Lessons learned from Africa
10. Some African countries have put in place innovative
approaches to HIV/AIDS. We were interested to hear whether these
approaches might offer lessons for countries facing new epidemics.
For example, the rate of AIDS testing in Botswana has quadrupled
as a result of a policy move to 'opt-out testing'.[29]
In 2004, 10% of Botswanan people living with HIV had access to
ARVs. Today, a third of Botswanans know their HIV status and
85% of those who need treatment get it.[30]
Nevertheless when we visited Botswana earlier this year we were
told that the sex trade and homosexuality were illegal and that
there were no AIDS programmes for these groups. Evidence from
UNAIDS acknowledged the benefits of 'opt-out testing' in generalised
epidemics but warned that "we have to be very careful in
terms of advocating that approach for every country because situations
vary enormously and stigma and discrimination are rife. In many
settings there is no confidentiality in the healthcare sector…
[but] the Botswana approach holds promise in many high prevalence
settings".[31]
We also heard about the Ugandan experience, where a relatively
successful ABC approach ('Abstinence, Be faithful and use Condoms')
has been followed by a less successful abstinence-focused programme.[32]
UNAIDS and WHO have noted that "current findings do
hint at the possible erosion of gains Uganda made against AIDS
in the 1990s".[33]
11. We accept that there is no one-size-fits-all
response to HIV/AIDS epidemics. National programmes should be
based on careful assessments of local need. Africa has carried
the heaviest regional HIV/AIDS burden for decades and has seen
a wide range of responses employed. As a key development partner
in Africa, DFID has a valuable perspective on these responses
and on best practice that most national governments facing new
epidemics will not have. As
emerging epidemics become more generalised, we recommend that
DFID ensure that its experience of best practice in Africa is
put at the disposal of governments elsewhere, including in Asia
and Eastern Europe.
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