On the border between South Sudan and the Democratic Republic of the Congo, Haut Mbomou is the province worst hit by HIV in the Central African Republic, with HIV prevalence at 11.9% compared to a national average of 4%.
Initially spared by the conflict that engulfed the country in 2013 and 2014, since 2018 Haut Mbomou has seen fighting between rival armed groups, continued insecurity and large-scale displacement of people. More than 47 000 people have been displaced by insecurity and violence in the province, adding to a population of some 3500 refugees from South Sudan and the Democratic Republic of the Congo.
Alerted by accounts of persistent medicine stock-outs, substandard care for people living with HIV and barriers to access to HIV and health services owing to insecurity, a joint mission of the Central African Republic Ministry of Health, the National AIDS Council, the World Health Organization, the Office of the United Nations High Commissioner for Refugees and UNAIDS visited Haut Mbomou from 8 to 12 April. Located 1000 km from the capital, Bangui, the province is among the most underserved by health and social services. Half of the health facilities in the province are closed owing to a lack of personnel or rundown facilities.
The Obo District Hospital, the main health-care facility in the province, lacks basic laboratory testing equipment, including for blood safety or tuberculosis screening. Access to antiretroviral medicines is greatly limited by regular stock-outs. The mission was also concerned by the absence of HIV prevention and sensitization efforts.
Access to food is increasingly a problem because insecurity limits farming, fishing and hunting and hinders the ability of humanitarian agencies to deliver nutritional support. For vulnerable people living with HIV, including refugees and displaced people, access to food and nutritional support is essential for antiretroviral medicine adherence and effectiveness.
The mission showed the complex nature of the challenges facing the HIV response in a context such as that in the Central African Republic, which is characterized by insecurity, population displacement and a collapsed health-care system. Those challenges call for urgent attention and action on the part of the government, the United Nations and others to address emerging and chronic health and HIV challenges.
Original source: UNAIDS
Published on 15 April 2019