I was talking to a lively group of women living with HIV in Bangui when I noticed Miriam sitting quietly – a little bit outside of the circle. She was holding her baby girl in her arms. Both she and her daughter were tiny. Too tiny.
It was her dramatic weight loss that had first alerted community mobilisers, who urged her to take a free HIV test in the displacement site where she was living.
Miriam was horrified when she tested positive, and discovered that her baby girl was also infected. She had not been tested during pregnancy and had unwittingly passed on the disease.
Miriam had only just arrived in Bangui – alone with her children – when she took the HIV test. She had fled from her village north of Bangui after her family’s house had been burnt down by rebels. Those same rebels had shot her husband dead.
She started to cry as she re-told her story to me. The women in the circle listened and nodded. In the two months since she was diagnosed, she said her only source of strength and comfort was this Mother to Child Transmission Support Group. The group of women, who tested HIV positive during their pregnancies, meet every fortnight to share their experiences, and support those who have been newly infected.
They have all been through the same things: the shock and denial of their diagnosis; the rejection by their partners and family; the pain of seeing their children ridiculed; and the difficult first weeks of coping with the new treatment – the antiretroviral drugs so strong that they make the women nauseous – especially on an empty stomach. And in a city like Bangui where humanitarian workers early on in the crisis found that 90% of the displaced population were living on one meal a day[i] – nearly everybody has an empty stomach.
The women share stories, advice and become “like a family”. Without these women, Miriam says, she might have given up.
This past year the women could only meet sporadically, due to the ongoing violence in the capital Bangui, where 50,000 people are still displaced a year after the peak of violence here.
It was not just support that they missed. Throughout the country, the majority of people could not access HIV testing or treatment, because health centres were closed and there was a shortage of drug supplies at clinics outside the capital city – increasing the risk of transmission, growing drug resistance in the population and leaving pregnant women with HIV unable to protect their newborns from transmission.
One woman, Estelle, told me that during the height of the violence she went without treatment for three months. She couldn’t find any services at the displacement site or at the local health centre.
Even before the crisis, the country had one of the highest adult HIV prevalence rates in Central Africa, with an overall estimated prevalence of 4.9% for adults. UNICEF CAR HIV Specialist Cecile Ndoli says that the crisis – which destroyed one-third of health centres – has resulted in an unknown number of new infections.
“We predict that the level of infection has risen due to the fact that mothers could not get tested during pregnancy; the use of rape by armed groups to terrorise communities; and the huge number of children out-of-school at increased risk of unprotected sex,” she said.
HIV testing and support services are being re-established in areas which are recovering from violence. Re-starting HIV prevention and treatment quickly is crucial and will save lives.
Madeleine Logan is a communications officer with UNICEF CAR.
A Spanish version of this blog was originally published in El Pais here.
[i] Multi-Cluster Initial Rapid Assessment, CAR, January 2014, Prepared by OCHA on behalf of the Humanitarian Country Team