People living with HIV/AIDS in West and Central Africa continue to suffer needlessly and die silently despite globally-agreed goals to curb the HIV epidemic by 2020, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a new report released today. This comes two years after UNAIDS announced its “90-90-90” goal to make sure 90 percent of all people living with HIV know their status, 90 percent of them have begun antiretroviral treatment, and 90 percent of those on treatment have an undetectable viral load by 2020.
 

In “Out of Focus: How millions of people in West and Central Africa are being left out of the global HIV response,” MSF is calling on supporting agencies to address the treatment gap by developing and implementing a fast-track plan to scale-up lifesaving antiretroviral treatment (ART) for countries where critical medicines reach fewer than one-third of the population in need, particularly the 25 countries that make up West and Central Africa. These countries account for one in five new HIV infections globally, one in four AIDS-related deaths, and nearly half of all children born with the virus.

“The converging trend of international agencies to focus on high-burden countries and HIV ‘hotspots’ in Sub-Saharan Africa risks overlooking the importance of closing the treatment gap in regions with low antiretroviral coverage," said Dr. Eric Goemaere, MSF’s HIV referent. "The needs in West and Central Africa remain enormous with three out of four people in need without access to HIV care – that’s five million out of the 15 million new people worldwide who should be started on treatment by 2020. The continuous neglect of the region is a tragic, strategic mistake: Leaving the virus unchecked to do its deadly work in West and Central Africa jeopardizes the goal of curbing HIV/AIDS worldwide.”

The West and Central Africa region has a low HIV prevalence with 2.3 percent of the population living with the virus. However, it is three times the worldwide prevalence of 0.8 percent, and pockets in the region have more than 5 percent of their population living with HIV, the threshold defining high prevalence. Despite this deceptively low average prevalence, only 24 percent of those in need have access to ARTs. It’s even worse for children – only 1 out of 10 receive ART, which is key in making sure they live long, healthy lives.

MSF’s report finds that in West and Central Africa needs are underestimated and little priority is given to HIV as a health issue in the region. The route to obtaining HIV treatment is an obstacle course for people living with HIV with barriers such as stigma, stock outs of diagnostics and drugs, patient fees, and unaffordable, burdensome and poor quality services. Recurrent crises following violence or epidemics compound already existing challenges to accessing HIV care. The report recommends major changes in policies and models of care reflecting both lessons learned from progress in the fight against HIV elsewhere as well as innovative approaches specially tailored to contexts with low ART coverage. Additionally, it details case studies in Central African Republic, Democratic Republic of Congo and Guinea.

“Closing the treatment gap in West and Central Africa will happen either now or never,” said Dr. Mit Philips, health policy advisor at MSF. “Countries with low antiretroviral coverage need to take advantage of the renewed ambitions worldwide to accelerate scale up of their HIV response. But it is unrealistic to think they can break the deadly status quo alone. If the world is serious in its goal of defeating AIDS, it is time to correct a too narrow focus of the fast-track strategy and, as a matter of priority and urgency, to bring lifesaving ARVs to some of the most neglected victims of HIV/AIDS.”

MSF has been working on HIV/AIDS since the late 1990s and currently supports treatment for more than 200,000 patients in 19 countries, primarily in Africa.

West and Central Africa is composed of 25 countries: Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, São Tomé and Príncipe, Senegal, Sierra Leone and Togo.