HIV/AIDS: Conflict in Central African Republic disrupts treatment

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.