14 November 2006

Congo-Kinshasa: Ex-Combatants Confront the Reality of HIV

Kabare — Craning their necks through the window of a medical centre in the eastern Democratic Republic of Congo (DRC), a dozen ex-combatants from the recent civil war watch images of sexually transmitted infections flashing on a television screen.

These men and women have just laid down their weapons in one of Africa's nastiest wars and are now coming to terms with the unseen danger of HIV. It is widely assumed that more than a decade of fighting between foreign-backed rebels, Congolese militia and the national army has spread the virus in eastern DRC, while crippling health services.

"I behaved badly. We took women, we raped because we had weapons; we were the 'maitre de terrain' [masters of the land], we made the laws. I slept with so many women I couldn't count how many," said Bahati, 26, who had just reported to the Kabare reorientation centre in South Kivu Province, run by the National Commission for Disarmament, Demobilisation and Re-insertion, known as CONADER.

A few days before, Bahati had belonged to the Rassemblement Congolais pour la Democratie, or RCD-Goma, one of several armed groups now integrated into a unified national army.

The Kabare reorientation centre in the hills 25km west of Bukavu, the capital of South Kivu, was receiving up to 1,000 former fighters each week in July. Across the country an estimated 180,000 ex-combatants are expected to go through a disarmament, demobilisation and reintegration programme that includes HIV/AIDS sensitisation.

There are fears that the short instruction period will be of small benefit, and infection rates will spike when the demobilised soldiers return to their rural areas.

Most male soldiers are in the 18-to-24 age group, which typically has higher levels of testosterone, aggression and willingness to take risks, and relatively low levels of maturity - a combination that can boost the probability of HIV infection.

"They have been part of armed groups that move continually, in which there is no sexual discipline, and which commit widespread rapes and acts of sexual violence. Even if we can't talk of sexual violence, the likelihood is that they have slept with numerous partners," said Brigitte Bampile, head of voluntary counselling and testing at the Kabare centre.

"I knew nothing about HIV/AIDS while I was fighting. We left our women at home so we satisfied our needs no matter how, when or where," admitted Julian, 39, a former fighter.

"These rapes have nothing to do with sexual need - people don't realise they are using rape as a weapon of destruction," said Christine Schuler-Deschryver, of the German government's aid agency, GTZ.

HIV programmes at Kabare are limited to awareness building, information about the virus, how it is transmitted and why ex-combatants are at particular risk of infection. A counselling and testing facility, supported by the Association for Social development and Protection of the Environment, was set up a few months ago.

"Our first goal is to know their HIV status, so that we know what levels of infection are going back into the communities," said Bampile. "Our second goal is to change their sexual behaviour, but this takes time and cannot be achieved in five days. What we encourage, however, is a more responsible behaviour vis-à-vis their sero-status."

Not only the men need testing: Hélène, 26, slept with several men while fighting for the RCD before falling pregnant - she has no idea who the father is.

"We had no means to survive so I sold my body to the men, and in return I received money to buy food and soap. We had no condoms, but I knew nothing about HIV/AIDS anyway, so I had nothing to worry about," she recalled. "I have already taken a test, but I never went to receive the results because I am sure it was positive. Now I am deciding whether or not to take another test."

Few were taking HIV tests, said Gilbert Kjabeka, coordinator of CONADER in South Kivu. "This is due to the lack of discretion. They live in dormitories, there is very little privacy and an individual will fear that others may see him go for a test. We need to find a formula where we can guarantee 100 percent anonymity and security."

One option would be to make HIV tests mandatory, but Bampile said this was highly unlikely. "Given the high-risk nature of former combatants, it wouldn't be a bad thing if testing was obligatory, as that would help us and the population, but it is the fundamental right of an individual to know, or to remain ignorant about, their sero-status."

According to the centre's statistics, 5 percent of ex-combatants taking the test are HIV-positive, but this figure has been met with scepticism.

"Look at the neighbouring countries - the prevalence rate in Tanzania's army is close to 15 percent, and 10 percent in Uganda's army," said Dr Rebecca Adlington, medical supervisor of the aid group Médecins Sans Frontières, which runs an AIDS treatment centre in Bukavu. "Since there is no intervention on prevention, care and treatment [in the Congolese militias], the true figure is likely to be higher than five percent."

[ This report does not necessarily reflect the views of the United Nations ]

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