MSF has been working in Zémio, a rural village in the far southeast of Central African Republic, since 2010. Our program includes comprehensive HIV care. Photos by Paul Uiterwaal
This week, I got to keep a promise I made months ago. I had been in Zémio, Central African Republic, less than a week when my team first approached me about World AIDS Day.
“MSF has been here for 6 years,” they said, “but we’ve never done anything to celebrate World AIDS Day.”
“Well, we will celebrate this year,” I promised.
Some of Zémio HIV team, left to right: Francisca, HIV counselor; Keri, HIV nurse supervisor; Jacques, pharmacist; Peeters, HIV consultant; Jean-Baptiste, TB consultant; Alain, pharmacist); Dr. Dorly; and Martin, HIV counselor.
The HIV component of a program is often the most difficult to manage over the long term. This is simply the nature of the disease – it is possible to treat, but not cure, HIV. Therefore HIV treatment is a treatment for life. Once you start patients on antiretroviral therapy, they can never stop taking the drugs. So, when MSF closes a project, we have to find a way to continue to treat patients. In Zémio in particular, since MSF is the only reliable supplier of antiretrovirals in the region, we have patients coming to us from as far away as 250 km (155 miles) and from across the border in the Democratic Republic of Congo. Further complicating the situation is the fact that the Zémio region has long been plagued by armed attacks, which makes the journey from a remote home village to Zémio for appointments and medication pick-up not just inconvenient, but also outright dangerous.
All of these issues combined have led us to realize that we must try something new in Zémio. We need a way to get these life-saving drugs to patients in remote areas without creating a system that won’t be sustainable when MSF is eventually forced to move its resources elsewhere. In Zémio, we are beginning an ambitious program to help patients organize themselves into community-based groups, where members can help each other adhere to the treatment and one person can come to Zémio to pick up all the medications for the other members. But in order for this strategy to work, we have another enemy to face: stigmatization.
The theme for World AIDS Day 2016: “Stigmatization Zero!”
Stigmatization of people living with HIV is a problem in every context in which I’ve ever worked. In Zémio, the level of scientific knowledge about HIV among the general population is the lowest I’ve ever encountered. People assume that HIV is a death sentence. If you are positive, you will die a horrible death and soon. In a context such as this, information can be a powerful weapon against fear. The more the population understands about the disease, the more people know that HIV is treatable and see that it is possible not just to survive with HIV, but to live a full and animated live, the less people living with HIV will be stigmatized. So I was delighted to discover that the international theme for World AIDS Day in 2016 was stigmatization.
Joseph, HIV counselor and focal point for World AIDS Day, greets the crowd gathered in front of the Zémio Health Center.
The Zémio team worked hard to create a program for World AIDS Day that was relevant to our situation and the cultural context of CAR. It was fun and engaging and informed the community about both the science and the social considerations of HIV. Zémio’s World AIDS Day celebration took place on Saturday, December 3, as the international World AIDS Day, December 1, is a public holiday in Central African Republic. Our celebration began with a morning march through town, ending at the MSF health center, where our community health workers performed a skit about HIV stigmatization.
The World AIDS Day march through Zémio town center.
A crowd watches the program.
We continued the festivities in the afternoon in front of a crowd of several hundred people. Our program was the result of the collaboration of our entire team. Our HIV counsellors and consultants led an information session. Our project coordinator recruited a traditional dance group to perform. Our doctor played in an HIV-prevention themed soccer game between “Team Condoms” and “Team Antiretrovirals” (Team Condoms won). Our tech log fitted the battery from one of our Land Cruisers to a microphone so the crowd could hear the message. Best of all, two of our HIV positive patients chose to share their histories, to stand up in front of a crowd of several hundred people and say, “I am HIV positive.” To me, there is no better way to combat stigmatization than for a community to see healthy, happy individuals who live with the virus.
The dance group performs in front of a crowd.
A patient shares her testimony.
The soccer match between “Team Condoms” and “Team Antiretrovirals”.
At the end of the day, I walked back through town to the MSF base with our two doctors and one of the HIV consultants. The four of us couldn’t stop smiling. After 6 years in Zémio, we had finally celebrated World AIDS Day, and we were over the moon with how well the event went.
In the coming weeks and months, our team in Zémio has some significant challenges to face. Our strategy of community engagement and placing responsibility for patients’ health into their own hands is indeed ambitious. The dangers and expense that patients face to travel to our clinic remain. Despite the success of our World AIDS Day program, the community has a long way to go before they could be called well-informed about HIV. And fear of disclosing their HIV-positive status remains the biggest obstacle to the success of our new HIV care model. But I believe in the Zémio team, in their dedication and desire to help their community. I’m excited to continue to work to realize our goal: zero stigmatization for people who live with HIV.