Featured Research

from universities, journals, and other organizations

Fighting against HIV in the Central African Republic: The importance of perseverance

Date:
March 4, 2014
Source:
Université de Montréal
Summary:
Drug stock-outs have made HIV patients wary. According to researchers, stock-outs of antiretroviral (ARV) drugs in recent years in the Central African Republic have had a dramatic impact on the health of HIV-infected people. These shortages have also created mistrust among patients toward the political and medical actors responsible for the fight against HIV/AIDS. And their wariness is likely to reduce their chances of getting better.

Patients at community hospital treatment center in Bangui.
Credit: Pierre-Marie David, Université de Montréal

Drug stock-outs have made HIV patients wary. According to Pierre-Marie David of the University of Montreal's Faculty of Pharmacy, stock-outs of antiretroviral (ARV) drugs in recent years in the Central African Republic have had a dramatic impact on the health of HIV-infected people. These shortages have also created mistrust among patients toward the political and medical actors responsible for the fight against HIV/AIDS. And their wariness is likely to reduce their chances of getting better.

According to Pierre-Marie David of the University of Montreal's Faculty of Pharmacy, stock-outs of antiretroviral (ARV) drugs in recent years in the Central African Republic have had a dramatic impact on the health of HIV-infected people. These shortages have also created mistrust among patients toward the political and medical actors responsible for the fight against HIV/AIDS. And their wariness is likely to reduce their chances of getting better. David lived in the Central African Republic from 2005 to 2008, where he worked as Access to Antiretroviral Treatment Coordinator for the Red Cross. He then conducted research on the social effects of ARVs in the context of that country. His findings were recently published in Global Public Health.

From hope to disappointment

The fight against HIV/AIDS is one of the eight "Millennium Development Goals" adopted in 2000 by the UN Member States. Under this objective, free access to ARVs has become widespread in various countries, including the Central African Republic. "In this way, around 14,000 people were able to receive treatment in 2011 in a country where prevalence of the disease was 5%, which is an epidemic generalized across the population," says David.

However, ARV distribution has created disappointment equal to the high expectations it initially raised.

On the one hand, free access to ARVs offered the possibility of living better with HIV, which as a result, became a treatable infection like others. On the other hand, carriers of the virus were less stigmatized by the population, and the availability of medications resulted in a doubling in the number of pregnant women agreeing to be tested for HIV (20,000 in 2008 vs. 40,000 in 2009). But the management of funds -- US $43 million -- was centralized by an unprepared state apparatus. The distribution networks that existed before free access disappeared, leaving a monopoly system that had become corrupt.

So much so that, from 2008 to 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria sporadically froze payments to ensure greater traceability. The supply of ARVs was affected, resulting in stock-outs that sometimes lasted more than two months in areas of the country with more than 220,000 HIV-infected people.

Biological and social resistance

Noting the extent of the problem when he returned to Bangui in 2010, David reframed his work to include the individual and social effects of treatment discontinuation. "Paradoxically, these shortages, in both real and symbolic terms, were a death sentence for those whom the drugs were supposed to save," he says.

On the one hand, many patients suffered virologic failure (or treatment failure) due to the strategies they used to compensate for a lack of ARVs. "For example, some people took their medications only every other day so they would have some left over in case of a shortage, while others relied on local healers in the absence of treatment," recalls David.

Such strategies likely increased the risk of drug resistance.

On the other hand, treatment interruptions were also interpreted by patients as a betrayal of those responsible for international programs. "In addition to biological resistance, I also noted social resistance, indeed a kind of cynicism," explains David. "And if, in ten years, we decide to give them second or third generation drugs to treat drug resistance, we will first have to ask how the development of new programs will be interpreted."

In other words, patients may reject these programs, and we will be deceived into believing that these men and women are refusing treatment for cultural reasons.

"However, there will be historical reasons for this social resistance, and in this sense, current stock-outs will be an explanatory factor for adherence or non-adherence to future treatment programs," he concludes.

About the situation in the Central African Republic

Since 2013, the Central African Republic has engaged in its third civil war, caused primarily by problems of governance that have degenerated into communal conflict between Christians and Muslims in a region greatly destabilized by fighting in Darfur and the Democratic Republic of Congo (DRC) and the spread of armed militias over a large part of the area.

According to the UN, the country is in the midst of a humanitarian crisis: half of the 4.6 million inhabitants of the Central African Republic are in a "state of humanitarian assistance," with 400,000 internally displaced and 68,000 refugees in neighbouring countries, mainly the DRC. In addition, approximately 1.1 million people are affected by food insecurity.

The situation deeply concerns David, not only because of the additional difficulties it raises for ARV distribution, but also because of the situation of survival it has created for the entire population. "Access to ARV treatment becomes problematic in the context of daily survival in a country that already generates little interest," he laments, recalling that less than 40% of basic humanitarian needs are currently filled. A call for international commitment.


Story Source:

The above story is based on materials provided by Université de Montréal. Note: Materials may be edited for content and length.


Journal Reference:

  1. Pierre-Marie David. Towards the embodiment of biosocial resistance? How to account for the unexpected effects of antiretroviral scale-up in the Central African Republic. Global Public Health, 2014; 9 (1-2): 144 DOI: 10.1080/17441692.2014.881521

Cite This Page:

Université de Montréal. "Fighting against HIV in the Central African Republic: The importance of perseverance." ScienceDaily. ScienceDaily, 4 March 2014. <www.sciencedaily.com/releases/2014/03/140304071154.htm>.
Université de Montréal. (2014, March 4). Fighting against HIV in the Central African Republic: The importance of perseverance. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2014/03/140304071154.htm
Université de Montréal. "Fighting against HIV in the Central African Republic: The importance of perseverance." ScienceDaily. www.sciencedaily.com/releases/2014/03/140304071154.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) — Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) — Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) — At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) — Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:  

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile iPhone Android Web
      Follow Facebook Twitter Google+
      Subscribe RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins