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As new fighting has put the North Kivu province of Democratic Republic of Congo (DRC) at centre stage, there is little discussion of the health crisis faced by people living with HIV/AIDS in this country. The situation of the epidemic however is catastrophic. It is estimated that there are nearly one million people affected by the disease, including 430,000 in urgent need of treatment and care. Of these, only 53,000 actually receive any. In other words, that is a needs coverage rate of barely 13%, whereas the average rate for all African countries is 50%. The DRC alone accounts for more than half of all these patients, who are living in a country with poor antiretroviral coverage.
Doctors of the World - Médecins du Monde (MdM) - can attest to this tragedy: 80,000 lives lost each year due to lack of the means to save them, because of delays in screening or financial barriers to access to care. In Goma, in both centres supported by Doctors of the World, the mortality rate rises by 30% each month amongst those who did not have access to treatment prior to their hospitalisation. According to Congolese law, care related to the disease should be provided at no expense, but it is only through the support of organisations like Doctors of the World that a portion of the patients are able to benefit from care or laboratory tests at no charge.
Call for a mobilisation
The goals set by the country are ambitious: that by 2015, more than 300,000 people will receive treatment that will enable them to live. To take this step forward, and to be ready when the International Conference on AIDS is held in Washington, we are calling for a general mobilisation. International donors should increase their support to the DRC, through the Global Fund against AIDS, Tuberculosis and Malaria, but also through direct financing in the DRC. The actual or planned closure of programmes by the World Bank and UNITAID represents a loss of chance for people with HIV in the country. The European Union should ensure that its next European Development Fund dedicated to the DRC include an ambitious component of fighting against HIV/AIDS. Its member states could allocate budgets to antiretrovirals, including primary health care in their cooperation. The US, meanwhile, has already earmarked the means to contribute very significantly to achieving this goal through the President’s Emergency Plan for AIDS (PEPFAR) but has so far refused to provide a scaled response in the DRC. A refusal to spend today will only cost more dearly tomorrow, in economic, social, and human terms.
Congolese political and institutional leaders must also take responsibility. In 2011, the previous government had spent less than $1 per person with HIV. We welcome the recent adoption of a budget specifically allocated by the Government to the fight against AIDS. The priority now must be to spend these funds effectively to support programmes for HIV/AIDS care. To that end, the national authorities and international stakeholders should promote a true health democracy, involving all stakeholders in policy development, starting with the patients themselves.
More than ever, it is necessary to invest substantial resources in access to HIV/AIDS screening, prevention, treatment and care services in the DRC. In ten years, the emergency situation in which Congolese people with HIV find themselves has not changed. We said then that antiretroviral treatment would allow patients to regain a level of health sufficient to live a normal life, to work, to care for their children and to contribute to society. Today we can say that they are furthermore helping to slow the epidemic’s momentum. Universal access to treatment and care for HIV/AIDS is therefore an issue of development, on both the individual and public health level.
The opportunity to provide a decent life for people living with HIV/AIDS will be presented to the Congolese government in the short term through a new Global Fund grant. It must seize this opportunity and demonstrate its willingness to change the state of affairs. However, the country, as we know, cannot rely on limited funding opportunities offered by the Global Fund alone to meet this challenge. We therefore call on international donors to increase their contribution to the DRC, and to fund ambitious programmes around a single priority: to save a million human lives.
Dr Thierry Brigaud, President, Pierre Salignon, General Director of Médecins du Monde and François Berdougo, HIV Advocacy Referral Officer for MDM in the DRC
