Hard choices: Central African Republic doctors say war boosting HIV prevalence


Violence that erupted two years ago has slowed the campaign to diagnose and treat the illness.

A conflict in the Central African Republic that has led to the collapse of the country’s health care system is threatening to accelerate the prevalence of HIV/AIDS, according to doctors and medical workers in the country.

“These mothers and children all have HIV/AIDS,” said the head doctor at the country’s only children’s hospital, Simplice Kango, as more than 100 women and their children sat on benches and covered the floor waiting for treatment.

Violence that erupted two years ago has slowed the campaign to diagnose and treat the illness, raising concern by health advocates that the prevalence of HIV/AIDS may rise from 3.8% among adults aged 19 to 45, according to a 2013 estimate by the United Nations.

The country plunged into chaos when mostly Muslim rebels and anti-government militia overthrew Christian President Francois Bozize in March 2013, sparking a wave of fighting that left at least 3,000 people dead. A transitional government in place since January 2014 has failed to extend its authority beyond Bangui, the capital.

The violence has stopped many people from reaching health care facilities, with clinics closing as medical personnel fled to safer places, allowing looters to empty the shelves of drugs. The stolen goods included life-prolonging antiretroviral therapies, which can also help prevent the spread of human immunodeficiency virus, or HIV, the virus that causes AIDS.

The war itself has sparked a humanitarian crisis, with 2.5 million people requiring urgent assistance and 900,000 having fled their homes to neighboring countries or internal camps.

The clashes scared off many of the “hundreds” of women who used to come to Bangui Pediatric for medical information and care, said Sibelle Balanga, coordinator of a HIV/AIDS support group for women and mothers at the facility. 

During the worst bouts of violence, the hospital was mostly treating victims of the fighting, including children struck by bullets and shrapnel or the malnourished, according to the United Nations Children’s Fund, known as Unicef.

“If women can’t come here for regular treatment their health deteriorates and their newborn suffers,” Balanga said.

Even before the crisis, which led to a breakdown of the nationwide health system, the country had one of the worst records in the world on health, with children under five years old having a 16% chance of dying, according to the World Health Organization.

Health authorities have lost track of HIV-infected adults and children after they didn’t receive treatment for several months when the health centers were inaccessible, according to Jean-Jacques Inchi Suhene, a HIV/AIDS specialist with Unicef.

“We don’t know where many are, so we are looking for them,” he said. “There is also a risk of developing a drug resistance due to frequent interruptions to treatment.”

Eliminating mother-to-child transmission can be possible with the right medication and treatment plans, Emmanuel Lampaert, medical coordinator for Medecins Sans Frontieres in Central African Republic, said in an interview.

“Getting people initiated on time and having the treatment for the rest of their lives and the follow-up is so important and a major issue,” Lampaert said. “The world can not forgot about Central African Republic.”


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