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Institute of Medicine urges ramp-up of AIDS prevention in Africa

A report released today by the Institute of Medicine (IOM), part of the US National Academy of Sciences, says that cases of HIV/AIDS in sub-Saharan Africa will greatly outstrip the availability of treatment by 2020. It urges nations inside and outside of Africa to intensify prevention measures as the best long-term strategy for combating the disease.


“Because treatment will only reach a fraction of those who need it…preventing new infections should be the central tenet of any long term response to HIV/AIDS in Africa,” Thomas Quinn, a co-chair of the 12-member committee that wrote the report said on Monday at a press conference in Washington, DC. Quinn, who directs the Center for Global Health at Johns Hopkins University in Baltimore, Maryland, added that, by the committee’s conservative projections, the number of people living with AIDS in sub-Saharan Africa will reach an “astounding” 70 million by 2050, unless intervening forces come into play (see graph).

The report, Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility, recommends that both the United States and individual African nations develop ten-year strategic “roadmaps” for combating AIDS, and that these prioritize prevention. It also urges long-term capacity building to produce the institutions and health workforce in Africa equipped to tackle the epidemic.

Building capacity “is a big challenge” in the face of the brain drain from Africa, conceded David Serwadda, the other co-chair of the committee that wrote the report. Serwadda is an infectious disease epidemiologist at the Makere University School of Public Health in Kampala, Uganda. Still, he added, building African expertise is vital because “African countries need to take greater ownership of this epidemic and rely less on the global community.”

The magnitude of the HIV/AIDS problem is most severe in sub-Saharan Africa. According to the 2009 epidemic update from UNAIDS and the World Health Organisation, the region accounted for 67 percent of all HIV-infected individuals and 91 percent of all new infections in 2008. About 33 million people globally are HIV-infected.

While about four million people in sub-Saharan Africa are receiving anti-retroviral therapy now, they represent “the tip of the iceberg,” said Patrick Kelly, the director of the IOM’s Board on Global Health. Because there are still at least 18 million people who are going to need treatment, he noted, “even if incidence was zero, we would still have a huge burden of care to provide over the coming decades.”

The current report grew out of an earlier IOM study that assessed the first five years of implementation of the President’s Emergency Plan for AIDS Relief.

Graph taken from ‘Preparing for the Future of HIV/AIDS in Africa:A Shared Responsibility’, by the Institute of Medicine.


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