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Abidjan - Angry Aids activists are urging western and central Africa to step up the fight against HIV, saying millions of people, especially children, are at risk from complacency and underfunding.
A six-day conference in Africa has thrown a stark light on the problems in a region whose two dozen nations extend from Mauritania in the north to Gabon in the south, and include some of the poorest countries in the world.
Coalition Plus, an alliance of Aids groups, said Aids-related deaths in western and central Africa are running at 5.1%, more than twice the 2.1% in the rest of the continent.
The region accounts for just six percent of the global population, but has at least 16% of the total of the world's adults - categorised as people aged over 15 - who live with HIV.
The share rises even more dramatically, to 25%, in the category of infected children aged from birth up to 14 years.
Even though the HIV pandemic is more than four decades old, nearly 80% of the estimated 540 000 infected children in West and Central Africa are not getting life-saving antiretroviral therapy, the UN's children's agency Unicef and AIDS programme UNAids said on Tuesday.
"HIV and Aids pose direct threats to the lives of 820 000 children and adolescents," they said in a report issued at the ICASA conference which ends on Saturday. "Yet we know what works."
In 2016, an estimated 60 000 children were newly infected with HIV in West and Central Africa, it said.
Among adolescents aged 15-19, Aids-related deaths are on the rise. Among the 10-19 age group, 16 000 people died last year, a rise of 35% over 2010.
"The rise in youth mortality is a scandal," Marie-Pierre Poirier, Unicef's director for West and Central Africa, told AFP.
"Most of these teenagers are unaware of their HIV status," she said.
"Everyone is responsible. Support from international donors is insufficient for the region's needs. And governments must give priority to the fight against Aids, even if they have limited resources," she said.
The situation is not entirely bleak - the region slashed mother-to-child transmission of HIV by a third from 2010 and 2016 - nor is it the same everywhere.
Adult HIV prevalence ranges from less than 0.4% in Niger to 6.2% in Equatorial Guinea, the figures show. Nearly half of all infected children in the region are in Nigeria.
But the major problems are common, say experts.
One is the lack of so-called point-of-care HIV tests, so that a patient can be diagnosed and immediately treated - a major step in prevention.
Another is availability of antiretroviral drugs, which suppress the virus but do not eliminate it.
The cost of Aids therapy has plummeted since the first triple-therapy drug regimen became available in 1996, and access to the lifeline - taken in a simple once-a-day pill - is spreading across parts of Africa.
In West and Central Africa, though, 1.3 million people who know they have HIV are still awaiting treatment.
Stigma and discrimination, as well as homophobia, are factors that help the virus to spread underground.
"We have to shift up gears, to that of 'emergency response,' we have to mobilise all of society - government, civil society, families," said Poirier.
