The Need for an International HIV/AIDS Volunteer Services Corps for Africa

By Sidi Jammeh, Chinua Akukwe, and George Haley

Africa is facing a formidable foe in HIV/AIDS. According to the latest report by the United Nations agency coordinating the global fight against the pandemic (Unaids), although Africa represents only 10 percent of the global population, it accounts for nearly 64 percent of HIV/AIDS worldwide — 25.4 million infected individuals, and counting. Africa is home to almost 76 percent of women living with HIV/AIDS worldwide. The southern region of Africa, which represents only 2 percent of the global population, is home to nearly 30 percent of the total number of persons living with HIV/AIDS worldwide. Unaids estimates that 2.3 million adults and children in Africa died of AIDS in 2004. Unlike the situation in North America, Europe, South America, and some countries in the Caribbean, where most people who need antiretroviral therapy receive the drugs, nine of every ten infected individuals in Africa that can benefit from these lifesaving drugs cannot access them.

Although remarkable successes have been recorded in the last few years in marshalling resources to fight the epidemic in Africa, a missing link has been the lack of a trained health and development workforce to successfully scale-up a multisectoral response in the continent. We discuss the need for an international volunteer HIV/AIDS service corps that will tackle health and logistics challenges that impede a timely and effective response against HIV/AIDS in Africa. Our proposal does not envisage another global bureaucracy but will match skill sets with identified needs in various parts of Africa, and complement available services in at-risk areas in Africa.

Why an AIDS Volunteer Service Corps?

There are multiple reasons for a volunteer AIDS service corps in Africa. First, HIV/AIDS, although a health condition, has almost single-handedly reversed past development gains in Africa. According to Unaids, life expectancy in Africa today is 49 years instead of 62 years without HIV/AIDS. Nine countries in Africa currently have life expectancy rates of less than 40 years.

Second, 95 percent of Unaids offices in Africa, in a 2004 review, identified lack of health personnel as a major hindrance in the fight against AIDS. Unaids estimates that between 19 percent and 53 percent of all deaths among government health employees in Africa are directly attributable to AIDS. This situation is compounded by some of the lowest physician-to-population ratios in the world. According to the World Bank, there is one physician to every 35,000 persons in Ethiopia, with near similar ratios in many African nations. Healthy workers are laboring to cope with an unprecedented surge in the number of AIDS patients. In some hospitals in Africa, AIDS patients occupy more than 60 percent of all available beds. Furthermore, thousands of health workers have left Africa for more lucrative careers in the West. Although South Africa has the largest number of individuals living with HIV/AIDS, at least 5,000 doctors left South Africa in recent years, according to Unaids.

Third, the non-health workforce in Africa is also reeling from the effects of HIV/AIDS. The International Labor Organization, in a recent report, indicated that HIV/AIDS by 2000 accounted for nearly 12 percent of total labor losses in Zimbabwe and more than 10 percent in Zambia. Agriculture, the mainstay of Africa’s economy (24 percent of the continent’s G.D.P. and 40 percent of its foreign exchange earnings) is under strain from HIV/AIDS. By 2020, AIDS may kill one fifth of all agricultural workers in Africa. AIDS is causing a shortage of teachers in Zambia and Zimbabwe. Businesses in the southern region of Africa sometimes hire two or more persons for the same job because of justified fears of losing a highly trained worker to AIDS.

Fourth, the healthcare infrastructure in Africa is reeling from years of inadequate funding and mismanagement. Community-based clinics need to be revamped, hospitals re-equipped, and training programs jumpstarted. Fifth, funding constraints remain a major obstacle in AIDS remedial efforts in Africa. According to Unaids estimates, the total expenditure on AIDS worldwide in 2004 was about US$6.1 billion. By 2007, at least US$20 billion a year will be needed for an effective fight against the pandemic. Nearly 43 percent of the US$20 billion will be needed in Africa. A recent World Bank guide on widening access to lifesaving HIV/AIDS medicines in developing countries concluded that it would require considerable resources to close the gap between the need to treat millions of people living with HIV/AIDS and the low national healthcare budget of poor countries around the world.

Sixth, prevention programs, despite more than two decades of effort, have not been very effective.Prevention programs encompass information, education, and communication campaigns against selected health conditions, targeted at specific audiences and populations at risk. A recent survey by Unicef indicates that up to 50 percent of young women in some countries with a high rate of HIV transmission are unaware of basic facts about the disease. Another survey of 73 low and middle income countries (most of them in Africa), which account for more than 90 percent of the pandemic, indicates that less than one percent of adults have access to voluntary counseling and testing services and only about one of every ten pregnant women have the opportunity to benefit from intervention programs that can prevent maternal transmission of HIV.

Seventh, we are not aware of any ongoing effort to meet the shortage of health and development workers in Africa through a feasible, immediate deployment of employed and motivated professionals in the West. The widely praised recent initiative by the World Health Organization to provide lifesaving medicines to 3 million people in developing countries by 2005 relies heavily on training or hiring new health workers in Africa.

Finally, the logistic challenge of providing lifesaving medicines to more than 4 million Africans that the Unaids and the World Health Organization deem qualified for urgent care should not be underestimated. These logistic challenges include training the local workforce, providing basic infrastructure such as portable water and basic sanitation, assuring constant electricity supply and telecommunication utilities to enhance coordination of services, developing verifiable management and clinical accountability systems, and improving epidemiological surveillance and reporting techniques.

What Are We Proposing?

We are proposing an International Volunteer HIV/AIDS Service Corps for Africa that will rely on a motivated volunteer in the West who is likely to continue receiving regular salary and other remunerations while on assignment. This volunteer will be linked through an employer or professional association to an agency or organization on the ground in Africa that is providing specific services in a specific target community, country, or region. We believe that if the opportunity exists to link a motivated paid volunteer in the West with an effective organization on the ground, many individuals quietly watching the unfolding tragic saga of AIDS in Africa will come forward and volunteer to serve to the best of their abilities.