Kinshasa and war-torn Bukavu region, DRC, celebrate first year of ARV treatment

ALT Pep BonetMSF ARV program. During an AIDS awareness session Tet, an MSF national staff member, talks about HIV/AIDS to young people. Working with members of the community helps in gaining trust and makes it easier to spread the messages.

The World Health Organisation (WHO) estimates that 100,000 people die from AIDS each year in DRC.

Today, October 15, 2004, marks the first year of Médecins Sans Frontières (MSF) providing anti-retroviral (ARV) treatment for people living with HIV/AIDs in the town of Bukavu, eastern Democratic Republic of the Congo (DRC). The MSF project in Bukavu is currently the only comprehensive ARV drugs for people suffering from AIDS in the whole of eastern DRC.

MSF also runs a second AIDS project in the DRC capital, Kinshasa, with the same record. It also started providing ARV treatment in October 2003.

In total there are now more than 456 people (127 in Bukavu and 329 in Kinshasa) under MSF-supported ARV treatment in the DRC.

The HIV virus is spreading fast in DRC. Unlike many other countries in southern Africa, there is no reliable data about the exact prevalence of the disease. There are many risk factors though, such as high rates of sexual violence, population displacement caused by war and lack of access to preventative health care, that suggest that the global AIDS epidemic is beginning to hit DRC hard.

The World Health Organisation (WHO) estimates that 100,000 people die from AIDS each year in DRC. The number of people living with HIV/AIDS in the country is put at 1,100,000 - a prevalence rate of 4.2%.

In Kinshasa, with a population of seven million, the prevalence rate is estimated at 3.8%, although the figure for the east of the country is thought to be far worse than the national average.

The national programme in the DRC tasked with combating the spread of AIDS - Le Programme national de lutte contre le sida (PNLS) - estimates that 350,000 people are hospitalised because of AIDS, with only 1,500 having access to ARVs - mostly from private sources.

In May this year, fighting broke out in the area for two weeks. However, a minimal programme was maintained during the hostilities and little interruption to treatment occurred. The overall adherence rate to ARVs during the period of insecurity was 92%.

Through its AIDs projects in the DRC, MSF intends to show that it is possible to provide quality care - including ARV medicines - to people living with HIV/AIDS in resource-poor and potentially insecure settings such as DRC, which is just emerging from years of war.

On the May 26 this year, fighting broke in the town of Bukavu between government and dissident forces, and it was feared that there would be a resumption of the war in the DRC. During two weeks of clashes there was; widespread looting in Bukavu; reports of rapes; and more than 80 people are thought to have died.

Some AIDS patients supported by MSF were either temporarily denied access to their treatment or fled across the border into Rwanda. However, a minimal programme was maintained during the hostilities and little interruption to treatment occurred. The overall adherence rate to ARVs during the period of insecurity was 92%.

The Bukavu AIDS project is the only one of its kind for MSF in a true conflict setting yet it has shown that it is possible to provide quality medical care for people living with AIDS in such environments. In Kinshasa no patient has stopped taking ARVs in the MSF programme despite the social barriers sometimes encountered to remaining on treatment.

In general, the approach of MSF to AIDS treatment in the DRC is to raise awareness about the dangers of the disease, provide counselling and testing, as well as a comprehensive package of medical care, including life-saving ARV medicines. The projects in Bukavu and Kinshasa are very much 'pilot' projects to develop a simplified model of medical care, which it is hoped can be replicated elsewhere in the country by state health actors.

The patients on ARV treatment are themselves one of the most important catalysts for promoting change to tackle the looming AIDS problem in DRC.

The patients on ARV treatment are themselves one of the most important catalysts for promoting change to tackle the looming AIDS problem in DRC. Many of the people now supported by MSF were all but dead or with very advanced HIV infection when they started ARV treatment.

"It is amazing to see how they are back to life, gaining weight, being healthy and smiling agai," said MSF doctor Heather Culbert. "In a context of high stigma levels about AIDS due to a lack of public education about the disease, people enjoying ARV treatment can be an important mobilser to other people by demonstrating what can be achieved."

Years of war in DRC, however, have completely decimated the health system in the country and national investment in AIDS treatment is a major priority. The Global Fund has dedicated $35 million to AIDS care over the next two years in DRC. But more money is needed. ARV drugs costs $29 per month - well out of reach of most Congolese.

As well as improving the model of care already provided and scaling up the number of people on ARV drugs, over the next year MSF aims to work closely with local and national health authorities to ensure that there is more widespread treatment available for people living with AIDS in the DRC. By building local capacities, a greater impact can be made on the growing AIDS problem in DRC. This will only happen though if more ARV drugs are made available and donors dedicate the necessary funds.