Reversing HIV Stigmas in the Democratic Republic of Congo
Editor’s Note: This interview does not represent the official positions of MSF but the interviewee’s own views.
Robert is a UK based doctor who has been working with Doctors Without Borders/MSF since 2014. Passionate about HIV/TB and maternal health, he is also a keen photographer and documented his recent mission in the DRC on his MSF blog and Instagram.
Could you describe your HIV and TB work in the eastern Democratic Republic of Congo?
Robert Verrecchia: I was working in the South Kivu province, across the border from Rwanda and Burundi. MSF covers 2 separate projects in the area, and both sites include HIV services. MSF is one of the only NGOs there right now, particularly treating HIV. Unfortunately, the outcomes of our work are limited due to:
- The populations holding strong traditional beliefs, often preferring traditional forms of medicine;
- The amount of gold mining in the area, meaning that the patterns and lifestyle of people working in the mines is very mobile, so ensuring long-term HIV treatment for them is really tough. It makes it hard for us to provide a continuity of care.
IN THE PHOTO: GILBERT, PRESIDENT OF THE HIV PEER SUPPORT GROUP, TEACHING THE COMMUNITY ABOUT STIGMAS AND ENGAGING WITH HEALTHCARE. CREDIT TO ROBERT VERRECCHIA.
The mining also attracts quite a lot of professional sex workers. There are a lot of single men away from their families, which attracts a lot of sex workers to these areas. Condom use is really low in these places, especially because they’re not really available. We put into place last year an STI screening clinic so that sex workers can come get tested and get treatment. There are just so many people there that providing treatment, or even giving out enough contraception, is logistically challenging.
We’re always trying to make things acceptable and available to our entire population. The sex workers are quite easy to engage with because they understand the risks, and tend to be quite open to share information with us. Interacting with the miners is much more challenging as their priority is to make money rather than look after their health.
IN THE PHOTO: CROWD OF ENGAGED CHILDREN LEARNING ABOUT HIV AT THE LOCAL THEATER GROUP PERFORMANCE-.CREDIT TO ROBERT VERRECCHIA.
What kind of stigmas would you like to reverse about working with HIV in the DRC?
R.V.: Stigmatization for HIV has occurred all over the world, and I think we still don’t understand it very well in developed countries. For example, did you know that once a patient is stable on treatment and takes it regularly every day then the chance of transmitting the virus to others is basically zero? In a stable relationship you wouldn’t even need to use condoms. Your life expectancy in the west is pretty much normal and the new drugs are very well tolerated. It has become a very manageable chronic disease. And yet even in the west the stigma around it remains huge. In areas like South Kivu, the massive misunderstanding means that when people get sick they’re much more likely to think it’s related to a curse or sorcery and may only present themselves to a hospital very late- often too late. This means that people relate HIV diagnosis with death.
The Global Fund funds HIV treatment around the world, providing the Congolese government with the drugs. All around the Congo the treatment should be free but, unfortunately, because of the healthcare model, the consultation isn’t free and because in large parts of the country no one can afford this, the clinics are not in place so the system just doesn’t work. Only when an organization such as MSF provides free comprehensive service can these people survive this otherwise fatal disease. Unfortunately for most organizations, this part of the world is simply seen as too difficult.
IN THE PHOTO: THE LOCAL THEATER GROUP TEACHING THE COMMUNITY ABOUT THE LIMITATIONS OF TRADITIONAL HEALERS WHEN SEEKING HEALTHCARE. CREDIT TO ROBERT VERRECCHIA.
Can you tell me about your work with the local theatre group in the DRC? What do they act out to teach the community? Does MSF organise this collaboration?
R.V.: The stigmatisation is a real problem, so in an effort to break that we are trying to put across a message that can be understood by the community. We paired with a local theatre group, who were very impressive and funny, demonstrating things like the dangers of unsafe sex and sharing razors and the importance of seeking medical care. They got a lot of attention, which after we could use to put across health messages, and while they performed we set up testing spaces where we could test about 100 individuals. We do this every time they come to perform.
On your blog you share the stories of HIV victims courageously sharing their story in public. Have they faced any backlash because of their openness?
R.V.: People performing and telling their own stories sends a really strong message out to people and showing that people are willing to talk about it was also important for breaking down the stigma.
As for any backlash, it’s difficult to say. Certainly as a foreigner who doesn’t speak the local language it’s quite difficult to really gauge how people are feeling. But the response seemed to be very positive; the 3 individuals were able to go shake hands with and talk to people afterwards and they seemed very pleased about how it went. There’s always a risk that they’re going to be faced with a higher level of stigmatisation, but they get it and they get what needs to be done to slowly move forward.
IN THE PHOTO: CHILDREN PLAYING IN SOUTH KIVU. CREDIT TO ROBERT VERRECCHIA.
Do you find it difficult working in a location so geographically and metaphorically far from your life in the UK?
R.V.: These places are fantastic. Often you’re working in really beautiful parts of the world, beautiful jungles and mountains and lakes with incredible friendly people, who you can’t always talk to but with whom you can still interact. It’s a real privilege to be able to visit and work in these places and even become a part of the life there. You’re often working in nice teams with MSF and sharing your difficult experiences with those around you helps you to bond as a team. Coming back home is often more challenging, to be honest.
What are your thoughts on the white saviour complex, and do you think about it when doing your work?
R.V.: Everybody goes out and does this sort of work because they want to have an impact and do a good thing, but I think when you find yourself going to these places you have to be very realistic and practical about your approach. You have to go in with a completely open mind and have the ability to step back and see how local people work, even if they don’t have the same level of training or clinical expertise as you. They understand the context and may have a good reason for working differently. Doing that also helps you develop bonds with local staff and make a more lasting difference to a situation.
Unfortunately, I’ve seen it few too many times where people will come from the outside and be very opinionated about how to tackle things. Oftentimes it’s about achieving a balance, because sometimes you see something that’s so bad you just want to tell people to change. For example, during my first day in the paediatric ward in a refugee hospital on the border between Thailand and Myanmar, a healthcare worker wanted to inspect a child’s throat. I highly suspected a severe form of throat infection and I knew that the examination would risk killing the child. I tried to dissuade him from it, but he went ahead with the throat inspection anyway and the child had to go into intensive care later that day. It hugely dented our relationship and I didn’t change the outcome. Those kind of events are tough.
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Your blog insightfully describes your recent experience in the DRC. Could you finish by describing your previous mission in the Central African Republic?
R.V.: The set up in the CAR was quite different; it was in the context of a really violent ethnic conflict. Somehow, where my project was based was relatively stable. Unfortunately, things did deteriorate and we did experience conflict in our area, and trying to find a balance between providing healthcare for opposing ethnic groups was very challenging and took a lot of sensitivity. Eventually things settled down in our region and the Christian and Muslim communities went back to living together in peace but this is not the case in the majority of the country- if anything the general situation has gotten worse.
It’s a hugely underreported area and conflict. But during my time there I really realised how important local acceptance was for our own security. Also, what was more worrying there to me than the direct injuries caused by fighting was what the longer-term consequences would be. We saw many people displaced and forced to live in the jungle without shelter. Being exposed to the natural forces and going to makeshift camps without facilities puts people at risk of illnesses such as malaria, diarrhoea and pneumonia. It’s the children that are the most vulnerable in these situations.