Democratic Republic of Congo (DRC) - HIV Humanitarian Overview

Humanitarian and HIV statistics

Humanitarian and HIV situation

Despite elections in 2006, the humanitarian situation in the DRC remains grave. An estimated 4 million people have died from preventable diseases and malnutrition in the last 7 years. DRC hosts the world’s biggest UN Mission, with approximately 17,000 troops, but violence against civilians remains high. In 2006 UNHCR estimated the population of concern to be more than 2,040,000 persons.

The eastern part of the country, specifically the North and South Kivu provinces, are most affected by the conflict, both internal and regional, due to the recent intensification of fighting of various armed groups and the national army.

Internally Displaced Persons (IDPs):

There are approximately 1.3 million displaced persons countrywide, of which almost half have been displaced in the last 6 months of 2007.¹ More than 70% of IDPs are concentrated in the province of North Kivu. Civilians are subject to direct attacks resulting in killings, burning of villages, widespread pillaging and sexual violence by security forces and other armed groups.

Refugees:

Approximately 315,000 Congolese remain refugees in neighboring countries. In the course of 2007, approximately 40,000 Congolese refugees returned home from neighboring countries. DRC currently hosts 182,000 refugees from seven neighboring countries.²

Insecurity:

From a humanitarian perspective the most challenging task of the new government will be the reinforcement and implementation of the Security Sector Reform (SSR). The government must also address the insecurity, which is primarily due to undisciplined elements within the National Army (FARDC) and the foreign and former demobilised rebel groups, which pose the main threat to civilians and humanitarian workers.

Humanitarian Access:

In addition to conflict, physical infrastructure is inadequate and limits access. Only 20% of the country remains accessible by road.

Water and sanitation: 46% of the population has access to drinking water. In rural zones this rate is only at 29%. The lack of drinking water and appropriate hygiene conditions increase the risks of death and water-borne diseases including diarrhoea, which is the cause of 12% of all deaths. 

Protection:

The situation is characterised by general impunity, serious and recurrent human rights violations, and particularly sexual abuse. Sexual and gender based violence (SGBV) levels are high in the DRC. In Ituri Province, 25 cases per day were registered between January and July of 2007. Since 1998, 41,225 cases in the provinces of South Kivu, Maniema, Goma and Kalemie have been documented. ³ According to the UN, 12,226 victims of sexual violence have been identified and assisted between January and August 2007.

Early recovery:

Post conflict and early recovery programs need strengthening to address returnee population needs and the country’s structural needs.⁴

Food/nutritional security:

Chronic household food insecurity affects 70% of the Congolese population due to limited access to appropriate agricultural supplies, crop pests and continued insecurity.

Health status:

The health care delivery system is inadequately decentralized for the large size of the country and mobile population. There are severe shortages of human resources trained to deliver antiretroviral therapy. Access to antiretroviral therapy (ART) is limited in many provinces. Systems for procurement and supply management of drugs are inadequate, and the cost of treatment remains high. Endemic diseases, such as malaria, plague, cholera, ebola (marburg), monkey pox, sleeping sickness, remain major threats.

Natural hazards:

There is potential threat for volcanic eruptions in North Kivu and seismic activities in the eastern part of the county along the Rift Valley. Wide scale flooding, road destruction in rainy season across the country and crop failure and diseases during extended dry periods are also of concern.

HIV epidemic

DRC has a large-scale growing HIV epidemic, with an estimated national average adult prevalence of 1.3% and 450,000 people living with HIV (PLHIV). The epidemic is strongest among young people between the ages of 15 and 24 and women accessing at antenatal clinics, and is on the rise. The driver of the epidemic is concurrent multiple sexual partners. The most severely affected age groups are 20–29 years among women and 30–39 years among men. The epidemic has severely affected children – an estimated 320,000 children younger than 17 years had lost one or both parents to AIDS at the end of 2003. Surveillance data indicates higher prevalence in the eastern part of the country than in the west.

Most at risk:

• Sex workers and their clients (According to a survey conducted by Médecins Sans Frontières in 2001, the prevalence of HIV infection among sex workers was 27%. ⁵
• Men in the armed forces
• Truck drivers
• Blood donor
• Prisoners

Most vulnerable:

• Women and girls  (Women and girls are increasingly vulnerable, especially in rural areas and refugee camps, as a result of their poor economic status, high rates of illiteracy and the high prevalence of SGBV)

Response to HIV among populations of humanitarian concern

National Strategic Framework: 2005-2009 includes strategies for:

• training additional health workers to deliver antiretroviral therapy
• expanding prevention and care facilities
• strengthening the capacity of national laboratories and improving the procurement and supply management systems for antiretroviral drugs and other supplies.

The National Strategic Plan for HIV/AIDS for 1999– 2008 ⁶ specifies that all reproductive health services should integrate services for preventing the mother-to-child transmission (PMTCT) of HIV, including access to voluntary counselling and testing, ART for women living with HIV and nutritional counselling for infant feeding.

Prevention priorities

• PMTCT
• Testing and counselling services

Care/treatment coverage

• Strengthening human resource capacity

• Coordinating mechanisms and monitoring and evaluation systems
• Increasing availability of ART – extending coverage to rural areas

The following cluster response plans of the Humanitarian Action Plan address HIV programming needs:

Health:

Improve access to primary health care for vulnerable people, including those living with HIV  (PLHIV), as well as conduct surveillance surveys to ensure most recent data. The Health Cluster will also distribute HIV testing kits to district hospitals, training of health care personnel in testing and treatment of opportunistic infections for PLHIV, sensitize displaced and returning populations on HIV, and pre-positioning of PEP kits (in conjunction with Protection Cluster).

