LOSING SIGHT OF THE SHORE IN AFRICA’S HIV RESPONSE

Much progress has been made in the treatment of HIV, argues ALLAN PAMBA

·

·

Twenty years ago, when I worked the wards as a young doctor in Kenya, HIV was still an overwhelming force. Even as treatment slowly became available in the West, many African countries remained without routine access, and too many of our patients came to the hospital prepared for the worst.

Much has changed since then. Today, millions across Africa are alive because diagnosis happens earlier, treatment is simpler and more accessible, and communities have become powerful partners in the response.

Change is inevitable, and this year’s call-to-action from the International AIDS Society, created to build momentum for the Road to Rio and the AIDS Conference 2026, reflects that: “#RethinkRebuildRise,” prompts us to honour the successes we have achieved but also to keep moving forward by reimagining our future.

We have built systems that were once unimaginable: laboratory networks spanning countries, integrated testing programmes, mobile outreach for hard-to-reach communities and strong local expertise that drives care where it matters most. Now, we face a new inflection point, which brings to mind an old Swahili proverb that translates thus:

“You can never cross the ocean until you dare to lose sight of the shore.”

Real progress requires the courage to move beyond what is familiar. We are all inclined to anchor our decisions to past experiences; past crises, past constraints, past failures. That instinct can protect us, but it can also limit our ability to imagine and build something better.

Africa’s success in its HIV response has repeatedly shown that we cannot chart a new course by looking only in the rear-view mirror. If we had clung to the limitations of the early 2000s, we would never have achieved the extraordinary gains we see today: stronger laboratory systems, community-led programmes, integrated testing and access to treatment that once felt impossible. This is living proof that Africa can reimagine what is possible; a truly transformative approach to the AIDS epidemic.

What lies behind us is only a fraction of what we can achieve. The health systems we are building now are more resilient, integrated to test for multiple diseases with just one blood sample, and, most notably, locally led. These will carry us far beyond the shorelines of our past challenges.

For two decades, Africa’s HIV response has relied on a combination of domestic commitment and large-scale external funding. That global funding environment is now in a period of uncertainty. Major programmes are under pressure, budgets are tightening and donor priorities are shifting to a broader array of global health threats.

It needs to be said that these shifts do not diminish the value of past support. But they make one truth undeniable:

For essential health services to continue, grow and maintain the gains we have achieved thus far, Africa must reinforce the systems that sustain them; particularly diagnostics, and do so proactively, in haste.

A recent article by the World Health Organization states: “To boost supply chain resilience and regional self-reliance, WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes Department, in collaboration with the Regulation and Prequalification Department, has been actively advocating for locally manufactured quality-assured medicines and diagnostics.

This work is carried out in close partnership with countries, manufacturers in Africa and partners such as the Global Fund and Unitaid. Strengthening high-volume laboratories alongside point-of-care capacity.”

This is the point at which we must lose sight of the shore and go beyond the horizon. Protecting HIV testing within integrated programmes for TB, HPV and other diseases, reducing duplication and stretching limited budgets further is the next stage of our journey towards Universal Health Coverage (UHC).

African Ministries of Health are increasingly recognising integrated testing models that optimise use of existing infrastructure. Rather than running parallel disease-specific systems, integrated approaches allow countries to test for HIV, TB, Hepatitis and HPV using shared platforms, staff and logistics.

There are already powerful examples of what integrated systems can achieve. In South Africa, for instance, national laboratory networks were able to scale up viral load testing rapidly by using shared infrastructure, coordinated sample transport and high-volume platforms that supported multiple diseases, not just HIV alone.

By consolidating resources, the country secured lower testing costs, increased capacity and reduced turnaround time, demonstrating how integration can strengthen affordability and resilience at a national scale.

When countries align infrastructure, workforce and financing across programmes, integrated testing becomes one of the most effective ways to protect essential services; especially during periods of global funding uncertainty.

The benefits are overwhelming: lower operational costs; faster testing turnaround times; more reliable service continuity; expanded reach into primary care settings; and improved preparedness for pandemics and outbreaks.

When integration is done well, patients experience a more seamless journey and health systems gain resilience. This begins with training and retaining the laboratory professionals who keep systems working and ensuring diagnostics are included in national financing strategies. This helps withstand shocks, whether economic, political or epidemiological.

We should be navigating ahead by maintaining effective disease responses through innovative domestic financing models, a critical path forward. With direct procurement of critical diagnostics, strategic funding reallocation to safeguard high-impact services, public–private partnerships aligned with national priorities and budget reforms that place diagnostics at the centre of health planning, our destination is in sight.

These efforts are not about replacing global support, but rather ensuring that external contributions are leveraged rather than depended upon. The most resilient systems are those built on long-term partnerships between governments, civil society, donors, health workers and industry, co-creating solutions with transparency and shared responsibility.

When I think back to the patients I treated two decades ago, I am reminded that progress is possible even in the most challenging of circumstances.

We now have an opportunity to safeguard the gains we’ve made and build systems that will carry Africa into the next generation of health challenges.Let us take it!

·

Dr. Pamba is the Executive Vice-President, Diagnostics, Africa Roche Diagnostics

​​​​​​​​​​​​​​​​​​​​