BURUNDI: IRIN interview with HIV/AIDS Minister Sindabizera
NAIROBI (IRIN) - The Burundi government says although the HIV infection
prevalence in urban areas has stabilised at 18.6 percent, it is concerned by a
significant increase in the level of infection in rural areas. At 1 percent in
1989, HIV prevalence in rural areas was 7.5 percent by 2001, the Burundi
minister for HIV/AIDS issues, Genevieve Sindabizera, told IRIN on Wednesday. She
attributed the stabilisation in urban areas to a higher literacy rate, better
means of communication, and increased acceptance and availability of condoms.
In order to avoid further deterioration of the situation in rural areas, she
said a national action plan targets vulnerable groups by way of an information
campaign carried out through peer educators, the promotion of condom use,
counselling of people living with HIV/AIDS, the reduction of the epidemic's
socioeconomic impact on people by the promotion of revenue-generating
activities, and the social integration and education of orphans.
With an average annual per capita income of US $140, the economic impact of
the HIV/AIDS pandemic has been dramatic in a country wracked by years of civil
strife. Burundi's HIV/AIDS secretariat has estimated that if transmission of the
virus continues at the current rate, life expectancy will drop below 40 years in
2010, compared to 60 years if there were no AIDS.
IRIN spoke with Sindabizera about Burundi's coordinated efforts to combat the
disease with limited medical infrastructure and expertise and scarce financial
resources.
QUESTION: In the United States, research shows that one-half of AIDS
victims undergoing treatment are infected by a virus which is resistant to more
than one anti-retroviral. What are your observations regarding the few AIDS
patients undergoing treatment in Burundi?
ANSWER: Indeed, we read more and more in the public media as well as
in scientific journals about the existence of virus strains resistant to several
molecules, especially in the West. In this country, it is said that the sick
people have been exposed to these molecules over a period of time and sometimes
intermittently; there are also those who are not taking the treatment regularly.
This may explain the phenomenon even if we know that there is genetic resistance
to certain molecules.
In Burundi, as well as in several African countries, access to treatment is
still limited to the few people in a higher income bracket - and even this has
not been for very long.
The biological follow-up is limited to certain tests to avoid future
secondary effects, and on the immunological state, which means the CD4
["helper" cells that orchestrate the body's response to certain
micro-organisms such as viruses] count. The assessment of biological resistance
is not possible in Burundi, and consequently we do not have reliable data on
this situation.
Nevertheless, clinical follow-up on the CD4 count shows genuine improvement
in most of the patients under anti-retroviral treatment, according to data
supplied by doctors who treat these patients.
Q: Your office has reported that the infection rate is increasing in
the rural areas, which is precisely where people are illiterate and uneducated.
What are your plans to deal with this problem before it gets out of control?
A: Figures show a progressive and alarming increase in the infection
rate, rising from less than 1 percent in 1989 to 7.5 percent in 2001 in rural
areas. The Burundi government's strategy is to intensify the fight at the
national level, and particularly in rural areas. This will be made possible
thanks to the participation of the public as well as private sectors, and
especially by putting emphasis on the participation of the communities
themselves.
This is how the National Programme for the Fight Against AIDS and Sexually
Transmitted Diseases has equipped itself with a multi-sector programme that
involves everyone, and which is decentralising the activities to grass-roots
level. This project is piloted by a National Council for the Fight Against
HIV/AIDS, which, for operational reasons, has central structures, including the
Permanent Executive Secretariat.
Q: How do you explain the stabilisation of the rate of infection in
urban areas? Does it imply that there is a lower rate of new infections and/or a
lower number of deaths of those infected?
A: Indeed, according to the figures obtained from urban areas over the
past three years, we get the impression that the rate of infection has
stabilised.
These figures are obtained from sero-prevalence observations in clinics. An
investigation of the sero-prevalence at national level will soon be under way,
and this will give us the true facts.
If stabilisation of the infection rate is proved to be true, it would more
likely be linked to the lower rate of new infections. This is because, in urban
areas, action in the fight against AIDS started much earlier. Furthermore, the
people are more literate and have access to the media. Also, the condoms have
become more acceptable thanks to awareness campaigns, and they are available and
accessible to city dwellers.
Q: How is work shared between the minister in charge of HIV/AIDS and
the minister of health in the fight against AIDS - is there no duplication in
their jobs?
A: Certainly, the Ministry of Health and that charged with the fight
against AIDS will forge close cooperation in the epidemiological sector.
Although HIV is known to be a big health problem in Burundi, it also has
multiple consequences, and on several sectors. That is why the Burundi
government, in order to put into practice its political commitment, set up the
National Council for the Fight Against HIV/AIDS so as to involve all national
sectors through the creation of the Ministry in the President's Office in charge
of fighting against HIV/AIDS. The ministry is charged with coordinating
activities of the various sectors.
The action of the Ministry of Health is essential, and its action will
emphasise medical aspects, such as offering treatment to the sick, national
epidemiological surveillance, and the prevention of HIV/AIDS - especially
prevention of mother-to-child transmission through anti-retroviral treatment.
Therefore, there will be no duplication in the activities of the two ministries,
but rather complementarity.
Q: What is the death rate among Burundi AIDS sufferers who are on
anti-retroviral treatment?
A: The death rate among people living with HIV/AIDS who are on
anti-retroviral treatment is not known. As I said earlier, the standardisation
of the anti-retroviral treatment started recently and a regular follow-up of
those getting the treatment is being put in place. Those figures may be
available in the near future.
Q: Effective treatment against AIDS requires the availability of
infrastructure such as laboratories. In Burundi, due to the war, not only
doctors left the country to go to work elsewhere, but also the existing health
facilities are no longer functioning. What is being done currently to improve
this infrastructure and encourage Burundi doctors working abroad to return home?
A: Like in other developing countries, Burundi doctors left or stayed
in western countries to pursue their studies. Because of this, the government is
looking for possible means to try to encourage them [to return home] and it is
hoped that they will return home as peace and security are restored in the
country.
In the meantime, training of medical and paramedical staff continues on how
to take care of people living with HIV/AIDS.
Concerning health facilities, efforts are being made by the government and
its partners to rehabilitate hospitals and health centres. In addition to
multi-sector programmes, infrastructure will be equipped so as to strengthen
operational capacity.
Q: Refugees will soon return home and internally displaced persons [IDPs]
will return to their villages. Taking into account the high infection rates in
refugee camps and among IDPs, what effect will their return have on the spread
of HIV/AIDS in the country and how will your ministry react?
A: We expect, among other things, a higher rate of infection in the
rural area if nothing is done about it. In order to prevent such a situation,
the 2002-2006 National Action Plan has called for actions targeting vulnerable
groups, as well as specific interventions - notably in the
Information-Education-Communication campaign carried out through peer educators,
the promotion of condom use, counselling of people living with HIV/AIDS, the
reduction of the epidemic's socioeconomic impact on people through the promotion
of revenue-generating activities, and the social integration and education of
orphans. The ministry will ensure that all those involved in various activities
realise these objectives.
[This Item is Delivered to the "Africa-English" Service of the UN's
IRIN
humanitarian information unit, but may not necessarily reflect the views
of the United Nations. Copyright (c) UN Office for the Coordination of
Humanitarian Affairs 2002
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