Patrick Luyeye and Selly Bentone, right,  examine Nadine who is 28-years old. Photo: Mario Travaini/MSF

Globally agreed goals to curb the HIV epidemic by 2020 will not be met unless the HIV response is drastically accelerated in West and Central Africa, where people living with HIV continue to suffer needlessly and die silently.  In a new report Doctors Without Borders (MSF) details the current inadequacies, issuing a stern warning to the world.
 
MSF calls for UN agencies, European donor agencies, the Global Fund and the United States President's Emergency Plan for AIDS Relief (PEPFAR), as well as affected governments and civil society to develop and implement a fast-track plan to scale-up life-saving antiretroviral treatment (ART) for countries where ART coverage reaches less than one-third of the population in need, particularly in West and Central Africa.
 
MSF’s report “Out of Focus: How millions of people in West and Central Africa are being left out of the global HIV response” explores the causes of the treatment gap in a vast region comprising 25 countries, with detailed case studies on three contexts: Central African Republic, Democratic Republic of Congo and Guinea.

Dr Eric Goemaere, MSF’s Senior Regional  HIV/TB support coordinator says the needs in West and Central Africa remain enormous with three out of four people in need not accessing HIV care – that’s five million out of the 15 million new people worldwide who should be started on treatment by 2020. “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 ART  coverage, he adds. “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 jeopardises the goal of curbing HIV/AIDS worldwide.”
 
The arm of  Julia, a patient ill with advanced AIDS at the Centre Hospitalier Kabinda. Photo: Mario Travaini/MSF

The West and Central Africa region is considered as having low HIV prevalence with 2.3% of the population living with the virus. However, it is three times the worldwide prevalence of 0.8% and pockets in the region have more than 5% of their population living with HIV, the threshold defining high prevalence. Despite this deceptively low average prevalence, the region accounts for one in five new HIV infections globally, one in four AIDS-related deaths and close to half of all children born with the virus. This is due to a very low ART coverage that barely reaches 24% of people in need.
 
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 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 lessons learned from progress in the fight against HIV elsewhere and innovative approaches specially tailored to countries with low levels of ART coverage. 
 
Dr Mit Philips, health policy advisor at MSF, says closing the treatment gap in West and Central Africa will happen either now or never: “Countries with low antiretroviral coverage need to take advantage of the renewed ambitions worldwide to accelerate scale up of their HIV response.

“But it’s unrealistic to think they can break the deadly status quo alone. If the world is serious in  defeating AIDS, it’s time to correct a too narrow focus of the Fast Track strategy and, as a matter of priority and urgency, to bring life-saving ARVs to some of the most neglected victims of HIV/AIDS.” 
 
Read the International Report on HIV in West and Central Africa.