Burundi

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

This story was first published by WHO

Getting life-saving harm reduction services to people who use drugs in Burundi was the aim of a recent learning trip to Kenya supported by the World Health Organization (WHO). This saw a team of Burundian physicians and health advocates travel to Mombasa County, Kenya, to learn about good practice from one of the pioneers of harm reduction on the African continent.

Led by Burundian non-profit, Jeunesse au Clair Medical (JCM), the team will push for a comprehensive package of harm reduction interventions in Burundi. Like many other countries in Africa, injecting drug use is not often acknowledged, and a public health response therefore not implemented.

Drug use is widely criminalised and stigmatised and its complexities misunderstood. WHO defines harm reduction as an evidence-based public health response that includes the provision of needle and syringe programmes (NSP), opioid substitution therapy (OST) and access to testing and treatment of HIV, tuberculosis (TB) and viral hepatitis B and C.

Keen to gain insight into the Kenyan experience and inform the development of a programme in Burundi, the Burundian team of doctors, a counsellor and a national coordinator of a network of people who used drugs, visited the Reach Out Center Trust in Mombasa. They observed the delivery of OST programmes and learnt about advocacy with local influencers – in an excellent example of south-to-south learning.

Kenya’s response to minimising the adverse effects of drug use, although not without its own challenges, has succeeded largely through grassroots advocacy and on-boarding key influencers – making it easier for harm reduction to be accepted. This multi-level approach includes collaboration between government and civil society, involving both law enforcement and networks of people who use drugs.

At a visit to the Mombasa Inspectorate in charge of drug-related offences, the team learnt first-hand from the Chief Inspector the importance of police engagement, highlighting the negative impact drug use can have on young lives and the need for strategies that work. Today, some 100 police officers in Mombasa are trained on harm reduction with their work focusing on supporting, not punishing.

In addition to police buy-in, identifying other key influencers such as spiritual and village leaders, other government officials, and people who use drugs themselves, can ensure that harm reduction programmes are effective and sustainable.

Advocacy wasn’t the only thing on the agenda, the team from Burundi also saw in practice how the Kenyan clinics functioned, how methadone is dispensed, they spoke with peer educators and outreach officers, and were trained on data collection for programme monitoring. An important learning if they want to show evidence to get government and donors on their side.

While Kenya is several years ahead in its harm reduction journey, with local input, their learnings can be adapted to other contexts.

“The burden caused by drugs requires interventions at grassroots and education must be provided by trained people to avoid misinformation,” said Dr Egide Haragirimana, clinical officer at JCM.

JCM are putting into action their learnings and will next be involving networks of people who use drugs to better understand what their needs are, to inform future harm reduction initiatives.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

The Burundian National Association of Support for People Living with HIV and AIDS Patients (ANSS) marked the twentieth anniversary of its creation on 4 July during a gala event that took place in Bujumbura, Burundi.

Created in 1993, ANSS’ mission is to promote the prevention of HIV transmission and to improve the well-being of people living with and affected by HIV. The ANSS was the first civil society organization in the country to provide HIV services to people living with HIV, including the distribution of antiretroviral therapy. At the end 2013, the ANSS was providing treatment to more than 6000 people in Burundi. From 2007 to 2013, the association provided HIV counselling and testing to more than 56 000 people as part of its HIV prevention efforts.

During the event, UNAIDS Executive Director Michel Sidibé commended the leadership of the association and its key role in providing services to people living with HIV in the country. The President of the ANSS, Jeanne Gapiya, committed to increasing access to antiretroviral therapy in Burundi as well as to continue working to ensure that the rights of people living with HIV are respected.

Burundi’s President Pierre Nkurunziza said his country is trying to increase access to education and health services as key elements to effectively respond to AIDS in the country. He met with UNAIDS Executive Director Michel Sidibé on 9 May in Bujumbura, Burundi.

After 13 years of socio-political crisis marked by civil war and political instability the government of Burundi has committed to the reconstruction of the country by focusing its efforts on the rehabilitation of health services and schools destroyed during the armed conflict. The President has also made the response to AIDS a priority and recently adopted a decree which aimed to significantly scale-up services to prevent new HIV infections among children.

Burundi depends on external assistance to finance 95% of its AIDS response. During his meeting with President Nkurunziza Mr Sidibé encouraged him to invest more domestic resources to ensure an effective, efficient and sustainable response.

As part of his official two-day visit to Burundi, Mr Sidibé visited the health centre of the National Association of Support for People Living with HIV and AIDS Patients (ANSS), and he also met with a large group of representatives from civil society.

