ICASA, a Moment of redesigning tools and Strategies in response to AIDS, TB and Malaria for a Healthier Continent.

Introduction: Conference overview.

The 23rd International Conference on AIDS and STIs in Africa (ICASA), organised biennially by the Society for AIDS in Africa (SAA), took place from 3 to 8 December 2025 at the Accra International Conference Centre in Ghana. The theme was “Catalysing an Integrated, Sustainable Response to End AIDS, TB, and Malaria”. This significant event also marked the 35th anniversary of the Society for AIDS in Africa (SAA), serving as both a reflection of progress and a call to action in the fight against AIDS, tuberculosis (TB), malaria, and other health challenges on the continent.

A notable highlight was the launch of the “Scientific Journal on AIDS and Infectious Diseases,” which aims to foster the sharing of scientific knowledge. ICASA also introduced a storytelling competition to promote HIV prevention and combat stigma. The youth pre-conference, which empowered young participants to engage actively in health advocacy, was held.

The conference served as a “wake-up call” for Africa, as evidenced by increased local participation, more assertive youth engagement, and greater involvement by African leaders. First Ladies from across Africa convened a high-level meeting with UN agencies and community leaders at the Ghana State House, underscoring their leadership in HIV advocacy and the importance of collective action.

Faith communities played a vital role by hosting a booth in the community village, facilitating vibrant discussions and demonstrating strong commitment through active participation and engaging activities. A round-table session brought together faith leaders, parliamentarians, and advocates under the theme “Unifying Voices for Action: Legislators and Faith Leaders.

Advancing an Equitable HIV Response.” This forum focused on fostering collaboration between faith leaders and legislators, maintaining HIV as a political priority, and advocating for sustainable domestic financing and access to long-acting injectable treatments.

My main takeaway and recommendations.

The key takeaways and recommendations discussed emphasise various topics including Traditional medicine, Clinical science, treatment innovations, epidemic trends, Prevention science, Legal and human rights, health systems, leadership, and sustainable financing.

1. About Traditional Medicines and Research.

Traditional medicine is increasingly recognized as a valuable complementary approach in HIV care. With 8 out of 10 (80%) medicines derived from plants, ongoing research into medicinal plants is crucial and should not be sidelined in the quest for an HIV cure. Scientific research remains the pathway to ending or controlling AIDS. Safe practices, cross-country experience sharing, and capacity building in research are essential. Promoting WHO guidelines, especially for new injectable treatments such as Lenacapavir (LA), is recommended to integrate traditional and modern medical approaches.

2. About Clinical Science, Treatment, and Care.

Advanced HIV disease (AHD) continues to pose significant risks, including late diagnosis, clinical complications, co-infections, and comorbidities. Diagnosing and managing paediatric TB requires more resources and stronger community engagement.

The emergence of long-acting drugs such as cabotegravir and Lenacapavir offers promise for both prevention and treatment, but affordability remains a challenge, underscoring the need for generic alternatives and robust drug resistance monitoring. Paediatric HIV care faces challenges with low viral load suppression and poor adherence, underscoring the need for innovative testing, prevention strategies, and access to new technologies, including ART monitoring tools and GeneXpert for TB, in child-focused health facilities.

3. About the HIV epidemic in Africa (2024).

Africa remains the epicentre of the HIV epidemic, with two-thirds of the world’s people living with HIV (PLHIV) residing on the continent—23.6 million people, of whom 21.7 million are on treatment (TAR). Women bear a disproportionate burden of infections and deaths. Key populations and their partners account for nearly half of new infections, a figure that has increased since 2010. There has been a notable decline in new infections (56%) and HIV-related deaths compared to 2010, as well as a sharp drop in paediatric infections. Pregnant women have seen increased TAR coverage, especially in Eastern and Southern Africa (93%) compared to Western and Central Africa (56%).

4. On Prevention Science and Social Barriers.

Long-acting PrEP is transforming HIV prevention, with innovations including bi-monthly cabotegravir injections, six-monthly Lenacapavir injections, and monthly Dapivirine vaginal rings.

However, challenges remain in addressing social inequalities and health system limitations, and in ensuring person-centred care. Barriers such as stigma, discrimination, lack of privacy, and economic constraints must be addressed. Engaging traditional and religious leaders is critical, as is training service providers to safeguard confidentiality and privacy. Community leadership and resilient programmes are needed, including mobilising domestic resources through public-private partnerships and integrating HIV services through multi-disease approaches.

