Stigma hampers fight against HIV/AIDS in South Kivu

In the volatile eastern Democratic Republic of Congo (DRC), where people are often more concerned about their safety than HIV/AIDS, widespread stigma and discrimination are driving the epidemic underground, especially in the province of South Kivu.

"When my neighbours learnt that I was positive, they made sure that I was thrown out of the rental house I was living in with my wife and three children," said Borauzima Lukabia, 34, in Bukavu, the provincial capital.

"Because of being stigmatised and discriminated upon, we often lack the means to earn a livelihood," he said. "Take me, for instance: I am 34, yet I have no work; no one will employ me. My biggest problem now is hunger; I am on ARVs and this means I am hungry all the time, yet I have no means of earning a living."

Getrude Muhemeri, the director of Fondation Femme Plus, a national non-governmental organisation (NGO) offering support to HIV/AIDS infected and affected people, told PlusNews that most people living with HIV/AIDS had suffered greatly in the intermittent conflict in the province during the past 10 years.

"War-affected people are mostly very poor; those infected often have to face a lot of stigmatisation, in addition to all the other problems related to violence," she said.

Fear of rejection

Although Bukavu has an estimated population of half a million, a spot-check of NGOs supporting people living with HIV/AIDS showed that only a few thousand were being assisted, which most NGO officials attributed to fear of stigma and discrimination if the HIV-positive status of a person should become known.

"In conjunction with our partners [other NGOs and governmental organisations], we provide psychosocial support to people living with HIV/AIDS; we also sensitise the families of those infected to get them to accept their relatives, but is not enough, said Dr Alex Kabanga wa Kabanga, a medical supervisor at NGO Catholic Relief Services (CRS).

"More efforts need to be made to have whole communities sensitised against discriminating and stigmatising the infected," he said. Although most people in the province knew what AIDS was, many still shunned their relatives who had declared their status.

"When someone is told that their brother has HIV, their response is often one of fear and the desire to give up that person to be cared for by an organisation; they seem to want nothing to do with an infected person," Kabanga said.

Photo: Jane Some/IRIN

Borauzima Lukabia, HIV-positive Bukavu resident

"It is because of this fear of stigmatisation that a lot of people would rather not reveal their status."

Kiungi Safi, 34, and her husband, a soldier who is also HIV-positive, said stigma meant that the only house they and their three children could rent was in an area prone to flooding. "Because of this, my husband and I are always suffering from opportunistic diseases that we get whenever our house is flooded during the rainy season," she said.

"My family depends on the little salary my husband gets from the army ... about 10,000 Congolese francs [US$20]. It is not enough to ensure we have food, let alone trying to rent a house in a better neighbourhood and, anyway, we will be thrown out if a new landlord found that we had AIDS."

Kabanga said, "A lot of people who know they are infected do not own up [to their HIV-positive status] because they fear discrimination. They say, 'maybe my wife will leave me, my children will be shunned by the neighbour's children, who will no longer want to play with them, fearing they will get infected, or the landlord will throw me out'."

CRS has been operating in Bukavu since 2005 and works with a network of about 100 volunteers, sensitising those who may be living with the virus and do not know it, as well as the families of people who have declared their status, to promote acceptance and support in the community.

"We use volunteers who visit people's houses, VCTs [Voluntary Counselling and Testing centres], market places and other public areas, and our volunteers often have to make several visits to one area before people begin to open up."

Supporting HIV-positive people in Bukavu

The organisation's biggest project is known as AMITIE, an AIDS mitigation initiative that offers care and support to people living with HIV, as well as orphaned and vulnerable children (OVC).

Kabanga said they had recorded some 1,137 people living with HIV/AIDS in Bukavu, to whom they provided psychosocial support and referred to medical facilities and NGOS where they could get antiretroviral therapy. CRS also assisted 1,843 OVCs, 1,537 of whom were of school-going age, but it could only pay school fees for 770 of them.

"We should pay school fees for all these children but our funds are stretched; all of them need food, others need support to get vocational training, and others need legal aid to benefit from their late parents' properties."

He said an issue of great concern was providing food to people already on ARVs. "AMITIE is a four-year programme, and we hope that our donors [USAID] will increase its aid annually to cover all these needs," Kabange said.

The main donors to NGOs, like CRS and Fondation Femme Plus, who work with several other local and international organisations to support people living with HIV/AIDS in Bukavu, are USAID and the Global Fund on HIV/AIDS, Tuberculosis and Malaria. The government's National Multi-Sectoral Programme for the fight against HIV/AIDS, known by its French acronym PNMLS, is the coordinating agency for all the organisations dealing with HIV/AIDS.

Dieudonne Zirirane, the HIV programme coordinator for Association Sante Familial (ASF), a national NGO affiliated to Population Services International (PSI), said the NGOs working with HIV/AIDS met every month, under the chairmanship of PNMLS.

The major challenges in the fight against HIV/AIDS in South Kivu included the vastness of the province; insecurity, which hampered access to vulnerable communities; funding; an increase in sexual violence in war-affected communities; and a lack of adequate information.

Most of ASF's activities were focused on supporting the health of vulnerable communities, especially those infected and affected by HIV/AIDS, in four main programmes that covered HIV prevention, family planning, preventing malaria, and a safe water project.

PSI, in conjunction with ASF, ran several social mobilisation activities aimed at informing the public about HIV/AIDS. "We undertake these activities to break the barriers, so to speak, in a bid to demystify HIV/AIDS to the largest number of people," Zirirane said.

"We target commercial sex workers, soldiers and the police, demobilised soldiers, truck drivers, the youth as well as people belonging to various religious faiths."

Approaching the targeted groups was achieved mainly by peer education, and a small group in every target group was trained to inform their colleagues about HIV/AIDS.

"In the field, the peer educators give out reference cards to whoever wishes to visit a facility for testing and counselling; the cards have a list of medical facilities and VCTs centres, where potential patients who produce them get served free of charge," Zirirane said.

ASF-PSI also marketed affordable condoms via a network. "Condoms available in health centres and other public places are provided under a ministry of health programme, but we realised that a lot of people did not like the free condoms, so they prefer to instead go through our network where they get to purchase a pack of three condoms for 50 Congolese francs [US 10 cents]."

Zirirane said the prevalence rate among pregnant women had been found to be about three to four percent; two percent among those who donated blood; four percent among documented victims of sexual violence, and 20 percent among commercial sex workers.

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