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HIV/Aids: Still Claiming Too Many Lives

Jacques Morisset's picture

Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

HIV/Aids remains one of the deadliest diseases in sub-Saharan Africa, causing misery and suffering to millions of affected people and their families. But there are also signs of hope, as new infections and the number of Aids-related deaths have come down significantly since the mid-2000s. Similar to the broader trend in the region, Tanzania has achieved some success in reducing HIV/Aids:

- HIV prevalence among adults declined from its peak in 1996 (8.4 per cent of those aged 15-49 years) to 5.8 per cent in 2007, though it has stagnated since then.
- The number of people dying from Aids has fallen by about one third, from 130,000 in 2001 to 84,000 in 2011.

The overall HIV prevalence in Tanzania (5.8 per cent in 2011) is lower, for example, than in Zambia (12.5 per cent), Malawi (10 per cent) or Uganda (7.2 per cent). And yet, further reductions in HIV infections could well be more difficult to achieve, as most transmissions occur through unprotected sex while policy has a limited capacity to change the underlying behavior patterns.

What is more critical, however, is that Tanzania is falling behind other countries in the region in reducing Aids-related deaths:
- Between 2001 and 2011, Zambia managed to reduce the number of people dying from HIV/Aids by 57 per cent; Zimbabwe by 61 per cent and Kenya by 52 per cent (compared to Tanzania’s 35 per cent).
- Tanzania currently ranks fourth in the world in terms of the total number of Aids-related deaths (after South Africa, Nigeria and India)
- An estimated 1.3 million children in Tanzania have lost at least one of their parents to the epidemic and are growing up as orphans.

The fact that so many Tanzanians still die from Aids, despite the existence of treatment, signals that the country’s health system does not reach those in need of HIV testing and therapy, and that antiretroviral (ARV) drugs are not accessible to the majority of the population:
- Only 40 per cent of the population with advanced HIV infection are on ARV medication.
- This ARV coverage is much lower than in Zambia (82 per cent), Kenya (72 per cent), Malawi (67 per cent) and Uganda (54 per cent), and far below the MDG target of universal access to ARV treatment by 2010.
- In addition, routine discoveries of counterfeit ARV drugs raise concerns about the quality of treatment available to those in need.

All of this raises the following questions:
- What is the reason for the low ARV coverage in Tanzania? Lack of access? Stigmatization? Poor quality of HIV/Aids counseling?
- Should the Government prioritize funding for HIV/Aids-related health services? Even at the expense of other health sector programs?
Does the Tanzania Foods and Drugs Authority have enough resources to monitor the quality and safety of drugs for the treatment of HIV/Aids?
What is the role of Tanzanians themselves in limiting the spread of HIV/Aids?

Note: The statistics above are derived from the World Development Indicators, UNAIDS data and the CIA World Factbook. All are publicly available.


Submitted by Anonymous on
You have written data, not 'statistics'. One expects World Bank professionals to know the difference. And professionals clearly state their sources. Please add clear sources and URLs to this post.

Submitted by Alissa on
Sub-Saharan Africa remains the region most heavily affected by HIV. In 2010, about 68% of all people living with HIV resided in sub-Saharan Africa, a region with only 12% of the global population. Sub-Saharan Africa also accounted for 70% of new HIV infections in 2010, although there was a notable decline in the regional rate of new infections. The epidemic continues to be most severe in southern Africa, with South Africa having more people living with HIV (an estimated 5.6 million) than any other country in the world.

The data sources are as follows: Data on HIV prevalence (population 15-49 years) and ARV coverage are from the World Development Indictors (WDI) and refer to 2011: URL: Data on Aids-related deaths and AIDS orphans are from UNAIDS (and their AIDSinfo database) and refer to 2011: URL: (UNAIDS TZ homepage) / (AIDSinfo database) The CIA World Factbook also shows the number of AIDS-related deaths by country, with data referring to 2009: URL: The CIA World Factbook is used in the blog to determine that Tanzania ranks 4th worldwide in terms of the total number of AIDS-related deaths. This is because the AIDSinfo database lacks information on India, which (according to the CIA World Factbook) was the country with the third largest number of AIDS-related deaths in 2009. In any case, the 2011 UNAIDS estimate of the total number of AIDS-related deaths in Tanzania (84,000) is very close to the 2009 estimate tabulated in the CIA World Factbook (86,000).

Submitted by Miriam Schneidman on
If we look at the countries which have made major strides in expanding access to antiretroviral therapy (ART) there are several key measures they have taken: (i) mobilized political support at the highest levels of government; (ii) decentralized service delivery and adopted a nurse-driven model of care, gradually integrating AIDS treatment into chronic care; (iii) introduced a policy of providing highly subsidized or free ARV drugs, which are primarily funded by donors (e.g. GFATM, USG PEPFAR program); and (iv) supported actions to ensure adherence to care, minimizing the risk of drop out (e.g. buddy system, peer educators, community worker support). Let me be a bit provocative in addressing the questions you raise. In my view, the debate of the early 2000s about whether countries should or should not initiate AIDS treatment programs is over, as many have demonstrated it is feasible, doable, and desirable. There are large socio-economic and health benefits for individuals, households and communities which have been well documented over the past decade. Two main challenges remain today. The first relates to the need to ensure that efforts to scale up access to ART are accompanied by measures to curtail new infections, so that we do not win the battle and lose the war against AIDS. Virtually all countries need to redouble efforts to strengthen prevention using a combination of proven strategies. The second and probably biggest challenge which remains is how to sustain the financing of AIDS treatment programs, because even though the cost of drugs has dropped dramatically since the early 2000s they still remain well out of reach of the majority of the poor in Africa. While most countries in sub-Saharan Africa remain highly dependent on donor funding there is a growing effort by governments to assume some financial responsibility. Turning to the questions you raise, Tanzania has the capacity to do more to contain the HIV/AIDS epidemic. First, as a country and a society, a decision needs to be taken that the provision of AIDS treatment is a priority. Leadership on this issue at the highest level is important but not sufficient. Second, the Ministry of Health and Social Welfare needs to develop a scale up plan with a clear strategy for how to address technical, operational and financing issues. The government will not be in a position to finance ART therapy for all who may need it but should consider a combination of financing strategies, including some subsidies from the national budget. The issue of counterfeit drugs and the capacity of the Tanzania Foods and Drugs Authority are being partly addressed through a regional drug harmonization initiative which Tanzania belongs to that aims to put in place policies and measures to minimize these risks. More needs to be done in this area but these are manageable issues. Finally, there needs to be a continuing emphasis on cost effective, high impact prevention strategies and individual responsibility in limiting the spread of HIV/AIDS.

I hate how diseases are like trends. after a while people stop paying attention. But these diseases don't just disappear if you stop thinking about it. in fact, as time goes on more and more people should be doing their part to help find a cure. Reading this really opened my eyes. thank you for bringing this to my attention.

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