MSF: Support needed for community-led HIV programs in West and Central Africa

Hortense talks with Dr. Gertrude Komoyo at the Centre Hospitalier Universitaire Communautaire of Bangui, where MSF runs the advanced HIV unit. Hortense’s daughter has been at the hospital for a week.
Central African Republic 2020 © Adrienne Surprenant/Collectif Item
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As the West and Central Africa (WCA) region continues to lag behind in the HIV/AIDS response—leading to people with HIV going without antiretroviral therapy (ARV) treatment—the support of donor countries like the US for community-led HIV interventions is key to reaching people with the virus and improving public health.

In 2019, WCA accounted for 21 percent of new HIV infections worldwide and 30 percent of deaths from AIDS-related illnesses. Adolescent girls and young women remain particularly at risk of acquiring HIV as they accounted for 58 percent of the estimated 240,000 new infections in the region the same year. HIV incidence also remains high for key populations like men who have sex with men and sex workers.

However, community-led responses have proven to be effective in removing barriers to HIV prevention and treatment, even among vulnerable populations, as the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) outlines in its new report, Community-led interventions: Sound investment for an effective HIV response in West and Central Africa.

In the Central African Republic, for instance, “community ARV groups” allow groups of people living with HIV and in stable conditions to designate one of their members to go and collect the drug refills for the coming months for the entire group. This reduces transportation costs and time spent in medical facilities—something that’s especially important as COVID-19 spreads and overwhelms health centers.

As well as making treatment more accessible, these community-led groups provide peer support and improve people’s probability of adhering to treatment in places where stigma against people living with HIV remains a harsh reality. It is especially important for people with HIV to stay on their treatments because if they “fail” treatment they could develop a resistance to their medicines and need more expensive, harder-to-access medicines. These groups, which were originally trialed in South Africa, have been so successful they’ve been adopted into HIV programs across the globe, including Mozambique, Zimbabwe, Guinea, and DRC.

National and regional community-led monitoring as well as community-led observatories have also helped improve HIV treatment in WCA by documenting care delivery challenges and generating data to influence policies and programs that affect people with HIV. For example, in many countries of WCA—such as DRC, Guinea, Cameroon, Burkina Faso—these monitoring groups keep track of the availability of ARVs and other essential supplies, raise the alarm when there are shortages of particular medications and supplies, and evaluate quality of services—like whether or not health care is provided free of charge to patients as a particular policy says it should be and/or if any people with HIV are facing any stigmatization by health facility personnel.

In other initiatives, community and civil society organizations engage, participate actively, and hold governments accountable in national and regional donor planning and subsequent implementation such as for The Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief (PEPFAR).

Unfortunately, in spite of the documented benefits of community-led initiatives, the environment for people living with HIV and community organizations continues to hinder their growth. Too often these types of programs remain underfunded by systems which constantly question their capacity and credibility to lead on interventions.

Currently, reports show that funding for HIV community-led responses remains unacceptably low and completely off track to the 2016 global political commitments “to ensure 30 percent of all service delivery for HIV is community-led by 2030.” A report by AIDSFonds shows that while 39 percent of all new HIV infections in 2018 were recorded among key populations in WCA, only 2 percent of HIV resources were targeted to their community-led interventions in the period 2016-2018.

One step to ensure support for community-led HIV initiatives is to include funding for them in the next UNAIDS strategy for 2021-2025. That’s why MSF and 25 other community and civil society organizations are calling on key HIV programing and funding decision-makers to increase engagement with and support to people living with HIV and community organizations in WCA during the 47th UNAIDS Program Coordinating Board (PCB) of December 15-18—where the UNAIDS strategy for 2021-2025 will be discussed.

But the fight can’t end this week. The Global Fund and PEPFAR, among other key health actors, will update their funding and program strategies in 2021.

All key actors in the policy and implementation of HIV programs agree that putting the person at the center of the epidemic response is important. But if health actors are truly committed to achieving the 2030 global goal of ending AIDS, then the support for community-led programs must begin right now to see a shift towards a bold commitment and actions that will validate the role of local interventions in WCA.