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Discounted healthcare for the internally displaced: Limits to decentralized access to HIV/AIDS treatment


The increased vulnerability of internally displaced people who are disconnected from the prevention and treatment of HIV-AIDS constitutes a new area of ​​concern for the managers of the regional technical group for the fight against this pandemic in the West region.

About ten meters from the main entrance of the West Regional Hospital in Bafoussam, an old building surrounded by a few fir trees displays its dilapidated walls. The only new element of this decor which recalls the constructions of the first years of Cameroon's independence on January 1, 1960, a banner hoisted by the regional technical group (Gtr) to fight against the human immunodeficiency virus/syndrome acquired immunodeficiency (HIV-AIDS) in West Cameroon. "Equalize" is the key word of this poster which expresses the will of the State of Cameroon to reduce the prevalence rate of this pandemic. A commitment shared by Mr. Onana Tsanga, member of the team in charge of monitoring and evaluation at Gtr-Sida Ouest. He specifies that according to the demographic and health survey (Eds) carried out in 2018 by the National Institute of Statistics (Ins), the prevalence rate of HIV-AIDS in the West region is 1,6%. . “Antiretrovirals are distributed free of charge in the 20 health districts in the West region. The health unit authorized to distribute ARVs must nevertheless present a certain standing and have at its disposal qualified personnel. The psychological follow-up is constant. Out of respect for patient confidentiality, we cannot label or categorize them as internally displaced or not. Newcomers to the Western region can receive their treatment just by showing their Tav (antiretroviral therapy) code,” he explains.

Sexual violence and risky behavior

The figure put forward by this member of Gtr Sida Ouest is well below the national threshold. Because, according to UNAIDS, the numbers of contagion are on the rise. In 2001, 650.000 people died as a result of AIDS and 1,5 million others were infected with HIV. To “end the AIDS epidemic as a threat to public health by 2030” the UN had set targets aimed at reducing annual infections to 500.000 in 2021 and 370.000 in 2025. Cameroon is the second country with the highest HIV prevalence in West and Central Africa. In the general population, HIV prevalence fell from 5,3% in 2004 to 3,4% in 2018. To achieve control of the HIV epidemic, Cameroon adopted the 90-90-90 targets of L AIDS in 2020. According to the CAMPHIA survey of 2017-2018, the performances in Cameroon are as follows: 90,56st 2%, 90,93nd 3% and 90,80rd 1%. One year later, the performances are: 90,68st 2%, 90,90nd 3% and 90,80rd XNUMX%. And since the outbreak of the Anglophone crisis marked by a large influx of internally displaced people who have swelled the ranks of sex workers in the cities of Bafoussam, Mbouda, Foumban, Foumbot, Magba, Dschang, Bangangté and Bafang, we fears an upsurge in contamination. Among them, people who are victims of HIV-AIDS have limited access to care because antiretrovirals, although free, are not available in all district hospitals. The patients, mostly sex workers, have difficulty accessing psychological care due to a lack of qualified personnel. Internally displaced people housed in border areas far removed from health districts and landlocked do not have easy access to Arv.
This evidence was brought back into the spotlight as part of the celebration of World HIV-AIDS Day on December 1, 2022. Internally displaced persons affected by HIV/AIDS encounter many difficulties in terms of prevention, access to care and support. Ita Ché, internally displaced, went to the Belle Idée health center in Bafoussam to take her HIV-AIDS test in mid-October 2022. She boasts that her "results are good", but underlines that in internally displaced, many people who are victims of HIV/AIDS do not know where to seek treatment. Facts that agree with the observations of the Moje Foundation, an organization committed to promoting health for all. “The magnitude of the impact of conflict and displacement on HIV transmission depends on many competing and interrelated factors: loss of livelihoods, access to education, type and duration of the conflict, the living conditions of internally displaced persons (IDPs) (whether in a formal or informal settlement), the context of their new location, access to health, including sexual and reproductive health and HIV programs. These factors also have direct implications on vulnerability to HIV”, explains a source in health circles in the West. She believes that factors related to the quality of coverage of services and programs also influence vulnerability to HIV. The characteristics of the HIV epidemic, prevalence among local populations, interactions with armed forces, sexual violence and risky behaviors associated with the new living conditions of IDPs have a direct influence on the risks of HIV transmission . According to civil society organizations based in Bafoussam like Horizon Femme, care and aid for orphans, vulnerable children and people affected by HIV/AIDS represent a significant problem for health authorities and organizations working on the ground, due to the excessive number of people requiring assistance, resources and limited capacities to make Displaced persons met by Journalists in Africa for Development (Jade) also highlighted the gaps in terms of information on accessible HIV/AIDS care services.
"If we want to improve assistance to vulnerable populations affected by HIV/AIDS, it is undoubtedly necessary to make more resources available and to implement programs aimed at making these services more accessible to the displaced" , underlines Charlie Tchikanda, executive director of the League of Rights and Freedoms. “There needs to be better coordination and a greater circulation of information among the people in charge of these services in order to
to promote systematic redirection and improve access to HIV/AIDS care services for displaced populations”, adds this human rights activist. Indeed, the HIV Free project, funded by CDC/PEPFAR in Cameroon, was recommended to the Baptist Convention of Cameroon to ensure the implementation in zone 1e composed of the regions of the West, the North-West and the South West. By using the strategies defined by the CNLS in its 2017-2023 strategy document and any other innovative strategies based on evidence, as well as the experiences gained from the implementation of the project in other regions, HIV Free Ouest with the support of the western regional public health delegation and the western regional AIDS technical group intend to put in place strategies to optimize the identification of cases to achieve viral suppression of all patients on antiretroviral therapy in all training health facilities in the region supported by CBC.

WHO is working in coordination with local authorities in Cameroon to support improved coordination of such services at the local level. As part of this survey, WHO provides technical support in data management, as well as capacity building in terms of data management.
information by providing, among other things, computers and office supplies. The new UNAIDS report stresses that "the world will not be able to defeat AIDS while reinforcing patriarchy". An option supported by the Executive Director of UNAIDS, Winnie Byanyima, commenting on this study published on the eve of World AIDS Day. “The only effective roadmap to end AIDS, achieve the Sustainable Development Goals and ensure health, rights and shared prosperity is a feminist roadmap,” added Ms. Byanyima.
A breath of fresh air
In addition, sex workers who live in countries where sex work is criminalized are 7 times more likely to be HIV-positive than in countries where sex work is legal or partially legalized. “These inequalities do not just harm individuals: they impede progress against AIDS, reduce the return on investment in the fight against HIV and put millions of people at risk,” argued UNAIDS. According to this organization, these nations need “a breath of budgetary air” to allow them to invest in health, in particular “significant debt cancellation and progressive taxation”. “Eradicating AIDS costs much less than not ending it,” concluded the UNAIDS chief. A position that contributes to the application of Article 12 of the International Covenant on Social, Economic and Cultural Rights, which states to this effect:
“1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

  1. The measures which the States parties to the present Covenant will take with a view to ensuring the full exercise of this right shall include the measures necessary to ensure:
    (a) Reduction of stillbirths and infant mortality, as well as healthy child development;
    (b) Improvement of all aspects of environmental and industrial hygiene;
    (c) Prophylaxis and treatment of epidemic, endemic, occupational and other diseases, as well as the control of such diseases;
    (d) The creation of conditions to ensure medical services and medical aid in the event of illness for all. »
    Guy Modeste DZUDIE (Jade)

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