Our health expertise

Our Historical Mission

Solthis was initially created to combat the HIV epidemic and provide broad access to quality, sustainable care. In 2003, the epidemiological data was alarming: mortality and incidence rates were rising in Africa, and access to antiretroviral (AVR) treatment covered only a fraction of the need.

Persistent Needs

Despite considerable progress, the HIV situation remains concerning in West and Central Africa. Many countries with fragile health systems face conflicts, humanitarian crises, and climate change. In 2022, 82% of adults living with HIV knew their status, 78% had access to ARV treatment, and 71% had an undetectable viral load. However, the situation for children and teenagers living with HIV is dire, with only 37% knowing their status and accessing treatment.

In 2023, 160,000 new infections were recorded, representing 12% of new infections worldwide. While new infections have decreased by 43% since 2010, this decline has been faster among men (49%) than women (38%). Women and girls account for 43% of new infections, with weak sexual and reproductive health services contributing to their disproportionate burden.

Coverage of programs to prevent vertical transmission of HIV increased from 29% in 2010 to 53% in 2022 but has stagnated since 2016. The region is home to 20% of pregnant women living with HIV worldwide but accounts for 52% of all pregnant women living with HIV who are not on treatment. Key populations and their partners and clients account for 74% of new infections, fueling the epidemic due to stigmatization and, in some countries, criminalization.

Our Action

In response to these persistent needs, Solthis continues its efforts to support the UNAIDS 2021-2026 global strategy, ‘Ending inequalities. Ending HIV.’ Our ambitious objectives include ensuring that 95% of people living with HIV know their status, receive treatment, and achieve viral suppression, as well as eliminating mother-to-child transmission of the virus. We aim for 90% of people living with HIV to receive preventive treatment for tuberculosis and for less than 10% to experience stigma, discrimination, or gender-based inequality and violence.

Leading cause of infectious mortality among people living with HIV

Tuberculosis is one of the leading causes of infectious mortality worldwide and is the leading cause of death among people living with HIV (PLHIV), with 161,000 deaths in 2023. According to the WHO, 10.8 million people worldwide contracted tuberculosis in 2023, 464,000 of whom were HIV carriers. Children are particularly affected by the disease, along with PLWHA, with approximately 1.3 million cases worldwide in 2024.

In 2014, the WHO developed the End TB strategy, which aims to achieve a 95% reduction in mortality and a 90% reduction in the number of new cases by 2035 compared to 2015. This strategy requires improving TB diagnosis, treatments, particularly for multidrug-resistant forms, implementing preventive strategies and continuing the collaboration between TB and HIV programmes.

Our action: Addressing the challenge of tuberculosis underdiagnosis

Additionally, Solthis continues to develop comprehensive approaches to combat tuberculosis, helping to achieve the objectives of the End TB strategy. Our efforts focus on the following areas:

• screening and management of tuberculosis;
• screening for tuberculosis in children;
• screening for tuberculosis in PLWHA and better coordination between HIV and tuberculosis programmes;
• implementation of preventive treatment for tuberculosis in the populations most at risk (PLWHA);
• tuberculosis screening in the general population in rural areas;
• work on issues of stigma (status sharing, peer engagement);
• integration of psychosocial dimensions in patient care, including issues of therapeutic compliance and prevention of the emergence of resistant strains.

According to the WHO, 250,000 sexually transmitted infections were contracted every day in Africa in 2021, which represents a quarter of the world’s curable STIs cases. 19 of the 20 countries with the highest incidence of cervical cancer are also located on the continent.

However, STIs are pathologies that can be treated, cured and controlled. Historically committed to the fight against HIV, Solthis has naturally extended its scope of action to other STIs.

Within our various projects, we systematically conduct informative, preventive, and awareness-raising activities to promote behavioral changes. We also support civil society advocacy for legislation that advances sexual and reproductive rights and health. Additionally, we are strengthening our commitment to combating STIs by implementing projects specifically targeting papillomavirus and cervical cancer, the leading cause of cancer mortality in Africa. We are also innovating with the roll-out of the first triple elimination initiative (HIV, Hepatitis B, and syphilis) in West Africa.

The 10th leading cause of death worldwide

In Africa, dying from viral hepatitis is a greater threat than dying from AIDS, malaria or tuberculosis. Yet the disease remains neglected in many parts of the continent.

Hepatitis B, a preventable and treatable infection, affects more than 60 million Africans. Despite the availability of diagnostic tools and effective treatments, more than 90% of people living with hepatitis B do not receive the necessary care. This results in at least 200,000 deaths per year in Africa, often among the youngest and most productive population on the continent. Less than one in ten people in Africa have access to screening and treatment, with the result that the disease often progresses to advanced liver disease, with the catastrophic financial burden that entails, as well as the emotional distress and stigma that accompany it.

