The availability of affordable rapid tests for HIV and effective antiretrovial (ARV) treatment has enabled many people to live long and healthy lives. Despite this, an estimated 60 percent of people living with HIV do not know their status, and those who are diagnosed still face a wide range of challenges in accessing treatment, particularly in sub-Saharan Africa.
For World AIDS Day, we share stories from some of the highest HIV prevalence countries in the world, where Médecins Sans Frontières / Médecins Sans Frontières (MSF) is working to break stigma and improve health. ‘access to testing and treatment for communities. who would otherwise be deprived of vital care.
Late diagnosis or interrupted treatment is devastating for people living with HIV. This leads to increased levels of the virus in the blood, which weakens the immune system and makes people even more vulnerable to deadly opportunistic infections, such as tuberculosis.
Higher virus levels also put the community at risk, increasing the likelihood of transmission. In communities where it’s common for people to drop out of treatment or go undiagnosed, our teams are witnessing a widespread infection that can set back years of progress in fighting the epidemic.
HIV can be controlled, it is not a death sentence. When treated properly, patients can live long and normal lives.
When the Burmese military seized power from the country’s democratically elected government in a coup on February 1, 2021, doctors and nurses were among the first to protest, abandoning their jobs just days after. The strikes, coupled with widespread insecurity and threats to healthcare workers, have severely affected the public healthcare system, including the National AIDS Control Program (NAP), which provides medicines, consultations and counseling over 150,000 people living with HIV.
Political unrest has wreaked havoc on Myanmar’s public health system, and many hospitals have closed or only offer a limited range of services, meaning there are few facilities where we can. refer patients with HIV when their condition is critical and they require more advanced care. care than what we can offer.
NAP is slowly recovering, but functioning facilities offer limited services and are unable to accept MSF patients into its program. Transfers likely won’t resume until at least 2023. Instead of reducing HIV activities this year as initially planned, MSF has expanded its services. We are now diagnosing and starting treatment for hundreds of new patients for the first time since 2019. Our teams have provided 7,200 consultations to NAP patients in Shan, Kachin and Tanintharyi states.
This spike in patients, as well as the interruption of medicine imports, threatened MSF’s medical supplies. For months, we were only able to offer shorter ARV prescriptions, which means people have to come to the clinic more frequently. We now lack the drugs to treat opportunistic infections, such as fungal meningitis, and the materials needed to diagnose HIV in infants. If the supply issues are not resolved, many people could die.
In MSF clinics in Myanmar, 2,929 appointments were missed between February and October this year, an 89% increase over the same period in 2020. Many people visiting our clinics have to travel long distances. . Not only is there a curfew that makes it difficult for some people to travel, but these trips are now fraught with challenges that can deter them from making the trip – assassinations, targeted bombings, and territorial battles are rife throughout. the country.
“The road between Chipwe and Myitkyina [in Kachin state] has been closed for months, ”said Brang Seng *, a patient diagnosed with HIV in April. “There are a lot of checkpoints and few pilots dare to come. I’m worried that the conflict will escalate, preventing me from traveling and then missing my date. I can only come if there is a taxi. They are not [available] everyday.”
Affordable intercity trains don’t run and bus lines are unreliable, which means people have to use more expensive private cars or motorcycles. The economic impact of the political crisis in addition to the COVID-19 pandemic means that many people cannot afford to visit a clinic. To help overcome these financial obstacles, MSF provides these patients with medicines via public transport. In Shan State, we have made 270 such deliveries since February. But that’s not a long-term solution, and it means patients who need to see a doctor or receive services like blood tests, which can only be done in a clinic, don’t get the care they need. they need.
Democratic Republic of Congo
Almost half a million people are living with HIV in the Democratic Republic of Congo (DRC), but access to testing and treatment remains a challenge, causing thousands of preventable deaths, 17,000 in 2020 alone. According to the United Nations, nearly a quarter of people living with HIV in the DRC do not know they have the virus. Not only do fear and stigma prevent people from getting tested, access to voluntary testing is almost impossible, and many health facilities do not offer free testing for people with symptoms.
Others stop their treatment because of a lack of available medicines, psychological support to help them continue their treatment or because of the cost of treatment, even though ARV treatment is supposed to be free. As a result, many patients develop an advanced stage of the disease.
“I arrived at the hospital in critical condition,” said Sara, a patient at the Luyindu Hospital Center (CHL), one of six establishments in Kinshasa supported by MSF. “I was hospitalized here for two months. Today I am back on my feet. I was able to leave the hospital. But I now live in the parish because my family denied me. Fortunately, the medical team is there to encourage me and follow my treatment.
“The stigma surrounding HIV in this region has serious consequences,” said Dr Adolphe Byakausa Matondo, medical director of CHL. “We did a lot of awareness raising in the hospital and in the community. Fortunately, today things have changed a lot.
According to UNAIDS, between 13,000 and 29,000 new HIV infections occur in the DRC each year, underscoring the need for free and rapid access to testing and treatment to avoid developing life-threatening complications. But there is still a lack of national and international resources to make this possible.
Mozambique has one of the highest HIV burdens in the world. In Beira, a port city on the country’s east coast, 4,390 people tested positive for HIV in 2019 and 2,766 in 2020. Unfortunately, the stigma makes it difficult to convince patients to start treatment. As a result, MSF teams treat many people with advanced HIV (commonly known as AIDS).
“Our main goal is to recognize cases in advance by screening patients and to clinically manage these patients at an early stage in order to reduce the mortality rate,” said Dr Shehezady Cruz of MSF. “It is important for patients to know that HIV / AIDS can be treated and that it is possible to lead a normal life, as long as treatment is continued.
However, people face many challenges in accessing or staying on treatment, including socio-economic barriers, lack of family support, access to a balanced diet, distance from health services and stigma. MSF is meeting these challenges by providing psychosocial support, monitoring patients with serious illnesses and offering outpatient consultations and referrals in collaboration with local health centers.
“Every month, like clockwork, [the MSF staff] was calling me to check on my treatment, ”said Santos Estrela *, who receives advanced HIV treatment from MSF in Biera. “The counselors, nurses and clinical care I received motivated me to continue. I felt that I was important.
Estrela was diagnosed with HIV more than five years ago after his wife fell ill. She was diagnosed with meningitis and HIV and died shortly thereafter. “I got depressed,” Estrela said. “I started to drink and smoke. I did not tell my family that I had HIV and I did not take the treatment. And it made my condition worse.
In 2020, Estrela was admitted to Beira Central Hospital. After starting treatment, he improved. “At that point, my family found out that I had HIV and supported me to continue taking antiretroviral therapy. The support I received from my family and loved ones helped me improve my situation. My family made sure I had good, nutritious food to keep me healthy. I felt strong. It was a strength that came from within and it motivated me to fight.