The December 2017 conference on tackling transmission of HIV from mothers to children was distinctively Burkinabé. Participants sat in a square format under tents as they would for a traditional gathering. But there was something else about the meeting that captured Burkina Faso’s battle against HIV/AIDS. Amid the health workers and UNAIDS officials sat a woman in a blue dress and a yellow stole — the country’s first lady.
Elsewhere, a first lady attending such an event could well be dismissed as mere symbolism. But in Burkina Faso, say experts and international donors, her presence highlighted a different reality — an unmatched success story where political will has been key.
Just 17 years ago, the landlocked West African nation had an HIV/AIDS prevalence rate of 2.3 percent, according to UNAIDS data. Since then, Burkina Faso has emerged as the world’s most successful combatant against the condition.
Burkina Faso cut its HIV prevalence rate from 2.3 percent in 2001 to 0.8 percent in 2016 — a drop of 65 percent, the most by any country.
The next most successful countries in this 15-year period are the Dominican Republic, which reduced the prevalence rate by 56 percent, from 2.3 percent to 1 percent, and Togo, which brought the number down by 53 percent, from 4.5 percent to 2.1 percent.
“Burkina Faso is making great strides to improve access to health-care services for the most vulnerable populations,” says Mark Eldon-Edington, head of grant management at the Switzerland-based international financing organization the Global Fund, which supports more than 17,700 community health workers in Burkina Faso.
To be sure, the country still faces challenges in areas that tax even developed nations, including vulnerable populations like female sex workers (FSWs) and men who have sex with men. “Despite the continuous decline of HIV prevalence among the general population of reproductive age,” writes Burkinabe researcher Henri Gautier Ouedraogo in the conclusion of a 2017 study of five major cities in the country, “the prevalence among FSWs is still very high.” The study found that, in the capital, Ouagadougou, for instance, the prevalence rate among FSWs was 8 percent — 10 times the national average.
Still, say experts, Burkina Faso’s unparalleled gains have been nothing short of dramatic — and are rooted in a combination of factors that differentiate it from others. Unlike many developing nations, including those in West and Central Africa, Burkina Faso has made significant domestic investments into the prevention of the spread of HIV. Instead of depending predominantly on foreign aid, the country pays for 60 percent of its HIV prevention program.
The country has been among the first in the region to have implemented the B+ initiative aimed at preventing mother-to-child transmission of HIV by providing antiretroviral therapy to all pregnant women who test HIV positive. Burkina Faso has been working with major international partners including the University of Oslo, the Bill and Melinda Gates Foundation, Terre des Hommes and the Global Fund to develop and implement innovative data collection and management methods. In 2016, the country introduced a free health-care initiative for children under 5 and for pregnant women, helping remove a key access barrier for vulnerable populations. It has recently adopted a strategy of treating all citizens diagnosed with HIV, irrespective of how they fare on other immunity-related parameters.
And then there is political leadership that has remained remarkably consistent on tackling HIV/AIDS, both when the country was ruled by dictator Blaise Compaore till 2014 — when he was deposed — and subsequently, by democratically elected leaders. “Burkina Faso benefits from a strong political leadership in the fight against HIV,” says Eldon-Edington. Current President Roch Marc Christian Kaboré chairs the National Aids Council of Burkina Faso and has committed that he will lead at least one session of the council every year. And his wife, Sika Bella Kaboré, who addressed the December 2017 conference, serves as a goodwill ambassador for UNAIDS in the country.
Burkina Faso’s accomplishments stand out even more when seen in the context of how it compared to other, richer West African nations some years back and how they stack up now. In 2001, Nigeria — Africa’s largest economy — had an HIV prevalence rate of 1.6 percent, Cameroon 0.8 percent and Benin just 0.2 percent, compared to Burkina Faso’s 2.3 percent. By 2016, Nigeria’s prevalence rate had risen to 2.9 percent, Cameroon’s to 3.8 percent and Benin’s to 1 percent, while Burkina Faso slashed its HIV incidence to a third of what it was.
These gains aren’t irreversible. And even with the country’s own investments against HIV/AIDS, international agencies need to remain engaged, suggests Eldon-Edington. “To stay on the right side of the tipping point and to accelerate the end of the epidemic, investments by the international community remain crucial, he says.
For the moment, though, Burkina Faso remains a beacon of hope, its model of success against HIV/AIDS a reminder that wealth isn’t always the best bet against some of mankind’s biggest challenges.
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