DRC: ARVs don't address stigma and poverty in Ituri

BUNIA, 26 April 2007 (PlusNews) - The majority of HIV-positive people living in the Democratic Republic of Congo (DRC)'s northeastern district of Ituri are not taking up the offer of free life-prolonging antiretroviral (ARV) drugs.

Since the government began providing the drugs five months ago as part of its National Multi-Sector Programme to Fight HIV/AIDS, the number of people taking advantage of the free medication has risen from 10 to just 38.

Ignace Bingi, coordinator of the anti-AIDS league of Ituri (LASI), a nongovernmental organisation, told IRIN-PlusNews that stigma was a major factor preventing people from seeking treatment early, with many HIV-positive people still being ostracised by their families and neighbours.

"At the beginning, they accuse the neighbours of poisoning them and only when they are very sick do they come to the hospital," he said. "In such conditions, many die in the hospital ... some who are left without families prefer to die in the hospital."

With the aim of encouraging more people to be tested and receive treatment for HIV/AIDS, the government and NGOs have come together to form the Multi-sector Committee for the Fight against HIV/AIDS (CMLS).

"We ensure free consultations for HIV-positive people in the hospital and also hospitalisation for the most vulnerable," said Bingi, whose organisation is a member of CMLS.

Ituri, a district in the DRC's Orientale Province, has been ravaged by an ethnic conflict in which more than six armed groups have fought intermittently since 1999, displacing 400,000 people and leaving more than 50,000 dead.

The region has been cut off from vital services, including HIV prevention, treatment and care. Although the violence has subsided and the DRC recently held democratic elections, health services have been slow to resume.

UNAIDS estimates HIV prevalence in the DRC at about 3.2 percent, but says it may be as high as 20 percent among women who suffered sexual violence in areas of armed conflict; rape was rampant during the conflict in Ituri.

Although surveillance remains poor, the National Multi-Sector Programme to Fight HIV/AIDS reports that the HIV prevalence in voluntary testing centres in Bunia, Ituri's main town, is 21 percent.

The expense and availability of food in the area is another problem. Without regular meals, people living with HIV deteriorate rapidly and cannot tolerate the strong drugs.

"Most of the patients we receive arrive when they have already lost 10 to 20 percent of their bodyweight and need intense nutritional support," Bingi told IRIN-PlusNews. With support from the United Nations World Food Programme (WFP), LASI is providing some of the area's HIV-positive residents with food parcels.

"In total we have been assisting almost 525 families affected by HIV," Bingi said. "We have also assisted around 50 families in self-sustaining projects such as gardens [to grow food]."

Previously, HIV-positive people in need of ARV drugs had to buy them from private pharmacies. According to John Kambale, a doctor who prescribes ARVs in the main hospital in Bunia, out of 19 HIV-positive people diagnosed at the hospital by November 2006, just 10 had been able to afford the medicines. "ARVs were expensive - about US$150 for five months' worth of drugs ... there have been many deaths."

Despite government support for the fight against HIV in the region, local health workers say much more needs to be done if the pandemic is to be brought under control. Kambale said drugs to treat opportunistic infections were still expensive and beyond the reach of most HIV-positive people.

"The government has done a good thing by providing free ARVs, but the opportunistic diseases are not being taken care of," he said. "We prescribe Bactrim [an antibiotic] as a prophylaxis for patients, but often they can only buy three or four tablets before stopping due to lack of funds."

In 2005, the World Bank, through its Multi-Country HIV/AIDS Programme for Africa, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, began supporting a large-scale initiative to provide ARVs to 25,000 people living with HIV in the DRC by 2009.

However, weak infrastructure and health systems, poor coordination, insecurity, inaccessibility and lack of funds as a result of the armed conflicts in the country have hampered the planned rollout. According to UNAIDS, just four percent of people living with HIV in the DRC have access to ARVs.

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Theme (s): Care/Treatment - PlusNews, HIV/AIDS (PlusNews), Stigma/Human Rights/Law - PlusNews,

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