![[DRC] An AIDS patient in the public hospital in Kisangani in the Democratic Republic of the Congo (DRC), May 2006. The poorest people receive little help in such hospitals, as health facilities are at a minimum. It is estimated that about a 1,000 people d](https://assets.thenewhumanitarian.org/s3fs-public/styles/responsive_large_2x/public/images/20066283.jpg.webp?itok=VUWC8Ayj "With health facilities at a minimum, AIDS patients recieve little help in the DRC")
Donors have poured millions of US dollars into combating HIV/AIDS in the Democratic Republic of Congo (DRC), but the government has yet to provide a comprehensive programme, leaving international NGOs and churches to provide care and treatment in the mineral-rich eastern provinces, where 10 years of conflict has all but wiped out health infrastructure.
In Bukavu, capital of South Kivu Province, health officials say ongoing violence prevents them from obtaining an accurate infection level. "We have not carried out a complete study on the province's prevalence rate because of the difficulties of doing so during war. Each time we try, it proves to be impossible," said Médard Mpinda, acting coordinator of the Multi-Sector National Programme For the Fight Against AIDS (PNMLS).
Prevalence in South Kivu is estimated at 3.1 percent, based on 2005 figures from antenatal clinics, but the true situation is unknown in rural areas, which remain inaccessible due to the violence. "Three percent is just the tip of the iceberg," Mpinda said.
FILLING IN THE GAPS
Médecins Sans Frontières (MSF)-Holland, the international charity, works in two HIV clinics in Bukavu - Bagira and Kadutu - providing more than 1,800 patients with HIV/AIDS care, support and treatment, of which around 700 receive free antiretroviral (ARV) drugs.
The idea is for the ministry of health to take total responsibility, but MSF says this is unlikely to happen in the immediate future and intends opening a third clinic at Bukavu's General Referral Hospital.
The opportunistic infections clinic in Bagira, 7km outside Bukavu, is unmarked so as not to perpetuate deep stigma against HIV-positive people, but a sticker tells visitors no guns are allowed, a reminder of the war between foreign-backed rebel movements, local militia and the Congolese army.
In South Kivu there are no HIV clinics run solely by the government: NGOs or the church support them all, and the authorities have yet to implement an effective programme for distributing ARVs or care for patients on treatment.
Many areas have no functional health centres; hospitals lack well trained staff and are poorly stocked with medication.
"Equipment is lacking, in fact, it has totally disappeared because of the war. You can equip a health centre today and it is gone tomorrow," said Jean-Paul Bisimwa, head of the National Programme to Fight AIDS.
At the Bagira clinic, five HIV-positive women at a table in the yard listened attentively as nurse Celine Kamba reminded them that HIV did not mean imminent death.
"We have these workshops because it is a real challenge to understand the importance of taking this medication every day for life. They have to realise that with ARVs, the virus is still there even if they feel better," said Kamba.
Halting the treatment or missing doses can lead to development of a resistant strain of the virus. "This could have major implications for treatment," commented MSF's HIV/AIDS specialist, Dr Rebecca Adlington.
MSF launched its voluntary counselling and testing (VCT) programme in 2002 and started treatment the following year. The organisation tests between 100 and 140 individuals per week, of whom 13 percent to 14 percent are positive. "This is a biased population, to the extent that they are exposed to HIV/AIDS sensitisation and suspect they have reason to be concerned, or they have come to the clinic with illness," said project manager Lysette.
Prevention programmes and VCT facilities are in short supply outside of town, but access is improving. "HIV treatment is Bukavu-centric but it takes a lot to treat patients. It's not just the diagnosis of HIV but counselling, learning how to predict the future, how to live positively - and there comes a moment when a patient needs medication or will die," said Lysette.
Since opening its centres four years ago, MSF has worked closely with local health authorities and personnel, to show local residents and international donors that it is possible to put people on ARVs safely in unstable settings.
Procuring ARVs from the Netherlands and ensuring adherence to medication are major challenges to treatment providers: ongoing conflict can break supply lines and prevent patients from accessing health centres.
MSF provides centres with security stocks to cover most eventualities, and gives patients backup medicine and documentation to enable them to access drugs at other centres if they are displaced by conflict.
In Bukavu, capital of South Kivu Province, health officials say ongoing violence prevents them from obtaining an accurate infection level. "We have not carried out a complete study on the province's prevalence rate because of the difficulties of doing so during war. Each time we try, it proves to be impossible," said Médard Mpinda, acting coordinator of the Multi-Sector National Programme For the Fight Against AIDS (PNMLS).
Prevalence in South Kivu is estimated at 3.1 percent, based on 2005 figures from antenatal clinics, but the true situation is unknown in rural areas, which remain inaccessible due to the violence. "Three percent is just the tip of the iceberg," Mpinda said.
FILLING IN THE GAPS
Médecins Sans Frontières (MSF)-Holland, the international charity, works in two HIV clinics in Bukavu - Bagira and Kadutu - providing more than 1,800 patients with HIV/AIDS care, support and treatment, of which around 700 receive free antiretroviral (ARV) drugs.
The idea is for the ministry of health to take total responsibility, but MSF says this is unlikely to happen in the immediate future and intends opening a third clinic at Bukavu's General Referral Hospital.
The opportunistic infections clinic in Bagira, 7km outside Bukavu, is unmarked so as not to perpetuate deep stigma against HIV-positive people, but a sticker tells visitors no guns are allowed, a reminder of the war between foreign-backed rebel movements, local militia and the Congolese army.
In South Kivu there are no HIV clinics run solely by the government: NGOs or the church support them all, and the authorities have yet to implement an effective programme for distributing ARVs or care for patients on treatment.
Many areas have no functional health centres; hospitals lack well trained staff and are poorly stocked with medication.
"Equipment is lacking, in fact, it has totally disappeared because of the war. You can equip a health centre today and it is gone tomorrow," said Jean-Paul Bisimwa, head of the National Programme to Fight AIDS.
At the Bagira clinic, five HIV-positive women at a table in the yard listened attentively as nurse Celine Kamba reminded them that HIV did not mean imminent death.
"We have these workshops because it is a real challenge to understand the importance of taking this medication every day for life. They have to realise that with ARVs, the virus is still there even if they feel better," said Kamba.
Halting the treatment or missing doses can lead to development of a resistant strain of the virus. "This could have major implications for treatment," commented MSF's HIV/AIDS specialist, Dr Rebecca Adlington.
MSF launched its voluntary counselling and testing (VCT) programme in 2002 and started treatment the following year. The organisation tests between 100 and 140 individuals per week, of whom 13 percent to 14 percent are positive. "This is a biased population, to the extent that they are exposed to HIV/AIDS sensitisation and suspect they have reason to be concerned, or they have come to the clinic with illness," said project manager Lysette.
Prevention programmes and VCT facilities are in short supply outside of town, but access is improving. "HIV treatment is Bukavu-centric but it takes a lot to treat patients. It's not just the diagnosis of HIV but counselling, learning how to predict the future, how to live positively - and there comes a moment when a patient needs medication or will die," said Lysette.
Since opening its centres four years ago, MSF has worked closely with local health authorities and personnel, to show local residents and international donors that it is possible to put people on ARVs safely in unstable settings.
Procuring ARVs from the Netherlands and ensuring adherence to medication are major challenges to treatment providers: ongoing conflict can break supply lines and prevent patients from accessing health centres.
MSF provides centres with security stocks to cover most eventualities, and gives patients backup medicine and documentation to enable them to access drugs at other centres if they are displaced by conflict.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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