In highly endemic regions, hepatitis B is most often transmitted from mother to child at birth (perinatal transmission) or by horizontal transmission (exposure to infected blood), particularly from an infected child to an uninfected child during the first five years of life. The earlier the infection occurs, the greater the risk of it becoming chronic, causing cirrhosis and cancer: 80-90% of infants infected during the first year of life and 30 to 50% of children infected before the age of 6 will develop a chronic infection (compared to less than 5% of healthy adults infected as adults).

The vaccine remains the keystone against this infectious disease and the WHO recommends that this vaccine be administered to all infants as soon as possible after birth, preferably within the first 24 hours. However, this recommendation has not yet been widely implemented.

Our action: to strengthen advocacy, virus screening and vaccination from birth.

In response to these needs, Solthis is continuing its advocacy work and is committed through its projects to:

• Expanding access to screening and treatment for people mono-infected with HBV. Although antiviral drugs are currently available to treat infected individuals, access to diagnosis and treatment for hepatitis B remains limited in many low-resource countries. Thus, in 2022, among people infected with the hepatitis B virus, only 13% were aware of their serological status and, among diagnosed patients, global treatment coverage was only 3%.
• Promoting vaccination from birth (triple elimination).

While the Ebola epidemic made it possible to strengthen health surveillance systems, Covid-19 has not spared African health systems, having a major impact on the continuity of care for the most vulnerable individuals. According to figures from the Africa Centres for Disease Control and Prevention (Africa CDC), Africa had recorded more than 12 million cases of infection and 256,557 deaths since the start of the pandemic as of January 2023.

WHO statistics estimate the real toll to be seven times higher, mainly due to a very large number of asymptomatic patients and under-screening. Although the continent has been less affected in terms of deaths, this pandemic revealed many challenges, particularly the management of serious cases, access to oxygen, the screening of suspected cases, the vaccination of the population and the implementation of hygiene protection and prevention measures in healthcare facilities.

In this context, Solthis aims to continue investing in the fight against emerging diseases, in order to support and develop the resilience of health systems and ensure continuity of care in the countries where it operates.”

Today, access to sexual and reproductive health (SRH) and the full expression of rights remain significant challenges. Women, in particular, face considerable difficulties in exercising control over their own bodies. Vulnerable and marginalized groups encounter numerous obstacles in accessing quality care. Despite progress, West Africa is experiencing a slowdown in advancements made so far. The region accounts for a substantial proportion of the continent’s maternal deaths. It is also in West Africa that the experience of motherhood among girls under the age of 15 is most widespread, exposing them to serious complications. Young girls there have a 20% chance of becoming pregnant during adolescence. The region also has the highest rate of unmet need for contraception among adolescent girls.

The implementation of comprehensive sexuality education programs faces strong resistance. Additionally, gender-based violence continues to impact life courses, reflecting deep social inequalities.

In 2023, Solthis produced a report titled ‘For a Feminist Approach to Healthcare: Promoting Sexual and Reproductive Health and Rights for All,’ highlighting our commitment to more inclusive care. Reflecting the strategies deployed by Solthis and its partners in the field, the feminist approach to healthcare that we offer is based on three pillars:

1. Empowering women to act and promoting self-care and reappropriation of the body;
2. Integrating the fight against gender-based and sexual violence into all actions: prevention, risk reduction and response;
3. Focusing services on individuals, particularly women, and taking their specific needs into account.

Solthis’ positioning and actions to promote sexual and reproductive health

To address the SRH needs of populations, particularly the most vulnerable and marginalized (such as people living with HIV, sex workers, or LGBT+ individuals), Solthis implements interventions that strengthen the exercise of their sexual and reproductive rights and improve access to comprehensive, high-quality SRH services.

The organization recognizes the importance of a comprehensive, integrated approach to supporting individuals in their sexual and reproductive health throughout their lives. Each SRH service is part of a set of interconnected components, with a particular focus on the following priorities:

• comprehensive sex education;
• contraception counsel and services;
• prevention and management of STIs/HIV;
• prevention, screening and management of cervical cancer;
• prevention, screening and management of gender-based violence;
• strengthening the management of young people and adolescents and taking into account the specific needs of people in vulnerable situations;
• integration of SRH and HIV services;
• comprehensive abortion care.

and at the primary health care level:

• prevention of mother-to-child transmission of HIV;
• prenatal care;
• emergency obstetric and neonatal care;
• postnatal care;
• referral to appropriate facilities.

In West and Central Africa, the maternal mortality ratio is 724 per 100,000 live births, the highest in the world. The risk of maternal death in giving life, meaning the probability that a 15-year-old girl will die from complications of pregnancy or childbirth during her lifetime, reached 1 in 27 in 2020 in the region, eight times the world average.

