Many national hospitals in the Democratic Republic of Congo (DRC) are not accepting new HIV-positive patients for antiretroviral (ARV) treatment. The only way to get onto a treatment list is to wait until a space opens up due to a death or drop-out, or seek the limited treatment options available outside the government's programmes, but few people can afford the drugs.
"At least in the big cities like Kinshasa [the capital] and Lubumbashi there is some coverage, but in rural areas there is a big problem," said Erick Ngoie, head of advocacy for Union Congolaise des Organisations des personnes vivant avec le VIH (UCOP-Plus), an umbrella network of organizations of people living with HIV in DRC.
Chief among the problems in the DRC's fight against HIV is a severe funding deficit. A major World Bank project recently closed after six years, while UNITAID, an international health financing mechanism that provides funding for paediatric and second-line ARVs, will end its funding to the DRC in December 2012. The cancellation of Round 11 funding by the Global Fund to fight AIDS, Tuberculosis and Malaria is likely to worsen the situation.
"ARV coverage in Kinshasa is about 30 percent, and much lower in the rest of the country - close to half of the health zones are not covered by any HIV treatment programme," said Anja De Weggheleire, medical coordinator for Médecins Sans Frontières in the DRC. "Many health zones may offer HIV services at only one site, and even then it may not be the whole package."
Only 12.3 percent of people who need life-prolonging ARV treatment have access to it, according to government statistics. Poor information and low testing coverage - just 9 percent of adults know their HIV status - means people are often diagnosed in very advanced stages of illness, when treatment options are limited.
"There is an urgent need for more centres because people need access to testing earlier. Many patients come here very late, with multiple pathologies... some arrive here and only survive a few days, while others die on the way to the hospital," said Dr Laura Rinchey, the manager of the MSF-run Centre Hospitalier de Kabinda (CHK) in Kinshasa.
MSF started 2012 with a campaign to highlight the huge funding gap in the DRC's HIV treatment programme, and urged people to seek testing and treatment. Since then, demand for services at CHK has gone up significantly, straining the centre's resources. "We are now treating about 3,200 patients, which is about 20 percent of people on ARVs in Kinshasa," Rinchey said.
At Réseau National d'Organisations Assises Communautaire (RNOAC), a national network of community-based organizations, patients who are well enough to live at home come to collect drugs provided by MSF and receive support from other people living with HIV.
"We help them deal with stigma, teach them how to live a healthy life, with a balanced diet, and give them treatment education," said Jean Lukela, coordinator of RNOAC. Stigma remains high, Lukela said, with many people being ostracized by their families after they test positive for HIV, and others turning to churches for 'healing', rather than seeking medical help.
Clarrise Kambele, 30, frail and recovering from an HIV-related illness that nearly killed her, shelters at the RNOAC centre. Diagnosed with HIV in 2009, she didn't start taking ARVs until she fell very ill in 2012. Her husband abandoned her and took their child to his parents' home, leaving her to fend for herself. Too sick to work, Kambele was soon living on the streets, where an RNOAC volunteer found her and brought her to the NGO.
"I was very weak and my feet had swollen so much I couldn't walk. Now I'm still weak but much better, but I don't know what will happen to me when I leave here. My husband won't take me back - he won't even let me see our child - and my own family is dead," she told IRIN/PlusNews.
"We need the government to take HIV as a priority, and take the lead in HIV information so people can know that someone living with HIV is just like anyone else - they should not be shunned," Lukela said. "All support for HIV programmes comes from outside - we need the government to put its hands in its own pockets to pay for HIV treatment and care."
UCOP-Plus's Ngoie noted that unless donors and the government commit more resources to fighting HIV, the country's programmes will probably fail. "Because of poor funding, NGOs have disappeared, community-based agencies have closed. Some of the centres that remain have no people trained to handle HIV," he said.
"In this situation, we cannot achieve 'zero new infections, zero deaths and zero stigma',” Ngoie stressed. “We don't want this to be just a slogan, we want it to be real."