War gives the Republic of Congo a late start with HIV/AIDS programs

Brazzaville was under siege in 1999, forcing 700,000 people to flee

The Republic of Congo (whose capital is Brazzaville) ended a five-year civil war with a peace agreement in 2004. But the psychological and social damage from the war is extensive and far-reaching. During the war, Médecins Sans Frontières (MSF) reported that over 700,000 people fled the capital and were subjected to acts of indiscriminate violence by both the rebel and government forces in the southern Pool Region.

A 19-year old girl (named Ms. A by health workers) returned to Brazzaville in 1999 to the MSF-run hospital. Her story echoes the suffering of many other returning refugees: "A group of us came out of the forest. When we reached the military roadblock at Makana, the men were separated from the women. In the queue, they chose me and put me in a room. When I tried to escape they fired shots at my feet. Luckily they didn't hit me. Five men raped me." According to the U.S. humanitarian organization International Rescue Committee (IRC), some 1,545 cases of rape were recorded in Congo during the civil wars. More than 52 percent of the cases involved adolescent girls. The actual numbers of rape are much higher than those reported, as talking about rape remains a taboo for women.

Today, the government has moved from emergency management to the operation of a neglected social and health sector. Preliminary statistics hint that women suffered disproportionately both during and after the war. A study on HIV prevalence in 2003 indicates that women under the age of 35 were twice as likely to be infected with HIV as men in their age group. While rape cases alone do not account for the high prevalence of HIV, many young women are still compelled to engage in risky sexual decisions that increase their risk of contracting the disease. Indirectly, the war continues taking a heavy toll on young Congolese women.

AIDS mural encourages us to choose life

It is not hard to find a young woman in Brazzaville who has lost a father, a son, or a brother to the war. In a purely monetary sense, the effect of the war on family units meant the loss of workers and breadwinners; when young women try to fill this gap, many feel compelled to use sex as a means to make money. At the Kintele refugee camp, 25 kilometers north of the capital, a Rwandan refugee asked health workers, "How can we convince a young girl who has not eaten from going to look for someone who can give her a little bit of money? If we don’t look at the overall problem of poverty among refugees, we will never solve the problem of AIDS."

To respond to this crisis and to intervene with young girls and other vulnerable groups, the government in Brazzaville is getting organized; they are beginning to build up their long-neglected social services sector. The work is proving challenging, as the war severely damaged the basic infrastructure of the country and the government’s ability to maintain its functional parts. The government only launched their national program in the fight against AIDS (CNLS) in July of 2003.

CNLS’s preliminary work has been primarily organizational in nature, involving the synchronization of the efforts of thirteen government ministries to form a multi-sector response to AIDS. Recognizing the magnitude of the predicament, the president of the Republic of Congo (who was recently chosen to lead the African Union) has taken a leadership role in the fight and has called on all of his citizens to begin the fight: "I am calling for nothing less than a revolution in mentalities, so that the behaviors of every Congolese are attuned to the mandate of the fight against AIDS."

Children are plentiful in Leketi, where the village chief asks for condoms

While the government is trying to take a proactive stance on HIV/AIDS, the state itself is in debt and lacks even basic health facilities. In a report published by the World Bank, Madame Michele Lioy stated that "The problems and constraints that retard the implementation of [HIV/AIDS] activities are numerous, all the more since Congo’s public health system is in such a weak condition." Because of these substantial constraints, CNLS has been forced to prioritize its work and limit programs for the next five years to only five of the eleven departments of Congo. The decision to take this approach presents a double-edged sword; this approach will create a strong national model to replicate in the future, but threatens to isolate the six departments that will not benefit from new services. In a country where stability remains unbalanced (the Ninja rebel group remains active in the west of the country), decisions such as these could be interpreted as political.

Communities without tactical or political pull remain isolated. The CNLS has decided to operate programs in communities situated along major transit routes, such as roads, rivers, and rail lines, but programs cannot possibly reach every transit axis. Many communities, such as the town of Leketi along the principal truck route from Gabon, have been sidelined. Leketi is a community of 1,500 people. Last year the village chief was invited to a sensitization seminar on HIV/AIDS. To get to the conference, he traveled 150 kilometers on a sandy dirt track road to the regional capital of Oyo. The drive took certain journalists three days due to the difficulty of the road.

Truckers along the trade route between Brazzaville and Libreville

The chief shared the government’s concerns about young women. Speaking of the situation in his community, he said, "I called the village together to talk about HIV/AIDS. But even while I encourage everyone to use condoms, there is no one in my village who sells condoms. You must understand that this makes it is hard to tell young women to not run with just anybody." While the chief understands the importance of the message of abstinence, fidelity, and condoms, he requests assistance to spread the message in his community. The chief’s primary concern remains basic health services. His health center was washed out by a flood two years ago and was forced to close. Treating even the most basic diseases such as malaria has become cost-prohibitive.

Some of the men who the young women in Leketi choose to run with are truckers who make the difficult drive between Oyo and Franceville, Gabon. But unfortunately the truckers have not been sensitized on HIV/AIDS. One driver named Albert stated that his assistant, Dennis, "has a girl in every village. But he doesn’t want to share!" When asked whether he uses condoms, he stated, "Would you eat a banana with the skin on it?" While the need in Leketi for HIV/AIDS education is great, the town is situated in a region that does not make the national program’s priority list. Unfortunately, they will have to wait another five years to receive HIV/AIDS services, which is when phase two of CNLS’s program will commence.

Workers for an association for prostitutes in Brazzaville

The situation in cities like Brazzaville, where the national program has already begun to operate, is more promising. Civil society is beginning to get back on its feet. In the HIV/AIDS sector, CNLS has funded twenty associations for HIV/AIDS for the past year, including one for prostitutes. Since there are close to 2,000 professional sex workers in Brazzaville, Michel Ndinga-Essango, the man who heads this association, has his work cut out for him. "These young ladies do not have the power to negotiate [terms of sex]. They are rejected women. Their profession is illegal and not accepted by our culture." He adds, "We are trying to teach them skills that they can use."

It will be a challenge for CNLS to find enough funding to build up similar HIV/AIDS programs in all areas of the country in a matter of years. Striking a careful balance between the areas that receive services and those that do not will be important to secure lasting peace and reconstruction for the nation. It is also essential to care for the young women most affected by the sexual violence of war regardless of where in the country they happen to live; as it stands, there is a risk that a great number of them will continue to slip through the cracks. Now, it is difficult to find organizations with a track record of successful and long-term social work. There is a visible scramble amongst local NGOs to be recognized as important players in the coming maturation of the country’s national program. Some time will need to pass before it is clear who is doing work of the highest caliber and who best understands the needs of Congo’s long-suffering population.