5. Legal, Human Rights, and Political Science Considerations.

The conference highlighted the need to protect vulnerable groups from stigma and discrimination, ensure equitable access to health, and promote gender equality and community empowerment. Legal, social, cultural, and political barriers continue to undermine rights and weaken HIV responses.

Despite progress, criminalization, funding cuts, stigma, and digital exclusion restrict access to essential services. Urgent reforms are needed, with strong political leadership and rights-based, community-led approaches. Stigma is identified as a greater barrier than the virus itself, shaped by cultural and gender norms, and can be mitigated through community resilience and peer-led support.

6. About Health Systems, Economics, and Implementation Science.

Progress in HIV response has stagnated, but there are clear opportunities for integration and innovation. Structured prioritization tools (such as TIER) can help define sustainable HIV service packages aligned with financial realities. Integrated antenatal care (ANC) platforms should deliver combined testing and treatment for HIV, syphilis, HBV, non-communicable diseases, and other maternal conditions.

Local manufacturing capacity and regulatory readiness for ARVs and HIV commodities need strengthening. Integrating digital HIV tools into national health strategies and budgets is vital. Rapid policy alignment and preparedness are needed to adopt WHO guidelines, particularly for LEN (Lenacapavir), which is slated for rollout in at least ten African countries by 2026. Key issues include regulatory readiness, community awareness, and dependence on global partnerships.

7. About Leadership and Sustainable Response.

Ending HIV requires leadership, community empowerment, equity, and sustained investment in prevention. Africa must prioritize health financing and local pharmaceutical manufacturing, with strong political will and decisive leadership to sustain progress. ICASA continues to bridge science and policy, but after 35 years, intensified efforts are needed.

The leadership framework for responding to funding crises includes:

• Only three African countries have committed 15% of their budgets to health (per Abuja Declaration).
• Ghana’s Accra Reset is developing a sustainability roadmap for domestic financing and accountability.
• Lesotho funds 80% of ARVs domestically, with 20% from donors.
• DR Congo’s Presidential initiative to end paediatric AIDS is supported by significant domestic funding of about 18 million.
• Kenya and Morocco are launching digital health infrastructure initiatives.
• Public-private partnerships are fundamental to sustaining AIDS responses.

Domestic resource mobilisation strategies include leveraging public-private partnerships, introducing special taxes on alcohol and tobacco, engaging the African diaspora, establishing emergency funds, and enhancing financial transparency through e-budgeting. Social contracting enables governments to fund civil society organisations, and domestic funding must be institutionalised to ensure long-term sustainability. Integrated approaches involving communities, families, and partners are crucial, particularly for child health.

8. Some Recommendations for Actions.

• Governments and communities should prioritise HIV prevention and build partnerships with the media for awareness and behaviour change.
• Integrate behaviour-focused counselling into prevention strategies and invest in primary health care and workforce development.
• Decentralize and integrate services, strengthen data systems for monitoring and evaluation, and include long-acting PrEP in guidelines and budgets.
• Funders should prioritise prevention alongside treatment, while Clinicians and communities must promote persistence, choice, and equity in HIV care.
• Legal mechanisms are needed to ensure sustainable funding and accountability; parliamentarians should monitor and oppose harmful bills and adopt global standards for equality.
• Respond to gender-based violence (GBV) with survivor-centred, stigma-free approaches for key populations.
• Adopt prioritization tools for sustainable HIV service delivery and strengthen ANC platforms for combined testing and treatment.
• Scale up local manufacturing and regulatory readiness for HIV commodities and integrate digital tools into national strategies.
• Accelerate policy alignment and preparedness for new WHO guidelines and treatment rollouts.
• Political leaders must champion public-private partnerships and draw lessons from initiatives like Accra Reset, Uganda’s Fast Track, and Lusaka Agenda.

Conclusion

Echoing one of the reports, “ending HIV transmission requires more than medicine; it demands leadership, community empowerment, equity and sustained investment in prevention”.

Ultimately, sustainable solutions to Africa’s health challenges require united efforts across leadership, resource mobilisation, and community empowerment. As Osagyefo Dr. Kwame Nkrumah said, “Divided we are weak; united Africa could become one of the greatest forces for good in the world.”

ICASA is always eye-opening. One never comes out of it the same. I left this conference motivated and better equipped to continue fighting pandemics, preventable deaths, and advocate for healthy communities and individuals for the well-being of all. Yes, I believe that, as humans, we are part of the problems on our continent, and we are the ones who should provide solutions, which is possible.

By, Fr. Matambura Ismael, SJ.,

AJAN Director.