Solthis is committed to the Sustainable Development Goals (SDGs) and the ambition to reduce the global maternal mortality ratio to below 70 per 100,000 live births by 2030. Most of these deaths would be preventable if health systems were strengthened as a whole. Solthis works to ensure the availability and quality of maternal, neonatal and child health services.

The West and Central Africa region has the highest infant mortality rate, with 92 deaths per 1,000 live births in 2021. This means one child in the region dies every 17 seconds (WHO, 2021). This rate is far from the United Nations target of 25 deaths per 1,000 live births by 2030. Within this infant mortality rate, neonatal mortality in West and Central Africa accounts for 30.5 deaths per 1,000. Most of these deaths would be preventable if health systems were strengthened overall.

Pneumonia and diarrhea alone account for 29% of these deaths. Vaccination is one of the best ways to protect children from these diseases. However, 1 in 5 children do not have access to these vaccines. Addressing this issue requires efforts at all levels, from the government to the family, in both the public and private sectors.

Solthis’ projects to improve infant care and collaborate with communities and healthcare professionals exemplify our ambition to combine capacity building, technological innovation, and user empowerment.

Worldwide, cervical cancer (CC) is the fourth most common cancer in women, with 660,000 new cases in 2022. Over 94% of the 350,000 deaths from cervical cancer that year occurred in low- and middle-income countries. In West Africa, cervical cancer is the leading cause of cancer-related deaths in women. Almost all cases of cervical cancer (99%) are linked to infection with high-risk human papillomavirus (HPV), a virus commonly transmitted through sexual contact.

HPV is primarily transmitted through sexual activity, and most people become infected shortly after becoming sexually active. Women living with HIV (WLHIV) are more vulnerable to persistent HPV infection than HIV-negative women; they are six times more likely to develop cancer. Our actions are in line with the WHO global strategy:

• A world where cervical cancer is eliminated as a public health problem.
• A threshold of 4 per 100,000 woman-years (incidence rate) for elimination as a public health problem.
• The following 90-70-90 targets to be achieved by 2030 for countries to be on track for elimination of cervical cancer:
  * Vaccination: 90% of girls are fully vaccinated before the age of 15.
  * Screening: 70% of women are screened using an effective test at the age of 35 and again at the age of 45.
  * Treatment: 90% of women identified as having cervical disease receive treatment.

Gender-based violence (GBV) can be defined as ‘any harmful act committed against a person’s will that is based on socially ascribed differences between males and females’.

Teenagers and young people are particularly exposed to GBV, especially sexual violence. This violence can occur within or outside the family. Several studies on sexual violence show that the vast majority of cases are committed by someone known to the victim. Worldwide, 1 in 10 girls under the age of 20 claim to have been a victim of sexual violence. These figures are probably an underestimate. It is estimated that, all ages combined, 1 in 3 women will be a victim of physical or sexual violence during their lifetime. Periods of social instability and psycho-affective vulnerability, such as adolescence, are recognised as periods in which sexual violence is more prevalent. Furthermore, numerous studies in various countries have revealed the significant frequency of sexual violence in schools. Perpetrated by other students or by the teachers themselves, this violence has a major impact on students dropping out of school and on the number of unwanted pregnancies among them.

The effects of climate change have a direct impact on our health. The impacts are already being observed worldwide: the severity or emergence of certain infectious diseases, antimicrobial resistance, but also an increase in chronic illnesses, deteriorating mental health and food insecurity. The burdens associated with these issues underline the importance of adopting approaches and modes of intervention based on multi-disciplinary collaboration linking human, animal and environmental health, and on contextualized and localized projects, supported by communities on a territorial scale, and including monitoring-evaluation and operational research components. Climate change thus calls for new forms of cooperation in health, at international level and within communities, in order to improve the monitoring and documentation of health risks, support mitigation and adaptation strategies and thus better understand and reduce health impacts.

Climate change is one of today’s greatest health threats. It is significantly altering the fundamental determinants of health. All over the world, heat waves are becoming more intense, and floods and natural disasters more frequent.

These upheavals are weakening already vulnerable healthcare systems, accentuating inequalities and jeopardizing food security, access to water and mental health. Stress, anxiety about the future and forced displacement are all realities that now weigh heavily on the shoulders of many communities.

In the face of this emergency, it is essential to think about health and climate together. This means devising health policies capable of adapting to new climatic risks and more resilient health systems, strengthening warning and prevention systems, but also listening to and involving local communities, often on the front line in the face of upheaval.

Integrating climate issues into public health initiatives is no longer an option, it’s a necessity. This calls for concrete, local responses, as well as international cooperation to better anticipate, adapt and protect populations, now and in the future.

Reducing and mitigating the impact of climate change on health also means acting on the causes, by promoting more sustainable and equitable lifestyles and development that respect the ecosystems on which our survival depends. Because by protecting the planet, we are also protecting our health.