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BURUNDI: IRIN interview with HIV/AIDS Minister Sindabizera

[This report does not necessarily reflect the views of the United Nations]

NAIROBI, 12 February (PLUSNEWS) - The Burundi government says although the HIV infection prevalence in urban areas has stabilised at 18.6 percent, it is concerned by a significant increase in the level of infection in rural areas.

At 1 percent in 1989, HIV prevalence in rural areas was 7.5 percent by 2001, the Burundi minister for HIV/AIDS issues, Genevieve Sindabizera, told PlusNews. She attributed the stabilisation in urban areas to a higher literacy rate, better means of communication, and increased acceptance and availability of condoms.

In order to avoid further deterioration of the situation in rural areas, she said a national action plan targets vulnerable groups by way of an information campaign carried out through peer educators, the promotion of condom use, counselling of people living with HIV/AIDS, the reduction of the epidemic's socioeconomic impact on people by the promotion of revenue-generating activities, and the social integration and education of orphans.

With an average annual per capita income of US $140, the economic impact of the HIV/AIDS pandemic has been dramatic in a country wracked by years of civil strife. Burundi's HIV/AIDS secretariat has estimated that if transmission of the virus continues at the current rate, life expectancy will drop below 40 years in 2010, compared to 60 years if there were no AIDS.

IRIN spoke with Sindabizera about Burundi's coordinated efforts to combat the disease with limited medical infrastructure and expertise and scarce financial resources.

QUESTION: In the United States, research shows that one-half of AIDS victims undergoing treatment are infected by a virus which is resistant to more than one antiretroviral. What are your observations regarding the few AIDS patients undergoing treatment in Burundi?

ANSWER: Indeed, we read more and more in the public media as well as in scientific journals about the existence of virus strains resistant to several molecules, especially in the West. In this country, it is said that the sick people have been exposed to these molecules over a period of time and sometimes intermittently; there are also those who are not taking the treatment regularly. This may explain the phenomenon even if we know that there is genetic resistance to certain molecules.

In Burundi, as well as in several African countries, access to treatment is still limited to the few people in a higher income bracket - and even this has not been for very long.

The biological follow-up is limited to certain tests to avoid future secondary effects, and on the immunological state, which means the CD4 ["helper" cells that orchestrate the body's response to certain micro-organisms such as viruses] count. The assessment of biological resistance is not possible in Burundi, and consequently we do not have reliable data on this situation.

Nevertheless, clinical follow-up on the CD4 count shows genuine improvement in most of the patients under antiretroviral treatment, according to data supplied by doctors who treat these patients.

Q: Your office has reported that the infection rate is increasing in the rural areas, which is precisely where people are illiterate and uneducated. What are your plans to deal with this problem before it gets out of control?

A: Figures show a progressive and alarming increase in the infection rate, rising from less than 1 percent in 1989 to 7.5 percent in 2001 in rural areas. The Burundi government's strategy is to intensify the fight at the national level, and particularly in rural areas. This will be made possible thanks to the participation of the public as well as private sectors, and especially by putting emphasis on the participation of the communities themselves.

This is how the National Programme for the Fight Against AIDS and Sexually Transmitted Diseases has equipped itself with a multi-sector programme that involves everyone, and which is decentralising the activities to grass-roots level. This project is piloted by a National Council for the Fight Against HIV/AIDS, which, for operational reasons, has central structures, including the Permanent Executive Secretariat.

Q: How do you explain the stabilisation of the rate of infection in urban areas? Does it imply that there is a lower rate of new infections and/or a lower number of deaths of those infected?

A: Indeed, according to the figures obtained from urban areas over the past three years, we get the impression that the rate of infection has stabilised.

These figures are obtained from sero-prevalence observations in clinics. An investigation of the sero-prevalence at national level will soon be under way, and this will give us the true facts.

If stabilisation of the infection rate is proved to be true, it would more likely be linked to the lower rate of new infections. This is because, in urban areas, action in the fight against AIDS started much earlier. Furthermore, the people are more literate and have access to the media. Also, the condoms have become more acceptable thanks to awareness campaigns, and they are available and accessible to city dwellers.

Q: How is work shared between the minister in charge of HIV/AIDS and the minister of health in the fight against AIDS - is there no duplication in their jobs?

A: Certainly, the Ministry of Health and that charged with the fight against AIDS will forge close cooperation in the epidemiological sector. Although HIV is known to be a big health problem in Burundi, it also has multiple consequences, and on several sectors. That is why the Burundi government, in order to put into practice its political commitment, set up the National Council for the Fight Against HIV/AIDS so as to involve all national sectors through the creation of the Ministry in the President's Office in charge of fighting against HIV/AIDS. The ministry is charged with coordinating activities of the various sectors.

The action of the Ministry of Health is essential, and its action will emphasise medical aspects, such as offering treatment to the sick, national epidemiological surveillance, and the prevention of HIV/AIDS - especially prevention of mother-to-child transmission through antiretroviral treatment. Therefore, there will be no duplication in the activities of the two ministries, but rather complementarity.

Q: What is the death rate among Burundi AIDS sufferers who are on antiretroviral treatment?

A: The death rate among people living with HIV/AIDS who are on antiretroviral treatment is not known. As I said earlier, the standardisation of the anti-retroviral treatment started recently and a regular follow-up of those getting the treatment is being put in place. Those figures may be available in the near future.

Q: Effective treatment against AIDS requires the availability of infrastructure such as laboratories. In Burundi, due to the war, not only doctors left the country to go to work elsewhere, but also the existing health facilities are no longer functioning. What is being done currently to improve this infrastructure and encourage Burundi doctors working abroad to return home?

A: Like in other developing countries, Burundi doctors left or stayed in western countries to pursue their studies. Because of this, the government is looking for possible means to try to encourage them [to return home] and it is hoped that they will return home as peace and security are restored in the country.

In the meantime, training of medical and paramedical staff continues on how to take care of people living with HIV/AIDS.

Concerning health facilities, efforts are being made by the government and its partners to rehabilitate hospitals and health centres. In addition to multi-sector programmes, infrastructure will be equipped so as to strengthen operational capacity.

Q: Refugees will soon return home and internally displaced persons [IDPs] will return to their villages. Taking into account the high infection rates in refugee camps and among IDPs, what effect will their return have on the spread of HIV/AIDS in the country and how will your ministry react?

A: We expect, among other things, a higher rate of infection in the rural area if nothing is done about it. In order to prevent such a situation, the 2002-2006 National Action Plan has called for actions targeting vulnerable groups, as well as specific interventions - notably in the Information-Education-Communication campaign carried out through peer educators, the promotion of condom use, counselling of people living with HIV/AIDS, the reduction of the epidemic's socioeconomic impact on people through the promotion of revenue-generating activities, and the social integration and education of orphans. The ministry will ensure that all those involved in various activities realise these objectives.

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