28 March 2014

Burundi: HIV Prevention Services Fail to Reach Those Most At Risk

The Burundian government's promise to bring HIV prevalence to zero by 2015 in line with the Millennium Development Goals seems set to fail.

One of the reasons for this is an unequal access to quality healthcare and prevention services for high-risk groups in Burundi.

According to the World Health Organisation (WHO), those most at risk of HIV infection are young people aged 15-24 who are sexually active, sex workers, people who inject drugs, men who have sex with men and transgender people.

Lack of information

Philippe Nkeshimana, a youth health programme coordinator, said: "Most high-risk groups in Burundi lack basic health information about their human rights, sexuality, family planning skills, HIV and AIDS, and sexually transmitted infections.

"For example, I know of very few initiatives, associations or NGOs in Burundi that advocate and provide medical care, prevention and support for those most at risk of HIV infection and promote sexual and reproductive health rights for young people."

Stigma and discrimination

Sexual minorities, particularly lesbian, gay, bisexual and transgender (LGBT) people, in Burundi face discriminatory laws and negative attitudes. Same sex relationships are illegal and carry prison sentences of up to two years and heavy fines. As a result, many people involved in high-risk sexual activities do so in secret, which makes it harder to reach them with HIV prevention and awareness-raising activities.

Club Hindura is an organisation for young people who advocate for HIV prevention in Burundi and work to reduce discrimination and stigma.

According to Gaston Ndayikengurukiye, a member of the club, stigma and legal discrimination are barriers to LGBT people seeking HIV prevention services, disclosing their HIV status and adhering to treatment. They discourage people from getting tested for HIV and seeking support that can improve their health and, in some cases, save their lives. Stigma can also confuse young people on the methods of prevention, such as condom use, which can be seen as a lack of trust or immoral behaviour.

Gaston said: "I share information and best practices in Hindura Club for reducing stigma and discrimination."

Stigma and discrimination also affect other high-risk groups, such as sex workers and people who inject drugs, as well as relatives and friends of people living with HIV and healthcare providers who work with those affected by the virus.

Sex workers at risk

Commercial sex is another challenge to the efforts in HIV prevention. A young girl, who did not wish to be named, said: "Poverty is causing many females in Burundi to sell themselves or practice the risky job of commercial sex."

However, the Burundian government's justice system condemns sex work, making it difficult for sex workers to access HIV information, prevention and treatment.

"If the struggle to bring HIV prevalence to zero by 2015 is to succeed, the government should adopt a strategy of supporting the key high-risk groups to have full access to what they need including materials, facilities, treatment , prevention and information," said Augustin Uwamahoro, who is also a member of Club Hindura.

According to UNICEF, HIV prevalence among adults aged 15-49 in Burundi is 3.3%. The Centre for Training and Research in Medicine and Infectious Diseases says it is 4.6% in urban areas, 4.4% in semi urban areas and 2.8% in rural areas.

Nkeshimana said: "Focusing on high-risk groups that experience discrimination and stigma to ensure access to free HIV prevention, testing, treatment and support services is a key solution."

Albert Masabarakiza, a young activist, added: "In order to prevent and reduce HIV prevalence, NGOs and other operators in the public health sector in Burundi should agree to provide facilities, sexual health prevention and treatment, as well as care services to the high risk groups, including adolescents," he said. "It is also necessary to provide accurate information to make sure people are aware and are not receiving misinformation from unreliable sources."

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