L to R: Minister of Health of Burundi, Dr Sabine Ntakarutimana, UNAIDS Executive Director Michel Sidibé and United States Ambassador to Burundi, Dawn Liberi.

Burundi marked its National AIDS Day on 8 May and committed to stopping new HIV infections among children and keeping their mothers alive. The Minister of Health of Burundi, Dr Sabine Ntakarutimana who opened the event at the Kamenge health centre in Bujumbura said, “I am committed to bringing Burundi to zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

Burundi’s health authorities report HIV prevalence in the country was 1.4% in 2010 with more than 98,000 people living with HIV in 2011. The country is struggling with a low HIV treatment coverage with only 49% of people eligible for antiretroviral therapy accessing it. Almost 2000 babies were born with HIV in 2011. The government has promised to improve treatment coverage especially for pregnant women living with HIV and recently Burundi’s President Pierre Nkurunziza adopted a decree which aims to significantly scale-up services to prevent new HIV infections among children.

“AIDS is a strategic entry point for advancing Burundi’s social agenda at several levels: protecting women, children and human rights,” said UNAIDS Executive Director Michel Sidibé at the event.

The country will be receiving support for scaling-up services from the United States of America according to its Ambassador to the country, Dawn Liberi. “We will double our financial contribution to cover eight of the 17 provinces in Burundi with services to prevent new HIV infections among children,” she said.

Burundi’s Second Vice-President, Gervais Rufyikiri (left) and UNAIDS Executive Director Michel Sidibé.

In 2011, UNAIDS and partners launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Burundi is one of the 22 countries that the Global Plan focuses on, where 90% of new HIV infections among children occur.

Mr Sidibé also visited the centre of health and family welfare (ABUBEF). The centre provides medical and care and support services to people living with HIV, as well as conducting HIV prevention programmes.  

As part of his official visit to Burundi, Mr Sidibé met with the Second Vice-President, Gervais Rufyikiri, who has championed the country’s drive to stop new HIV infections in children. In 2005, Burundi emerged from a long civil war and the Vice-President asked UNAIDS to support the country’s efforts towards greater development. He said, “I am asking the international community to pay more attention to Burundi. We are in the process of rebuilding our country and we need your support.”

The UNAIDS Executive Director continues his official mission on 9 May with a meeting with the country’s president.

L to R: United Nations Resident Coordinator Rosine Cori Coulibaly, UNAIDS Regional Director for West and Central Africa Meskerem Grunitzky-Bekele, Minister of Health and Fight against HIV/AIDS, Dr Sabine Ntakarutimana, 2nd Vice President of Burundi Gervais Rufyikiri, US Ambassador to Burundi, Pamela Slutz.

Burundi is a small densely populated country located in sub-Saharan Africa with an HIV prevalence of 2.97% among the general population. It is also one of 22 countries worldwide that has contributed to the development of and signed up to implement the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

In an effort to inform and mobilize the general population about the possibility of a new Burundian generation free of HIV, the Government of Burundi spearheaded a national launch of the Global Plan at the end of October.

Classified as a low-income country, Burundi’s economy has been highly affected by a long period of civil war, which has had a significant impact on sanitation, infrastructure and human development. In this context, preventing new HIV infections among children has been one of the country’s main challenges, with coverage of HIV services reaching only 30% of pregnant women at the end of 2010. To effectively respond to this challenge, Burundi has developed a national plan for the period of 2011-2015 in accordance with the Global initiative.

“Every man should accompany his wife to pre-natal consultation and—jointly with her—request an HIV test,” stated His Excellency the 2nd Vice President Gervais Rufyikiri during the launch. “Engagement of men is key to the success of this initiative,” he added.

The U.S. Ambassador to Burundi, Pamela Slutz, emphasized that in order to help the Burundian government eliminate new HIV infections among children, the U.S. Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), had dedicated US$ 10 million exclusively for the implementation of such programmes in the country.

Speaking at the launch, the Minister of Health and Fight against HIV/AIDS, Dr Sabine Ntakarutimana  said that activities like family planning reproductive health and HIV will be harmonized and articulated in the health system to promote efficient results.

UNAIDS Regional Director for West and Central Africa, Dr Meskerem Grunitzky-Bekele, who represented the UNAIDS Executive Director at the launch, highlighted that Burundi understood the need to act now. “The price to be paid for the country’s inaction will be too high for future generations,” she said.

This Global Plan provides the foundation for country-led movement towards the elimination of new HIV infections among children and keeping their mothers alive. The Global Plan was developed through a consultative process by a high level Global Task Team convened by UNAIDS and co-chaired by UNAIDS Executive Director Michel Sidibé and United States Global AIDS Coordinator Ambassador Eric Goosby. It brings together 30 countries and 50 civil society, private sector, networks of people living with HIV and international organizations to chart a roadmap towards achieving this goal by 2015.

