HIV/AIDS: Conflict in Central African Republic disrupts treatment

News Stories, 3 September 2014

© UNHCR/A.Kitidi
Nayo is a South Sudanese refugee in Central African Republic. The 58-year-old is one of the thousands of residents in the CAR living with HIV. UNHCR is helping to identify and prioritize needs.

BANGUI, Central African Republic, September 3 (UNHCR) Conflict forced Nayo to flee her native South Sudan and seek shelter in neighbouring Central African Republic, but it has not prevented the 58-year-old refugee from receiving the medical treatment that keeps her alive.

"Fighting has forced me twice to leave South Sudan for the Central African Republic, once as a little girl and once as an adult," she tells UNHCR. "I'd love to see my country, even though it's at war. But I am tired of running. I am too old and too sick," she adds resignedly.

Nayo is one of tens of thousands of people in the Central African Republic, including refugees, living with HIV. But while others now struggle to access treatment, she has access to vital free medicine thanks to a church organization in Bangui, the conflict-torn capital of the Central African Republic.

When a UNICEF-led inter-agency group compiled the last major survey in 2010, the prevalence of HIV across the country was 4.9 per cent one of the highest rates in Central and Western Africa. Women and people living in urban areas are particularly at risk, most being infected by heterosexual partners.

Nayo was infected by her husband. "We were staying at a refugee camp in Mboki [in eastern CAR near the border with Democratic Republic of the Congo], when he started getting sick," she recalled.

"There were rumours going around the camp that he was suffering from AIDS, but he never admitted it. As the discrimination around us grew, my husband refused treatment. He died at a hospital here in Bangui [in 2004] and this is when I found out that I was also ill," Nayo revealed.

Until 2012, when the current cycle of conflict began, UNHCR had helped refugees infected with the virus. They received monthly financial aid and medical assistance, as well as food support through the World Food Programme.

But a vital database with information on these patients disappeared when offices belonging to UNHCR and its partners were ransacked in 2013, while many health facilities that treated those living with HIV with retroviral drugs were looted and medical staff were forced to flee. Moreover, the distribution of these drugs outside Bangui has been disrupted, affecting the treatment of refugees in remote rural areas.

"The already weak health system of the country almost broke down completely. This enormously reduced the access to treatment for people living with HIV," explained Heinz Henghuber, a health consultant to UNHCR.

The situation got even worse after the violence escalated dramatically in December 2013. Access to care became even more difficult, increasing the risk of developing drug resistance due to the frequent interruption of treatment. The instability has also affected awareness-raising programmes in a country where discrimination against people living with HIV is prevalent.

In response, UNHCR recently completed a verification process that will allow it to rebuild its database and resume full assistance in urban areas to refugees and asylum-seekers living with HIV in Central African Republic.

The refugee agency, as part of its role in taking the lead on providing care in emergencies for those living with HIV, is also helping to identify and prioritize the needs of all those infected with the HIV virus or with AIDS in the Central African Republic to ensure that people receive vital antiretroviral treatment regularly.

To this end, UNHCR staff have been analyzing and triangulating reports and statistics from national partners, non-governmental organizations, other UN agencies and The Global Fund to Fight AIDS, Tuberculosis and Malaria.

For Nayo, who has also suffered sexual violence and a beating by militiamen, this work by UNHCR and its partners is vital. But she turns to her church to give her strength and medicine to overcome the many hurdles she has faced and will continue to face. She prays for more years, strength and to see her grandchildren grow.

By Aikaterini Kitidi in Bangui, Central African Republic

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Crisis in the Central African Republic

Little has been reported about the humanitarian crisis in the northern part of the Central African Republic (CAR), where at least 295,000 people have been forced out of their homes since mid-2005. An estimated 197,000 are internally displaced, while 98,000 have fled to Chad, Cameroon or Sudan. They are the victims of fighting between rebel groups and government forces.

Many of the internally displaced live in the bush close to their villages. They build shelters from hay, grow vegetables and even start bush schools for their children. But access to clean water and health care remains a huge problem. Many children suffer from diarrhoea and malaria but their parents are too scared to take them to hospitals or clinics for treatment.

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Crisis in the Central African Republic

Silent Success

Despite being chased from their homes in the Central African Republic and losing their livelihoods, Mbororo refugees have survived by embracing a new way of life in neighbouring Cameroon.

The Mbororo, a tribe of nomadic cattle herders from Central African Republic, started fleeing their villages in waves in 2005, citing insecurity as well as relentless targeting by rebel groups and bandits who steal their cattle and kidnap women and children for ransom.

They arrived in the East and Adamaoua provinces of Cameroon with nothing. Though impoverished, the host community welcomed the new arrivals and shared their scant resources. Despite this generosity, many refugees died of starvation or untreated illness.

Help arrived in 2007, when UNHCR and partner agencies began registering refugees, distributing food, digging and rehabilitating wells as well as building and supplying medical clinics and schools, which benefit refugees and the local community and promote harmony between them. The Mbororo were eager to learn a new trade and set up farming cooperatives. Though success didn't come immediately, many now make a living from their crops.

Mbororo refugees continue to arrive in Central African Republic - an average of 50 per month. The long-term goal is to increase refugees' self-reliance and reduce their dependency on humanitarian aid.

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The escalating violence in Central African Republic (CAR) has caught everyone in its web, including refugees from countries such as Chad, Cameroon and Democratic Republic of the Congo (DRC). For the Congolese living in places like the CAR capital, Bangui, or the town of Batalimo, home was just a short trip away across the Oubangui River. UNHCR earlier this year agreed to help those who wished to repatriate due to fear for their safety. The refugee agency has since mid-January facilitated the return home of hundreds of these refugees. The following photographs, taken earlier this month by UNHCR staff members Dalia Al Achi and Hugo Reichenberger, depict the repatriation of a group of 364 Congolese. The refugees portrayed were heading to the riverside town of Zongo in Democratic Republic of the Congo's Equateur province, where they spent a night in a transit centre before continuing to their hometowns. They were relieved to be leaving, and some were in poor health. The decision to return to the country they had fled during the years of civil war from 1996-2003 was not easy. Some 6,000 of the 17,000 Congolese refugees in Central African Republic have registered with UNHCR to go home.

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