Water and Sanitation:

Use of water points for HIV prevention and awareness messages

Food security:

Support emergency food assistance households of malnourished children, displaced, returnees or repatriated and other vulnerable groups (including PLHIV, victims of sexual violence, etc.)

Funding for HIV in humanitarian situations

Global Fund: Through Round 7, DRC received a grant of approximately USD 70 million in November 2007 for the provision of a comprehensive service package for the prevention, care and treatment of HIV in priority health zones. Principal recipient: UNDP.

MAP (World Bank Multi-Country HIV/AIDS Programme): USD 102 million as of Sept 2006

PEPFAR: None

Central Emergency Response Fund (CERF): The CERF allocated USD 36.6 million in February and USD 11 million in August from its under funded emergencies window to DRC. Another USD 5 million in October 2007 from its rapid response window to address urgent needs in North Kivu.

The 2008 Humanitarian Action Plan for DRC requests a total of USD 575,654,186 and focuses on five priority areas of action:

1.      Morbidity/ Mortality: reduce maternal and infant mortality

2.      Malnutrition: reduce Global Acute Malnutrition (GAM) rate

3.      Protection: reinforce assistance and protection mechanisms for civilian populations including victims of sexual violence; demining activities; and protection of children at risk.

4.      Displacement: respond to protection and assistance needs of displaced populations

5.      Returns: respond to the identified needs for return and reintegration of those wanting to return to areas of origin.

The 2007 Humanitarian Action Plan assessed the humanitarian needs at USD 686 million, and as of November 2007 64% of the funding requirements were covered. 

The three-year Country Assistance Framework (CAF) was prepared jointly by UN agencies in consultation with the Government, the World Bank, and donors to implement key strategies focusing on Poverty Reduction Strategy Papers (PRSP) priorities for social sectors, primarily health, education, HIV, and recovery of rural economies will serve as a basis to transition from relief to development and link with the 2008 HAP. 

Humanitarian and HIV coordination structures

National:

The Programme National Multisectoriel de Lutte contre le SIDA” (PNMLS) provides technical assistance and coordination to all HIV programmes in DRC, at national, provincial and local levels. Of the 32 members of the PNMLS, 23 are Ministers of various development sectors.

National Programme against AIDS (Programme National de Lutte Contre le Sida)
Kinshasa, DRC
Fax: +243 88 436 75
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The DRC is a pilot country for the cluster approach (all clusters are present), the Good Humanitarian Donorship (GHD) initiative, the Pooled Fund and the expanded CERF. UNICEF is cluster lead to half of the clusters in DRC.

NGOs are actively participating in the cluster’s work and provincial and national authorities are often attending cluster meetings and are also consulted on various humanitarian issues. ⁷ 

UN:

The HIV Thematic Group brings together the heads of UN and donor agencies, and the Joint UN Team on AIDS (JUNTA), its technical arm, brings together HIV focal points from 21 UN and donor agencies present in the DRC.  It is the key mechanism of joint and coordinated action within the UN system and serves as an HIV task force for HIV in humanitarian situations.

The UN country team (UNCT) defines its support to the HIV National Strategy within the Country Assistance Framework and the Development Action Framework (UNDAF).

UN Theme Group on HIV/AIDS and WFP Representative:
Félix Bamezon, Chair,
Telephone: +243 81 700 67 10
Fax: +243 81 301 04 82
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UNAIDS Country Coordinator:
Pierre Somse
Telephone: +243 81 880 08 40
Fax: +243 224 36 75
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MONUC, Kinshasa: SRSG:
William Lacy Swing
Tel: +243 81 890 6000
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Humanitarian Coordinator:
Ross Mountain
MONUC, Kinshasa               
Tel: +243 81 890 6000,
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OCHA, Head of Office:
Gloria Fernandez
Kinshasa                                
Tel: +243 81 333 0146.
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OCHA, Head of Regional Support Office for West Africa:
Besida Tonwe
Nairobi           
Tel: +225 22 405 170
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OCHA presence

In addition to the main office in Kinshasa, OCHA has sub-offices in Baraka, Beni, Bukavu, Bunia, Goma, Kalemie, Kisangani, Lubumbashi, Mahagi, and Uvira. Moreover, in response to sudden emergencies OCHA deploys mobile temporary antenna offices, currently located in Moba, Mwenga, Walikale, Dungu, Shabunda, Minova, Kitchanga, and Masisi. The OCHA Team comprises 137 staff (23 internationals and 114 nationals).

Key international organizations present in the DRC

All major UN agencies are present in the DRC along with major developmental and financial institutions of the UN system and regional organizations. More than 70 international humanitarian organizations are also operating in DRC. A contact list can be accessed through: http://www.rdc-humanitaire.net/f/article.php3?id_article=32

Key organizations working in HIV in humanitarian situations
Espoir , Vie & Solidarite (EVIS)
Tel: +243 09 98 412 745
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Central Network of AIDS Service Organisations (CANASO)
Tel: +243 68 57 01
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Training on the IASC guidelines

One training in May 2006 hosted by UNICEF

Additional resources

UNHCR RDC map September 2006

Informations pour la communaute humanitaire en RDC