appointed Acting Vice Chancellor of that university, made this observation during a dialogue with Champions of an HIV Free Generation and other stakeholders.

The dialogue, which also brought together Cabinet Ministers, Members of Parliament, representatives of National AIDS Councils, UN agencies and others, took place in Pretoria in September 2018 to explore innovative ways of increasing the use of domestic resources in responding to HIV and AIDS.

Prof Poku said the African continent had borne the very brunt of the assault of the HIV epidemic years with glaring signs that a lot still needs to be done to halt and reverse it. “We are not really winning against the epidemic, and that is not really because we are not trying hard. I think the effort that has gone in particularly over the past ten years, has been on parallel to any of the public health responses that the world has faced ever since recorded time,” he said.

His view was that more money, attention and heartache had been spent on the HIV epidemic than any other known epidemic in modern history and so debating lack of progress at this point would not be a fair reflection of the efforts that have been put in. “I think in the midst of the despondency and despair we also need to take heart in the innovative methods and methodologies we have adopted and learned from this epidemic that will stand us in good stead as a continent in moving ourselves forward, particularly as we chase down the biggest challenges of all, which is universal health coverage under the Sustainable Development Goals (SDGs),” he said.

Prof Poku acknowledged the fact that resources for responding to HIV and AIDS were dwindling due to challenging times driven by external forces. “Development financing has remained static since 2011. In real terms it means we have had a 40% decline in development assistance, particularly focusing on health. There are no further additional commitments by developing partners as a result of their own economic and political challenges and also a broad recognition that priorities in the world under the Sustainable Development Goals (SDGs) have shifted.”

He said the driver of the change in terms to the drying up of the well of external financial resources coincided neatly with the expansion of the agenda that the world committed to under the SDGs. “AIDS is now positioned amidst over 172 different commitments the world signed up to in moving toward the SDGs. One clear implication of that is that irrespective of our expectations, we will have to do more with less. There is no new money that is going to make itself available, and it is actually more likely that the existing finances will see a gradual decline post 2021.”

Already, he said, there was the retrenchment of American financing for the epidemic which continued to account for three quarters of the global spending on the HIV epidemic.“As they retrench, new partners are not necessarily stepping up to the table. They are also diversifying their investments in terms of development assistance, while at the same time there is also a change in the way development support is offered to developing countries.”

Prof Poku said the re-classification of some countries as middle income economies had brought new challenges. “The trend now is to re-classify most of the growing economies on the continent as middle income. At one level, that is a wonderful idea, because it means that the continent is maturing. But of course, the implication is that this will have an immediate impact on health because concessional loans and bilateral financing declines when a country is re-classified.”

Some countries that have recently been dubbed middle income economies are in the SADC Region where the highest infections are located. “We can’t look beyond the continent for answers anymore. Maybe that is not quite a bad thing. Ever since the epidemic intensified, in terms of global response to it, the domestic financing for the epidemic has been traditionally very very high. It has varied between 39% to 48% of domestic contribution to the financing of the epidemic.”

He said it was doubly important that Member States that had put millions upon millions of people on treatment are kept on treatment regardless of the drying up of financing of the epidemic.

The cohort being enlisted on treatment is predominantly women, particularly younger women. “So we have a moral obligation to maintain the commitments we have made to the generation that we enlisted on treatment and with prevention being disappointingly low in terms of efficacy of our traditional strategies.”

He urged the Member States   to scale up best practices while reformulated poor ones. “Going forward, the big challenge for us has to be how we negotiate within our governments or parliaments for additional support, for strategic resources to maintain the fight against the epidemic. This has to be done with science as a fundamental bedrock,” he suggested.

Calling for efficacious interventions, Prof Poku urged Member States, also, to plan with young people, particularly younger adolescent girls given the youthfulness of the continent. “We expect the African population to increase to 1.5 billion by the year 2050. About 40% of that growth will take place in the most affected countries in the continent. I don’t need to belabor the point about the implications on vulnerability. That is quite obvious.”

He said prevention must be emphasized at all times.

“We must ensure that we think innovatively about how we bridge the financing gap,” he concluded.

This article by Moses Magadza originally appeared in The Sentinel; a quarterly newsletter of the Human and Social Development and Special Programmes of the SADC Parliamentary Forum.