I am in Luanda, Angola right now, and what an interesting place. It is the most expensive city in the world: a can of coke costs $5, a car and driver for the day costs between $250-$300, and a basic hotel room with a view of people living in shacks below and cranes building more skyscrapers above is $380 (and it is difficult to find it for less).
Luanda feels like Africa mixed with Latin American and European energy and music. The traffic is bumper to bumper. It is not possible to have more than two meetings in a day because it takes that long to get from one area to another in the city. But it feels calm. Drivers in Luanda have figured out how to navigate the maze…slowly weaving in and out, letting a car in as they make a two lane road into three, and double parking with half the car on the sidewalk. Hardly anyone honks, it is hot and slow, and it feels like there is a sense of order to the chaos.
Angola is a country that has tremendous wealth, primarily derived from oil and other minerals. That wealth is controlled by an elite few, and there are wide disparities between the rich and the poor; 54% of the population lives on less than $1.25 a day. The public health challenges in Angola are significant. The under-five mortality rate in 2010 was 161/1,000 births, and the maternal mortality rate is 610 per 100,000 live births.
The estimated HIV prevalence rate is between 2% and 3%, which is very low for this part of the world. That is why MSH’s Building Local Capacity for the Delivery of HIV Services in Southern Africa Project (BLC) has been asked to work here, along with other organizations, to maintain that prevalence rate and maybe even lower it. It will be challenging in a place where health infrastructure is weak, and where AIDS discrimination is high. Since Angola borders Namibia, Zambia, and Botswana to the East and South (countries with high HIV prevalence, between 17% and 20%) it might only be a matter of time before the prevalence rate goes up if nothing is done.
You might ask why BLC should focus on a place with a 3% prevalence rate when countries such as Namibia have a 20% prevalence rate. The reason is that since 2004, HIV prevalence among pregnant women has increased by 0.4% (2.7% in 2004 to 3.1% in 2007). This is a big increase in a short period of time. And the situation in some areas is worse, especially in Cunene province along the Namibia border, where the prevalence rate is estimated to be at 9.6%. In Angola, where only 20% of pregnant women and infants have PMTCT coverage and 33% of people living with AIDS receive antiretroviral treatment, civil society organizations desperately need innovative, evidence- and community-based approaches to provide quality HIV prevention services.
BLC along with other partners will be supporting these efforts over the next few years.
Angola has an excellent opportunity to keep the HIV prevalence rate low now, rather than having ato work uphill later on to lower a high prevalence rate, as many other Southern African countries are struggling to do now. I am looking forward to working in Angola with many talented people and partners to design evidence- and community-based interventions to improve HIV prevention and treatment programs.
Kathryn Reichert is the Monitoring and Evaluation Director and Angola Country Lead for MSH’s Building Local Capacity Project; a regional 5-year project focused on building the organizational, leadership, management and governance capacity of civil society organizations and government entities to improve and expand HIV and AIDS service delivery.