Central African Republic: prevention strategies making in-roads, but cases of HIV continue to climb
Bangui, Central African Republic - Each week Eric receives a free supply of HIV medication. The 15-year old orphan and former street-child contracted the virus at birth from his parents, who have since died, but only learned recently, after a series of homosexual affairs with other street children and following tests at a government laboratory that he was infected.
“No one ever talked about it on the street,” said Eric. “I sometimes see my friends from the street and we still don’t talk about it. They don’t know I’m HIV positive.”
These days when he goes out Eric often walks with his eyes fixed on the ground. He walks to the Voice of the Heart Foundation, a UNICEF-supported institution that supports children without homes, where Eric also gets a free medical check-up and meal. The center has also convinced Eric’s grandmother, who kicked the boy out of the house because she couldn’t afford to feed him, to let him move back into her home.
Eric’s personal story is certainly tragic but health experts here acknowledge that it’s also utterly common. The streets of Bangui are filled with a generation of children orphaned by HIV who walk looking at the ground. But to the extent that social services in this country have been able to medicate, feed and find him shelter, Eric’s story also represents something of a success. The social welfare net for children, funded by tens of millions of dollars from the Global Fund against AIDS, Malaria and Tuberculosis, can be said to be working. Yet beyond central Bangui, preventing the spread of HIV is much more complex.
“Every year the problem of preventing the spread of HIV is getting much bigger in Bangui but it’s getting even larger outside the capital,” said Pascal Roda, director of the Voice of the Heart Foundation in Bangui.
The numbers tell part of the story. While the number of sites that provide antiretroviral therapy has grown in the past two years from 23 to 46, and the number of people receiving treatment has risen from about 2,300 to 9,800, the number of children receiving similar treatment is just over 400. Yet surveys indicate that there are around 72,000 orphans under the age of 17 who are HIV positive, a number that has more than doubled in the past five years.
“UNICEF has been helping build capacity in the CAR in the area of HIV for years but when you look at the statistics on the spread of HIV, it’s like we’re still just getting started,” said Mahimbo Mdoe, UNICEF’s resident representative in the CAR.
In Bangui efforts have been focused on preventing the spread of the disease. On top of posters and billboards along streets, the government and UN agencies and their partners also sponsor classroom training, radio programming and touring theatre groups. Health professionals believe these programs are having an effect but worry that the stigma of the disease, an inability to reach all children as well as traditional belief continue to hinder progress.
“Kids see what happens to other children who have HIV and so even if we do testing most children don’t return to find out whether they tested negative or positive,” said Roda. “They might be infected with this very deadly virus, which medicine can help fight, but they’d still rather not know.”
Some nationwide surveys organized by UNICEF indicate that only about 30% of children return to learn the results of their HIV tests. At the same time a different survey indicates that despite the massive investments in educating children about prevention only 24% of children in the CAR could successfully identify two ways of preventing the transmission of HIV and reject two misconceptions.
At the Voice of the Heart there is a particular emphasis about Bangui’s large number of street children. While HIV isn’t the main infection these officials detect in street children (intestinal parasites is the biggest cause of concern) they worry that the several thousand estimated street children are particularly vulnerable to getting HIV because of the high incidence of homosexuality among them.
“Their way of life, the way they are beaten down, it help fuel the spread of HIV,” said Denis Kouanini, the Chief of Health at the Foundation.
On top of offering testing and trying to reunite street children with their families, the Voice of the Heart offers lessons on preventing HIV and encourages these children to get tested. Given the large number of homeless and street children, they say any strategy aimed at preventing HIV among youth has to have a component focused on street children.
Asked if he worries if he may have spread HIV to one of his sexual partners during the time he spent living on the street, Eric nods softly and resumes staring at the earth.
“No one ever talked about it,” he said.