Fighting against HIV in the Central African Republic—The importance of perseverance

March 4, 2014, University of Montreal

According to Pierre-Marie David of the University of Montreal's Faculty of Pharmacy, stock-outs of antiretroviral (ARV) drugs in recent years in the Central African Republic have had a dramatic impact on the health of HIV-infected people. These shortages have also created mistrust among patients toward the political and medical actors responsible for the fight against HIV/AIDS. And their wariness is likely to reduce their chances of getting better. David lived in the Central African Republic from 2005 to 2008, where he worked as Access to Antiretroviral Treatment Coordinator for the Red Cross. He then conducted research on the social effects of ARVs in the context of that country. His findings were recently published in Global Public Health.

From hope to disappointment

The fight against HIV/AIDS is one of the eight "Millennium Development Goals" adopted in 2000 by the UN Member States. Under this objective, to ARVs has become widespread in various countries, including the Central African Republic. "In this way, around 14,000 people were able to receive treatment in 2011 in a country where prevalence of the disease was 5%, which is an epidemic generalized across the population," says David.

However, ARV distribution has created disappointment equal to the high expectations it initially raised.

On the one hand, free access to ARVs offered the possibility of living better with HIV, which as a result, became a treatable infection like others. On the other hand, carriers of the virus were less stigmatized by the population, and the availability of medications resulted in a doubling in the number of pregnant women agreeing to be tested for HIV (20,000 in 2008 vs. 40,000 in 2009). But the management of funds – US $43 million – was centralized by an unprepared state apparatus. The distribution networks that existed before free access disappeared, leaving a monopoly system that had become corrupt.

So much so that, from 2008 to 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria sporadically froze payments to ensure greater traceability. The supply of ARVs was affected, resulting in stock-outs that sometimes lasted more than two months in areas of the country with more than 220,000 HIV-infected people.

Biological and social resistance

Noting the extent of the problem when he returned to Bangui in 2010, David reframed his work to include the individual and social effects of treatment discontinuation. "Paradoxically, these shortages, in both real and symbolic terms, were a death sentence for those whom the drugs were supposed to save," he says.

On the one hand, many patients suffered virologic failure (or treatment failure) due to the strategies they used to compensate for a lack of ARVs. "For example, some people took their medications only every other day so they would have some left over in case of a shortage, while others relied on local healers in the absence of treatment," recalls David. Such strategies likely increased the risk of drug resistance.

On the other hand, treatment interruptions were also interpreted by patients as a betrayal of those responsible for international programs. "In addition to biological resistance, I also noted social resistance, indeed a kind of cynicism," explains David. "And if, in ten years, we decide to give them second or third generation drugs to treat drug resistance, we will first have to ask how the development of new programs will be interpreted."

In other words, patients may reject these programs, and we will be deceived into believing that these men and women are refusing treatment for cultural reasons.

"However, there will be historical reasons for this social resistance, and in this sense, current stock-outs will be an explanatory factor for adherence or non-adherence to future treatment programs," he concludes.

About the situation in the Central African Republic

Since 2013, the Central African Republic has engaged in its third civil war, caused primarily by problems of governance that have degenerated into communal conflict between Christians and Muslims in a region greatly destabilized by fighting in Darfur and the Democratic Republic of Congo (DRC) and the spread of armed militias over a large part of the area.

According to the UN, the country is in the midst of a humanitarian crisis: half of the 4.6 million inhabitants of the Central African Republic are in a "state of humanitarian assistance," with 400,000 internally displaced and 68,000 refugees in neighbouring countries, mainly the DRC. In addition, approximately 1.1 million people are affected by food insecurity.

The situation deeply concerns David, not only because of the additional difficulties it raises for ARV distribution, but also because of the situation of survival it has created for the entire population. "Access to ARV treatment becomes problematic in the context of daily survival in a country that already generates little interest," he laments, recalling that less than 40% of basic humanitarian needs are currently filled. A call for international commitment.

Explore further: DNDi and Cipla advance development of pediatric 4-in-1 ARVs to fulfill new WHO guidelines

More information: Pierre-Marie David published "Towards the embodiment of biosocial resistance? How to account for the unexpected effects of antiretroviral scale-up in the Central African Republic" Vol. 9, Iss. 1-2, 2014 of Global Public Health.

Related Stories

DNDi and Cipla advance development of pediatric 4-in-1 ARVs to fulfill new WHO guidelines

June 30, 2013
The World Health Organization's new HIV treatment guidelines, released today at the 2013 International AIDS Society (IAS) Conference, include new antiretroviral (ARV) therapy (ART) recommendations for HIV-infected children, ...

South Africa rolls out new single dose AIDS drug

April 8, 2013
South Africa's health minister on Monday launched a new single dose anti-AIDs drug which will simplify the world's biggest HIV treatment regime to just one life-saving pill a day.

International groups urge Francophone nations to fight AIDS

October 12, 2012
About 50 non-governmental organisations on Friday urged the French-speaking nations holding a summit in Kinshasa at the weekend to "make concrete commitments" to fight AIDS in Africa.

Malnutrition decreases effectiveness of HIV treatment in pregnant African women

February 18, 2014
In Uganda the prescription of three antiretroviral (ARV) drugs, which aim to suppress the virus to prevent disease progression, have resulted in huge reductions in HIV mortality rates. However, disease is not the only scourge ...

Mozambique launches Brazil-funded drugs plant to battle HIV

July 21, 2012
Mozambique on Saturday launched a Brazilian funded pharmaceutical plant that will make anti-retroviral drugs to battle the HIV/AIDS scourge in the southern African country.

Only 1 in 3 HIV-infected black Americans gets effective treatment: study

February 6, 2014
(HealthDay)—Even though drugs that can keep HIV at bay are available, only about one in three black Americans with the AIDS-causing virus have their infection under control, U.S. health officials said Thursday.

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.