As 2023 came to a close, global donors joined together to pledge US$777.2 million to accelerate progress toward eliminating certain neglected tropical diseases (NTDs).
In 2013, The Network of African Science Academies, in collaboration with the United States National Academies, convened a committee of 16 diverse experts, including me, to discuss the current state of tobacco use, prevention and control policies in Africa.
The committee’s findings, recently published in Preventing a Tobacco Epidemic in Africa, were alarming: Without comprehensive tobacco prevention and control policies, smoking prevalence in Africa will increase by nearly 39 percent by 2030, from 15.8 percent in 2010 to 21.9 percent. While tobacco use and tobacco-attributable mortality rates in Africa are currently among the lowest in the world, data indicate that without intervention, this situation will change dramatically for the worse.
The committee’s report also revealed some startling findings about tobacco as it relates to Africa’s women and youth. Though fewer African women smoke, they are disproportionately affected by tobacco through not only the direct effects of smoking, but also secondhand smoking and the secondary effect of smoking on pregnant women and their fetuses. African youth, meanwhile, represent the largest potential market for tobacco, and levels of smoking in this highly vulnerable population will continue to rise as aggressive tobacco marketing encourages the uptake of smoking. Both women and youth are also targets of covert messaging from the tobacco industry that is designed to mainstream smoking behavior as an element of evolving social norms and empowerment.
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In a rural village in central Africa, my colleagues and I stood over a registration book for antenatal care clients with the goal of identifying clinic-level data that could be extracted for a project evaluation. As we made our way through the book, the left sides of the pages were filled with names of women, dates and HIV test results — it was clear that almost all of the women who tested HIV positive received some form of antiretroviral therapy (ART). As my eyes ran to the right across spaces for follow-up records, however, the fields became increasingly emptier, and our team began to discuss the various barriers to services, even a highly effective service like prevention of mother-to-child transmission (PMTCT).
Access and adherence to the greater continuum of HIV care is influenced by several factors, including community-level gender norms and related behaviors. For example, HIV-positive men may avoid HIV testing and may spend a significant amount of their income attempting to address symptoms of their illness rather than confirming their HIV status. Often, these behaviors are driven by fear that knowledge of a positive HIV test result could compromise their leadership at home and cause family instability. Research has also identified instances when men undermine their wives’ access and adherence to ART, even taking their wives’ medication for themselves. Interestingly, despite such challenges, women are more likely to access and adhere to HIV-related treatment and care than men.