Noe Sebisaba and his STOP SIDA NGO are helping to mitigate the impact of HIV in Burundi
Courtesy of UNHCR

Noe Sebisaba knows how to turn an adverse situation into something life-affirming. In 1996 he and his family were forced to flee a Burundi in turmoil and ended up in the Kanembwa refugee camp in Tanzania. While in the camp, in 1998, he discovered that he was living with HIV. His wife, who was also HIV positive, died of an AIDS-related illness. On World AIDS Day 2001, at an event organized by the UN refugee agency UNHCR, Mr Sebisaba decided to openly declare his own HIV status, the first known African refugee to do so. He has never looked back. As he says, “I decided to let HIV know; ‘I’ll control you, you’re not going to control me’…I was tired of silence and I found a new reason to live. To challenge HIV and preach forgiveness and love.”

Although initially rejected by his family and community, the disclosure helped galvanize him to challenge the stigma and discrimination rampant among refugees and the host population in Tanzania. He developed a grassroots, community organization, STOP SIDA (STOP AIDS), to intensify the involvement of refugees and the local community in the AIDS response and to disseminate HIV awareness messages at public events, through individual contacts, visits and peer groups.

Active in a number of camps across western Tanzania, STOP SIDA distributed educational materials and advocated support and care for those infected with and affected by the virus. Using himself as an example, Mr Sebisaba found a unique way to help individuals and communities become agents of change in challenging HIV. And he was able to confront some of the particular vulnerabilities faced by refugees whose lives have been uprooted due to conflict, persecution or violence.

There are myriad factors that can increase the vulnerability to HIV of the many millions of refugees and internally displaced people around the world. They often lose their source of income and may have to resort to high-risk behaviour to satisfy their needs. Health and education services often lapse and sources of information on HIV prevention and treatment provision can be disrupted. Social and sexual norms, networks and institutions can also break down and women can be especially vulnerable as rape is often used as a weapon of war during conflicts. In fact, Mr Sebisaba’s wife was herself raped by soldiers in Burundi during the civil war.

The fact that STOP SIDA was able to have an impact in Tanzania was a testament to Mr Sebisaba and his partners’ will and determination. He showed that refugees are not only passive recipients of aid but have powerful coping mechanisms, resilience and ingenuity. Many refugees and members of the surrounding communities participated in STOP SIDA activities and there was a marked increase in take-up of voluntary counseling and testing.

Burundi’s President Pierre Nkurunziza visits STOP SIDA
Courtesy: Noe Sebisaba

In 2005 Mr Sebisaba was repatriated to Burundi by UNHCR and was able to continue his work. In the last seven years the agency has helped nearly 500,000 Burundians return home and supports their continued access to treatment and HIV prevention programmes.

Since 2006, STOP SIDA-NKEBURE UWUMVA has operated in the country, especially in areas with a large number of returnees. Supported by UNHCR and other partners, with offices in the capital Bujumbura and the eastern Cankuzo province, the NGO continues to spread the message of prevention, behaviour change, tolerance and the need for voluntary counseling and testing. Outreach has been especially important in rural areas where AIDS information and anti-stigma messaging find it difficult to penetrate.

In addition, STOP SIDA has become an implementing partner of UNHCR in three camps for Congolese refugees in Burundi where staff use their expertise and experience to help mitigate the impact of the epidemic, including ensuring that clients can receive drug treatment from local hospitals.

Some 450,000 people, both former refugees and those who stayed behind, are being reached by STOP SIDA activities in the eastern provinces of Cankuzo and Ruyigi. In the Congolese camps and surrounding communities some 25,000 are benefiting from the NGO’s initiatives.

UNHCR, the lead UN agency for challenging HIV among refugees and internally displaced people, has co-produced a video about the organization called Love in the time of AIDS, which will be featured during the UNAIDS Programme Coordinating Board thematic session on forced displacement at the Board’s 24th meeting on June 22 to 24. STOP SIDA is highlighted as a best practice of community leadership and mobilization.

What gives Mr Sebisaba the most satisfaction is the feeling that he and his fellow activists have been able to help people accept a positive HIV diagnosis with a degree of hope and optimism and have encouraged people to talk about the epidemic.

“With my decision to say openly that I’m living with HIV, I’ve done my part to try to change the face of the virus. I think I’ve shown that it’s not an automatic death sentence and that you can still lead a rich life. Where I’ve worked, people have been more able to talk openly about having HIV and more people are getting tested. I never have a moment’s regret about disclosing my status. I think it’s really making a difference.”