ARV distribution hindered by the war

DRC: ARV distribution hindered by the war

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

KINSHASA, 4 Mar 2005 (PLUSNEWS) - With less than one percent of HIV-positive people in the Democratic Republic of Congo (DRC) on anti-AIDS drugs, the country - which has been torn apart by six years of conflict - is slowly trying to launch its treatment programme.

According to Dr Jacques Kokolomani, coordinator of the National AIDS Programme (PNLS), about three million people are estimated to be currently living with HIV/AIDS - an HIV prevalence rate of 5 percent.

"Only 4,000 really profit from the antiretroviral (ARV) drugs while the number of people supposed to be given ARV treatment is approximately 400,000," Kokolomani told PlusNews.

The continuing conflict between armed factions, mainly in the east of the country, had caused a delay in the government's response to the epidemic, he noted.

"Due to the war, we couldn't launch the two most important programmes of free distribution. People have to buy the ARV drugs for themselves," Kokolomani said.

The cost of the medication varies between US $29 to $40 per month, depending on where the patient lives. The western regions are further from distribution centres and more difficult to access.

Nevertheless, after international donors injected US $137 million into a five-year HIV/AIDS programme, the government has vowed to step up its efforts.

A World Bank loan of US $102 million will enable about 25,000 people to access ARVs by 2009. An additional 15,000 HIV-positive people could receive subsidised medication from last year's Global Fund grant of US $35 million.


But people living with HIV/AIDS are calling for the treatment to be made completely free.

"We are demanding the government be pragmatic, to concretise its initiative of putting ARV treatment at the disposal of infected Congolese for free," said Jean Lukela, a representative of people living with HIV/AIDS in the capital, Kinshasa.

Lukela is one of the 501 patients who are treated free of charge by Medecins Sans Frontieres - Belgium (MSF) in the treatment centre (CTA) in Kinshasa. The project takes care of patients and of their family via a home and community care programme.

"People living with the virus are in general unemployed or extremely poor. They can't have access to ARV drugs if they have to buy them," Lukela said. "Those who can do it count on their relatives' charity, which can't go on forever. And ARV drugs are taken for a lifetime."

But the situation is more difficult for people living outside the capital. The country, 80 times as big as Belgium, has few HIV testing facilities in its 11 provinces.

The six years of conflict between six foreign armies and some 20 armed groups displaced large numbers of Congolese.

In the east of the country, rape is still considered a weapon of war. Despite the peace deal signed in December 2002, sexual violence continues and clashes still triggers new refugee and displaced movements.

Aid workers are concerned that the widespread rapes have pushed up HIV prevalence rates in most areas in the east. Dr Jean Kalume head of the local NGO Docs, estimated that in 2004, 12 percent of the women who had been raped in Kivu were HIV-positive.

The 12 percent prevalence rate is similar to that of cities like Kisangani, Kindu, Goma or Bukavu. But government statistics indicate a lower figure of around eight percent in the east of the country.


All the ingredients for the rapid spread of HIV/AIDS are there, but the authorities have yet to implement an effective programme to distribute ARVs or care for patients on treatment.

Nevertheless, humanitarian organisations have stepped in to close that gap. MSF-Netherlands provides free treatment to 1,220 people in Bukavu, the capital of South Kivu.

Catherine Van Overloop, AIDS project coordinator of MSF-Belgium, noted that small NGO treatment programmes were available in Kinshasa, in the provinces of Eastern Kasai, Katanga and the Bas-Congo.

"But it isn't the case in the east, most affected by the war, where the prevalence rate is the highest. Many areas have no equipped structures. If there are hospitals, they are no longer working, or there aren't material and medicines any more, and nobody can provide care to infected people there," she added.

The high cost of the ARVs has led to the sale of fake medication, mainly in the south-eastern province of Katanga, bordering Zambia and Tanzania.

"These ARV drugs have circulated, killing misinformed people who would buy the drugs without an HIV test," the president of the order of pharmacists, Jean-Baptiste Kalonji, told PlusNews. He added that he had already "seized products at doctors and patients' homes."

But people living with the virus have expressed concern over the duration of ARV treatment schemes in DRC.

"We wonder what will happen after these programmes come to an end," Lukela said. "MSF gives free ARV drugs for three years, and other programmes will take five years. What's coming next, what will happen to us?"


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