Lack of treatment makes HIV one of the main causes of death in CAR, according to MSF

There are few centers for the treatment of HIV and in addition, most patients have to pay for the test


HIV continues to be one of the leading causes of death in the Central African Republic (CAR) where around half of diagnosed patients do not receive treatment in a country where extreme poverty, widespread violence and a serious shortage of facilities and services converge. health personnel, among other aspects, according to the alert Doctors Without Borders (MSF).

According to the NGO, in 2019 some 4,800 people died of AIDS in the country, in which about 5,500 new cases are confirmed each year and where there are persistent problems in the antiretroviral (ARV) supply chain and barriers to early detection and patient care.

“While the Central African Republic has the highest HIV prevalence in the West and Central Africa region, less than half of the 110,000 people estimated to be living with HIV are on ARV treatment,” explains Laurent Lwindi Mukota, Advisor. MSF HIV doctor in the country. “The situation is even more alarming for children: less than a quarter of those under 15 who know their HIV status are under treatment,” he illustrates.

RCA, immersed in a conflict since the end of 2013 from which it has not yet fully emerged, is considered the country with the lowest life expectancy in the world and is completely dependent on insufficient external funding for its response to HIV.

MSF emphasizes that very few health centers, among a small number of health facilities, offer HIV care and testing, forcing patients to have to make long and often dangerous trips to find a clinic offer such services. But it is not enough just to arrive, since these centers often lack the material and drugs to offer ARV treatment.


“In a country where the majority of the population lives on less than two dollars a day, the economic barriers to accessing care are aggravating this situation,” laments Marie Charlotte Bantah Sana, director of the program against communicable diseases of the Ministry of Health and Population.

As explained by this official, “most have to pay to take an HIV test and, later, they have to pay for additional tests out of pocket before they can start treatment.” As a result, “30 percent of all patients cited for a pre-treatment evaluation do not return to start their medication regimen,” he says.

In Bangui, where HIV prevalence is twice the national average, MSF teams have provided free medical care and psychological support to patients who are in an advanced stage of the disease and who have also been co-infected with tuberculosis since the end of 2019. .

In the first year of the MSF project at the Bangui Community University Hospital Center, 1,851 patients had been admitted for HIV treatment, including 558 patients who had just been diagnosed as HIV positive. Outside of Bangui, MSF offers treatment to patients with advanced HIV in Paoua, Carnot, Kabo and Batangafo.


In addition, to ensure that more people can access treatment, MSF has created ‘community antiretroviral groups’ in Bambari, Batangafo, Bossangoa, Boguila, Carnot, Kabo, Paoua and Zemio.

In this system, groups of patients living with HIV designate one of their members to collect everyone’s medication doses for the coming months, thus reducing transportation costs and the time spent on medical consultations.

The NGO emphasizes that they not only allow more people to access treatment, but also help patients to self-manage and actively participate in it and serve to promote companionship and support and to achieve greater adherence to treatment, in a country where stigma against people living with HIV remains a harsh reality.

“This system is important because some people are embarrassed to go to the hospital for HIV treatment. And because of it, they can avoid doing it and continue taking their medication,” explains Serge, who is part of a community group in Carnot. In total, MSF has helped establish 276 such groups, comprising some 2,300 patients.

This community-led initiative, according to MSF, has proven even more important in the context of COVID-19, when access to healthcare facilities was drastically reduced, particularly due to the infection prevention and control measures needed to prevent the spread of the virus.

“There is still important work to be done to decentralize, destigmatize and guarantee that HIV testing and treatment are free and accessible to all,” warns MSF, which emphasizes that despite the advances in the last decade, many still persist ” barriers in the fight against HIV that will have to be broken down little by little “.

“It is necessary to redouble efforts, and increase investment, to make free HIV testing and care available to everyone in the country,” claims the organization.

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