This is according to Michel Sidibe, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), at end of a fact finding trip to southern Africa.

Sidibe was speaking to Health-e on Friday shortly after meeting with deputy president Kgalema Motlanthe and health minister Dr Aaron Motsoaledi.

‘€œLesotho is demonstrating that universal access is possible. Three years ago 20% of people needing treatment had access to antiretroviral treatment, today it stands at 55%,’€ said Sidibe.

He lauded the ‘€œ’€Know your status’€ campaign in Lesotho where he said 41% of people knew their HIV status while in many parts of Africa the figure was closer to a paltry 15%.

Sidibe said it was critical to ensure that the Prevention of Mother to Child Transmission (PMTCT) programme was implemented widely as it presented the best chance of eliminating paediatric HIV. ‘€œIt is virtually eliminated in the rest of the world and there is no reason why we cannot achieve it in Africa,’€ he said.

Sidibe said he had met with the South African government to ‘€œfollow-up on the ambitious and inspiring goals’€ of treating 80% of those needing antiretrovirals and halving new infections by 2011.

He said Motsoaledi had given him clear indications that government was committed to ‘€œpicking up the pace of action’€.

‘€œPolitical commitment is key to achieving anything. You cannot break the silence without political leadership, you cannot change service delivery systems without political commitment, you cannot create mechanism for accessibility without political commitment and political leadership determines the space afforded to civil society input which in turn brings about the social change needed,’€ said Sidibe.

He said in the light of the known fact that for every one person put on treatment, five new people were newly infected, prevention needed to be central to any future programmes. ‘€œThis could never happen without strong leadership at all levels,’€ he said.

Sidibe said it was time to not see AIDS as being ‘€œin competition’€ with other health programmes, but rather a vehicle towards achieving many other health outcomes.

‘€œBy saving the HIV positive mother (by giving her anti-retrovirals) and her newborn baby (PMTCT), you are creating opportunities to address among others sexual and reproductive issues, change health delivery systems, engage men, change child health outcomes and improve maternal health,’€ said Sidibe.

He said another central focus of his job was to ensure that ‘€œnobody dies from TB’€.

‘€œIt should not happen if we have good integration (between TB and HIV services),’€ he said.

Sidibe said he was on a mission to ‘€œalert the world’€ that the demand for antiretroviral treatment was high and increasing. ‘€œSouth Africa already has 750 000 people on treatment and is aiming to have 1,4-million on treatment by 2011. Almost all the people accessing treatment in Africa are on first line treatment (simplest regimen for people starting treatment, before resistance or side-effects develop), but we know from experience that around half of these people will eventually become resistant to their first line therapy and will need to access second or third line which is very expensive. This is going to be a major, major challenge for the continent and could lead to an increasing number of deaths,’€ he warned.

Sidibe said it was in the light of these challenges that he was calling for a single drug regulatory authority for Africa. ‘€œThis is part of the debate I want to establish and hope this could ensure that quality drugs could be delivered at a more affordable cost and in a sustainable manner.’€

He said a single drug agency could play an oversight role in the pricing of drugs, manufacturers would be able to negotiate with one entity instead of ‘€œrunning from country to country’€ and it could open the door for the local production of quality drugs.

Sidibe said the financial crisis was already leading to stock outs across the continent and was putting the lives of people on treatment in danger. ‘€œWe need to relook the way in which we are doing things,’€ he said.