Exactly 20 years ago, in 2002, Médecins Sans Frontières opened the first (free) outpatient HIV treatment center in Kinshasa, Democratic Republic of Congo. When the doors of the center opened, the situation was critical: more than a million men, women and children in the Democratic Republic of Congo were living with HIV, but antiretroviral (ARV) treatments were scarce and unsustainable. Much has changed for those living with HIV 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 medical coordinator. “The cost of antiretroviral treatment made it simply out of reach for most patients. MSF also didn’t have antiretroviral drugs in the first few months of the centre. Our team could only treat symptoms and opportunistic infections. It was very difficult.”
2002: MSF opens the first center with free HIV treatment
“It was so busy, we opened at dawn and didn’t close until nightfall”
As the first health facility in Kinshasa to offer free antiretrovirals to patients, MSF’s treatment center was quickly flooded with HIV-infected patients in need of treatment. “It was very busy,” recalls Dr. Mashako, “consultations started at dawn and finished at night. There were so many patients…”
MSF almost immediately started supporting other centers with HIV care
To improve access to care and treatment, MSF has started supporting other health centers and hospitals by offering free screening tests, access to care and treatment. In Kinshasa alone, we have supported about 30 healthcare institutions in this way over the past 20 years.
Pilot model: also involve nurses to prescribe HIV treatment
Our teams also set up a pilot model of care where nurses could prescribe care and monitor HIV-positive patients. This was a crucial initiative because at the time only a handful of doctors per province were authorized to do so. Over 20 years, this support has led to the training of countless healthcare workers and nearly 19,000 people in Kinshasa alone have received free antiretroviral treatment.
Next challenge: Bringing HIV care closer to patients
“This medical support was obviously essential, but not sufficient,” says Dr. Mashako. “We needed to bring treatment closer to patients, so we partnered with the nationwide network of patient organizations to establish patient-driven ARV distribution centers.”
The approach was so successful that it was eventually included in the Democratic Republic of Congo’s national HIV/AIDS plan.
2008: Fighting advanced HIV, challenges still huge in HIV care
However, MSF’s work in the country must be seen against the backdrop of a lack of national and international resources to win the fight against HIV/AIDS and ensure access to care and treatment for all.
“When we set up an inpatient advanced HIV care unit in 2008, we never imagined it would still be full of patients more than a decade later,” says Dr. Mashako. “Over the years, we have doubled the capacity of the original beds, but we still have to regularly set up tents to welcome patients. This reflects the immense challenges that the fight against HIV/AIDS in the Democratic Republic of the Congo continues to pose.” .
Since it opened, more than 21,000 people have been admitted to MSF’s state-of-the-art HIV treatment unit in Kinshasa.
2022: Huge progress made, but major challenges still remain
Great progress has been made over the years in the fight against HIV/AIDS in the Democratic Republic of the Congo and the current situation is simply incomparable to what it was in 2002: access to treatment has greatly expanded and the number of new infections has halved. However, huge challenges remain in the fight against HIV.
A country like the Democratic Republic of Congo depends almost exclusively on international donors to fight HIV/AIDS. But such support is insufficient given the scale of the challenges.
“This is a reality we’ve been denouncing for years,” said Dr. Mashako. “Lack of funds means lack of testing, lack of training for health care workers, chronic shortages of medicines or huge disparities in HIV services between provinces. HIV will not be defeated in the Democratic Republic of the Congo if donors do not they will 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 six provinces: North Kivu, South Kivu, Maniema, Ituri, Kasai Oriental and Kongo Central. This support comes in the form of direct patient care, training for healthcare professionals, and the provision of essential medicines and medical supplies.
