by Bryan Teixeira [Europe NGO Delegation]
In March 2013, fighting between Sélékarebel forces and the Central African Army resulted in the ousting of President Francois Bozizeand overthrow of the government of the Central African Republic (CAR). Tens of thousands of people fled. Health facilities were looted and many were abandoned. As a result, thousands of people living with HIV (PLHIV) on antiretroviral therapy (ART) are now estimated to be ‘lost’.
Prior to this conflict, the country had up to 15,000 PLHIVon ART.
The CAR is one of the least developed countries in the world. It has endured several coups since its independence from France in 1960. It is a therefore an additional challenge to ensure a wide range of services during this crisis. Only a few agencies are operating outside the capital and there is high turnover and vacancies in international and humanitarian staff.
Earlier in August 2013, a group of UN independent experts noted that the rule of law in the CAR is “almost non-existent”, with abuses of power and human rights violations now pervasive in the country.
“We are seriously concerned over reported acts of killings, torture, arbitrary detention, gender-based violence, enforced disappearances, ‘mob justice’ and the pervasive climate of insecurity and the absence of the rule of law which have prevailed in the country in the last five months,” the human rights experts said. They urged authorities to take immediate steps to put an end to human rights violations.
The UN Special Rapporteur on extrajudicial, summary or arbitrary executions, Christof Heyns, noted that there have been a number of killings, with some 46 cases allegedly documented.The Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, noted that torture seems widespread in CAR. And the Special Rapporteur on violence against women, Rashida Manjoo, stressed that there have been numerous cases of sexual abuse and rape reported in all of the localities that Séléka combatants have passed through.
Kristalina Georgieva, European Commissioner for Humanitarian Aid and Crisis Response, recently observed: “There is the risk of a very bad outcome. To the north, Chad is in a precarious state, calm for now but under huge pressure from the conflicts on its doorstep in Darfur, Libya, northern Nigeria and Mali.To the south, the Democratic Republic of the Congo is a vast and largely ungoverned space.”
The Inter-Agency Task Team (IATT) to Address HIV in Humanitarian Emergencies is involved in responding to this crisis. The IATT includes representation from several UN and other international agencies, e.g., UNDP, UNFPA, UNHCR, UNICEF, WFP, WHO, IMO, MSF, Red Cross, as well as UNAIDS along with the NGO Delegation at the UNAIDS Programme Coordinating Board.
There is widespread shortage of ARVs and lack of medical and other health personnel. Sexual and gender-based violence is extensive. Access to post-exposure prophylaxis (PEP) is limited. Pre-existing HIV transmission through blood transfusions and other occupational hazards is increasing. HIV related stigma and discrimination are high, resulting in the usual low uptake of testing, adherence to medication, and general HIV awareness. Multiple partners, low condom use, and transactional sex to supplement the economic needs of women and girls all increase the risk of HIV transmission.
The IATT is active in calling on its partners, donors, national authorities and others to take urgent action to ensure at least minimum services. Urgent HIV-related actions include ensuring ARV supplies as well as male and female condoms. PLHIV who had fled to hide in the bush and elsewhere need to be reached and provided with longer-term ARV rations.
This situation highlights the need for HIV-related emergency preparedness. HIV must be a cross-cutting concern in all emergency responses. National HIV coordination mechanisms need to be stronger, including safe and confidential data collection and tracking of PLHIV on ART, as well as essential services for the clinical management of rape survivors.