Exactly 20 years ago, in 2002, Doctors Without Borders opened the first center for (free) outpatient HIV treatment in Kinshasa, DR Congo. When the centre’s doors opened, the situation was critical: more than a million men, women and children in DR Congo were living with HIV, but antiretroviral (ARV) treatments were scarce and unaffordable. A lot has changed for HIV patients since then, although significant challenges remain. An overview of 20 years of HIV care…
Early 2000s: HIV is a death sentence
In the early 2000s, the virus was killing between 50,000 and 200,000 people a year worldwide, according to UNAIDS. “For many, HIV infection was a death sentence,” said Dr. Maria Mashako, MSF’s medical coordinator. “The cost of antiretroviral treatment simply made it out of reach for most patients. Even MSF had no ARVs in the first months of the centre. Our team could only treat symptoms and opportunistic infections. It was very difficult.”
2002: MSF opens first center with free HIV treatment
“It was so busy, we opened at dawn and didn’t close until night”
As the first health facility in Kinshasa to offer free ARVs to patients, MSF’s treatment center was quickly overrun by HIV patients in need of treatment. “It was very busy,” Dr. Mashako recalls, “Consultations started at dawn and ended at night. There were just so many patients…”
MSF almost immediately started supporting other centers with HIV care
To improve access to care and treatment, MSF started supporting other health centers and hospitals in offering free screening tests, access to treatment and care. In Kinshasa alone, we have supported about 30 health institutions in this way over the past 20 years.
Pilot model: also involving nurses to prescribe HIV treatment
Our teams also set up a care pilot model where nurses could prescribe treatment and monitor HIV-positive patients. This was a crucial initiative because only a handful of doctors per province were allowed to do this at the time. Over 20 years, this support has led to the training of countless health professionals and nearly 19,000 people in Kinshasa alone received free ARV treatment.
Next challenge: bringing HIV care closer to patients
“This medical support was of course essential, but not enough,” says Dr. Mashako. “We needed to bring treatment closer to patients, so we partnered with the national network of patient associations to set up ARV distribution centers, managed directly by patients.”
The approach proved so successful that it was eventually included in DR Congo’s national HIV/AIDS plan.
2008: Fighting advanced HIV, still huge challenges in HIV care
However, MSF’s work in the country must be seen against a backdrop of a lack of national and international resources to win the fight against HIV/AIDS and ensure access to treatment and care for all.
“When we set up an admissions unit for advanced HIV care in 2008, we never imagined that it would still be full of patients more than a decade later,” says Dr. Mashako. “Over the years, we have doubled the original bed capacity, but we still have to set up tents regularly to accommodate patients. This reflects the immense challenges that the fight against HIV/AIDS in the DRCongo still poses.”
Since opening, more than 21,000 people have been admitted to MSF’s state-of-the-art HIV care unit in Kinshasa.
2022: Huge progress made, but major challenges still remain
Over the years, great progress has been made in the fight against HIV/AIDS in the DR Congo, and the current situation is simply incomparable to that of 2002: access to treatment has greatly expanded and the number of new infections dropped by half. Yet enormous challenges remain in the fight against HIV.
A country like DRCongo is almost exclusively dependent on international donors to combat HIV/AIDS. But that support is insufficient given the magnitude of the challenges.
“This is a reality that we have been denouncing for years,” said Dr. Mashako. “The lack of funding means a lack of testing, lack of training for health care providers, chronic drug shortages or huge disparities in HIV services between provinces. HIV will not be overcome in DR Congo if donors do not step up their efforts.”
MSF’s support in the fight against HIV today
By 2022, MSF will support the Ministry of Health in providing HIV/AIDS care and services in Kinshasa and in six provinces: North Kivu, South Kivu, Maniema, Ituri, Kasai Oriental and Kongo Central. This support is provided in the form of direct patient care, training for health professionals and the provision of essential medicines and medical supplies.