Daily Archives: May 13, 2017

Insecurity Creates Challenges for HIV Treatment in Southeast C.A.R.

ZEMIO, C.A.R. � Violence in the southeastern part of the Central African Republic, where five U.N. peacekeepers were killed this month, has made it tougher for HIV-positive residents in the remote, lawless region to get treatment.

The prevalence rate of HIV in southeastern C.A.R. is 13 percent, nearly three times the national average.

The migration of people between the bordering areas of South Sudan and the Democratic Republic of the Congo contributes to the spread of the disease in all three countries.

“Here, it’s a crossing where everything converges. It’s why the level of HIV is high,” said Bienvenu Sapioko, a government nurse who works at the only hospital in Zemio. He said the rebels and refugees in the area also increase the high prevalence.

An internal U.N. report obtained by VOA found HIV rates increased following the arrival of the Ugandan security forces in the C.A.R. in 2009. The Ugandan and American forces tasked with tracking down Joseph Kony and his Lord’s Resistance Army ended their mission in April and are heading home.

With prostitution, polygamy and effectively no state authority in the area, weak education contributes to the problem.

Stigma, superstition

“People believe in the power of nature and traditional doctors. So bush doctors, shamans are also very common in the community,” said Olivier Pennec, the Doctors Without Borders project coordinator in Zemio.

Stigma compounds the problem.

“Before, the people didn’t treat themselves. The people would hide the microbes, this disease,” said Marcel Elonga, a community leader. They would hide and “speak about this parasite, parasite, parasite.”

HIV-positive people in local communities can also find themselves shunned by their peers.

“They don’t want him in the community,” community leader Pierre Yakanza said, describing how some people here see an HIV-positive person. “They don’t want to be close to him. ‘Leave him over there. We don’t want to associate with him or have him in the community meetings or give him a job.’ He’s rejected.”

Local health workers spread information about safe sex, but even access to condoms remains a challenge.

Treatment available

More than 1,500 people now come to Zemio’s hospital from nearby and as far away as Uganda, South Sudan and the Democratic Republic of the Congo for the free HIV treatment offered by Doctors without Borders.

Hospital officials said previously one person would die every month or so from the disease, but they haven’t registered a death since 2014.

In 2012, Agnes Davouragouni said she used to be sick all the time.

“When I did the test and found out I was positive, my husband said he doesn’t have HIV, so he left me the same day,” said the 35-year-old woman, who now lives alone with her three children, selling wood and charcoal to get by.

Once a year, Davouragouni walks 45 kilometers to Zemio over the course of two days in order to get a checkup as part of her treatment. She walks mostly at night and sleeps under a tree along the way.

“The roads are very insecure. I don’t have a motorcycle or the money to pay to get here,” she said. “There’s a lot of fear to travel on these roads.”

Bandits and rebel groups, including the remnants of the Lord’s Resistance Army, all move around the area. The security void will worsen with the departure of Ugandan and American forces in the next few months.

Group efforts

Recognizing the challenges of getting medication, Doctors Without Borders developed a new community approach in which HIV-positive patients work in groups to bring back antiretroviral drugs in bulk every six months, reducing travel time, costs and exposure to risk.

Farmer MoA�se Ouele picks up the antiretroviral drugs for his group of about 30 people and drives them two hours down the road to his village Kitesa, about 50 kilometers away.

“It was really tiring for me to come each month to the hospital,” Ouele said. “But now, this program helps a lot with this problem, despite the insecurity of the LRA that is growing.”

Doctors Without Borders is transitioning out of the area at the end of the year and is handing over the administration of the program to the Ministry of Health.

Source: Voice of America


CAPE TOWN, A report that speaks to a possible decriminalisation of sex work has been completed and will soon be made public, Deputy President Cyril Ramaphosa said on Thursday.

He said this when responding to questions from Members of Parliament in the National Assembly.

The Deputy President was asked what government’s position is on the decriminalisation of sex work, in light of the fact that sex workers remained the most vulnerable to HIV infection because of the continued criminalisation of sex work.

The South African Law Reform Commission has completed its report on the issue of the possible decriminalisation of sex work, the Deputy President said.

He said Cabinet has decided that the report should be released for public comment as part of a broader consultation process.

Once comments have been received from the public, government will finalise a position on the various options proposed in the Law Reform Commission’s report, he said

In 2016, the South African National Aids Council launched the National Sex Work Sector Plan to, among other things, reduce the spread of HIV among sex workers.

The plan provides for a standardised minimum package of services to be provided by all implementing partners within and outside of government.

The Deputy President said on Thursday that the core package of services has been designed to encompass the multi-faceted lives of sex workers.

It calls for national coordination of a range of interventions to respond to the biomedical, behavioural and social and structural barriers that confront sex workers on a daily basis.

Evidence indicates that effective HIV prevention, care and treatment packages for sex workers, their clients and their children should be tailored to local contexts, and that such interventions should be led and implemented by sex worker peers.

The Sex Work Sector Plan, therefore, seeks to support sex workers not only with healthcare services, but it is also supporting them with human rights, psycho-social and economic empowerment services, he said.

The Deputy President said as this work continues, all sectors of society are encouraged to support the National Sex Work Sector Plan, understanding that reduced infection rates among sex workers will impact on infection rates in the general population, while ensuring that the Constitutional rights of sex workers are protected.