Client Report

Preventing HIV/AIDS in Sub Saharan Africa

What are some ways we could fund effective, non-vaccine HIV/AIDS prevention efforts in Sub Saharan Africa?

The Simms are a couple approaching retirement age with two grown children. Mrs. Simms served in the Peace Corps in Uganda in her youth, and has maintained connections to the country and a strong interest in its development.

The couple is highly concerned about the fact that AIDS is still a leading cause of death in sub-Saharan Africa, and that the number of newly infected people in the region outnumber those who gain access by 2 to 1. They are not interested in giving to finding a vaccine, as they believe there is plenty of money going into that project already.

Instead, the Simms would like to support a program or programs that are viewed as effective and “not moralizing”, and that are rooted in a respect for local culture and knowledge. They would also like to understand the context of AIDS prevention NGO work in the region.

According to UNAIDS, Sub Saharan Africa accounts for 70% of the world’s total new HIV infections.

Overview of the Issue

Overview of the Issue

According to UNAIDS, in 2013, there were 24.7 million people living with HIV in Sub Saharan Africa. The region accounts for 70% of the world’s total new HIV infections. While in recent years there has been tremendous progress in both treating those infected with HIV and preventing future transmissions, the epidemic continues to plague millions around the world. The countries in Sub Saharan Africa are home to by far the most people living with HIV. These communities are continually held back by the economic damage and human suffering brought by HIV/AIDS. Because the virus primarily affects people of working and caregiving age, the economic impact of HIV is especially devastating, leaving communities a weakened workforce as well as vulnerable, orphaned children. HIV/AIDS is spread primarily through unprotected sexual contact, although the disease can also spread from an infected mother to her baby or through the use of infected needles. Since HIV came onto the scene in the 1980’s, there have been many efforts to stop the spread of the virus. Here are some of the most popular prevention initiatives.

Popular Prevention Initatives

Popular Prevention Initatives

  • Behavior Modification Programs. Governments and nonprofits around the world have invested millions in behavior modification programs aimed at stemming the spread of HIV. One of the most widely used approaches in the 1990s was ABC, or “Abstinence, Be Faithful and Use a Condom.” The effectiveness of the ABC approach has been widely debated. Women, in particular, often don’t have enough power to demand that their sexual partners use a condom or be faithful. The general consensus is that the ABC approach is too simplistic and needs to take into account “underlying socio-cultural, economic, political, legal and other contextual factors “(see call-out on why Sub Saharan Africa is disproportionally affected by HIV/AIDS,  to the right).
  • Preventing mother-to-child transmission. HIV positive mothers can infect their babies during pregnancy, labor or through breastfeeding. However, when the mother takes anti-retrovirals during and after pregnancy, takes steps to have a safe labor and avoids breastfeeding, the risk of transmission can go from 15-45% to below 5%. Most of the largest HIV/AIDS funders work to some extent on preventing mother-to-child transmission (MAC AIDS FundWellcome TrustChildren’s Investment Fund Foundation). The Global Plan is a coalition of 25 countries and 30 civil society groups which had a goal of getting 90% of pregnant mothers with HIV onto anti-retroviral treatment by 2015. However, in December 2014, UNICEF reported that this goal is still out of reach, with only 67% of pregnant HIV-positive women in middle-and-low income countries receiving the most effective drugs for mother-to-child transmission.
  • Programs for sex workers. Programs working to prevent HIV transmission to sex workers can be highly effective, especially in places with strong government support, like in Thailand.
  • Promoting male circumcision.The WHO reports that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. There are quite a number of organizations which are collaborating on furthering voluntary medical male circumcision in Sub Saharan Africa. A non-surgical product, called Prepex has been released in the region (with funding from international agencies), and allows for for adult male circumcision in just two 5-minute visits to a nurse.
  • Vaccine research. Finding a vaccine for HIV would of course be the most exciting way to prevent HIV infections. While millions of dollars has been put into finding a vaccine for HIV, the world still doesn’t have an effective drug to prevent HIV. However, at Davos in 2015,Bill Gates said that he expected a vaccine by 2030.
Suggested Areas for Giving

Suggested Areas for Giving

Given the clients’ giving interests and the current needs for HIV prevention, I’d suggest thinking about giving to the following initiatives:

  1. Preventing Mother to Child Transmission. Mothers2Mothers is a South African charity (with fundraising offices in the US and UK) that trains, employs, and supports Mentor Mothers, or mothers living with HIV. These Mentor Mothers work alongside doctors and nurses in understaffed health centers to educate pregnant women with HIV on how to prevent HIV in their children and keep their families healthy.

Mothers2Mothers has found that the women Mentor Mothers serve are more likely to take antiretroviral drugs to prevent mother-to-child transmission of HIV. Furthermore, the infants of mothers in the Mothers2Mothers program are more likely to receive ARVs than those infants whose mothers are not in the program.

  1. Promoting voluntary medical male circumcision (VMMC) Jhpiego, (Johns Hopkins Program for International Education in Gynecology and Obstetrics) funds projects in safe, medically supervised male circumcision. Population Services International provides a suite of voluntary medical male circumcision services and advocacy in Africa, and recently circumcised its one millionth client.
  1. Preventing violence against women. HIV disproportionally affects women over men in Sub-Saharan Africa. Women are more likely to be HIV positive, and because of the unequal gender dynamics in many African communities, women are often not able to make their own decisions about their sexual relationships. Too many times, it’s their husbands or boyfriends who make the decisions for them.

The Ugandan-based nonprofit, Raising Voices (very kindly suggested to me by Dr. Helen Epstein herself), works on reducing intimate partner violence, and recently conducted a controlled trial of a program that not only reduced partner violence, but also reduced sexual concurrency.