Some AIDS work in Africa ‘mismatched’ from actual causes, says UN-backed report

The publication of potential “mismatches” between prevention strategies and the actual causes of HIV/AIDS in some African countries has already helped to improve efforts to combat the disease, according to the lead United Nations agency on the issue.

The Joint UN Programme on HIV/AIDS (UNAIDS) said that a series of reports from Kenya, Lesotho, Swaziland and Uganda showed a “relative lack of evidence-based policies and programmes.”

On Lesotho, for example, which has the third highest adult prevalence in the world, the study shows that there is an ‘exceptionally high’ number of multiple and concurrent sexual partnerships before and during marriage, UNAIDS said.

“Yet, according to the report, national prevention strategies do not explicitly address concurrent partnerships and no activities are designed specifically for adults, married couples and people in long-term steady relationships.”

Meanwhile, the agency noted that efforts in Kenya are aimed at the general population. “Even where the evidence shows a clear need for it, Government funding aimed at other most-at-risk groups, such as sex workers, their clients, men who have sex with men and injecting drug users is ‘negligible or non-existent,’” UNAIDS said.

At the same time, some countries under study have already begun to adapt. Uganda, for example, recommended the establishment of clear policies, standards and guidelines to improve counselling and testing services, IEC (information, education and communication) and behaviour change interventions for married and long-term sexual partners, people living with HIV and at-risk groups.

“Swaziland also recommended that married, cohabiting and steady couples be acknowledged as a priority population and, further, that stronger political leadership for HIV prevention be exercised in order to build widespread engagement to address the complex norms underlying the level of vulnerability to infection in the country,” UNAIDS said.

“The leadership demonstrated by the countries that have undertaken this analytic work is a first and important step towards building effective prevention strategies,” said Mark Stirling, Director of UNAIDS Regional Support Team for Eastern and Southern Africa.

The Analysis of Prevention Response and Modes of Transmission Study series is supported by national AIDS authorities, UNAIDS and the World Bank. Mozambique and Zambia are preparing forthcoming reports.

Debrework Zewdie, Director of the World Bank’s Global HIV/AIDS Unit, said, “These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response, and identify how prevention might be more effective. They are guiding the programmes we support."