West Africa, the poorest region in the world, is preparing to treat 400 000 HIV positive people with anti-retrovirals within the next three years. This translates into anti-retroviral access for at least one-third of the people in the region in need of treatment. Currently, some 10 000 people in West Africa have access to anti-retroviral treatment.

Members of the Economic Community of West African States (ECOWAS) will hold a regional consultation in Dakar, Senegal on December 10 and 11 to scale up efforts and ensure they meet their target by 2005.

According to Bernard Schwartlander, Director of the World Health Organisation’s HIV Department, countries have already taken action in specific areas such as strengthening health care systems, expanding the human resource capacity in the health, social and community service sectors, and achieving greater affordability of HIV-related medicines and diagnostics.

Schwartlander said the ECOWAS countries were committed to establishing a broad multi-sectoral coalition of governments, civil society, the United Nations and the private sector.

Next week’s meeting aims to bring together the widest array of partners who can support the ECOWAS countries in the further design and implementation of the initiative as an urgent priority.

The approach by the 15 ECOWAS countries is in stark contrast to that of its Southern African partners, the Southern African Development Community (SADC). Many SADC countries such as Botswana, Mozambique and Zimbabwe have decided to go it alone and use anti-retrovirals to treat chronically ill patients while other countries such as South Africa has opted to wait and calculate the costs. Indications are that the South African government will set up pilot sites in the new year.

Pilot projects to initiate HIV treatment were carried out in the West African region as early as 1998. Treatment Action Campaign leader Zackie Achmat, who has been invited to the meeting, described the ECOWAS announcement as the most exciting development in Africa for decades.

“Though the target is cautious, this is a real step forward,” said Achmat. The poorest area in the world by almost all indicators, West Africa is also home to an unparalleled rate of population growth, endemic political instability and serious public health issues.

Although life expectancy varies widely (from 38 years in Sierra Leone to more than 69 years in Cape Verde), most West Africans can expect to live fewer than 50 years. Infant mortality rates exceed 10% in nine of the countries. The percentage of people living on less than one dollar (R9-R10) a day is estimated to be as high as 73% in countries like Mali and Nigeria.