 photo: gus cairns |
Gus Cairns talks to an African doctor who is calling the rich world’s politicians to account
The openly gay mayor of Paris, Bertrand Delanoë, made a barnstorming oration at the opening of the 2003 International Aids Society Conference. With much Gallic waving of hands he inveighed against anti-condom fundamentalists who “deny our young people sexual safety when all they are doing is searching for passion, for love - for life!”
But it was a quiet African woman, sitting alongside him in a magnificent traditional dress, who made the most eloquent plea for people with HIV.
Marie-Josée Mbuzenakamwe is a 39-year-old doctor from the small central African country of Burundi. Though not as infamous as its twin neighbour Rwanda, Burundi has shared in its recent history of civil war and genocide. One in nine Burundians has HIV, though in the north, Rwandan refugees swell the figure to one in four - many of them women infected through rape.
Asked by the conference’s community activists to represent the voice of people with HIV, Marie-Josée explained the reality for people living with HIV in her country.
Three thousand patients in Burundi are on antiretroviral (ARV) drugs when 90,000 need them. 40,000 dead of Aids in a country of six million. $1.24bn contributed by the G8 countries to the Global Fund - set up by those countries themselves - when it needs $10bn. And she showed a graph contrasting what the G8 should be contributing, according to their wealth, against the pitiful amount they actually have given.
Her comment? “There are two realities: one made of words, which is ultimately meaningless, for the words are not followed by results; and the other, the one in which we live, in which the number of deaths and infected people grows every day.”
We meet the following day, in the noisy coffee bar of the conference centre. Marie-Josée has swapped her robe for a more chic blue-grey number, but still looks the picture of cool elegance in a heatwave-struck Paris.
How did she get involved in HIV?
Marie-Josée makes it clear the one thing she’s not going to talk about is her own HIV status. “I’m too involved. It’s still dangerous for people to be public either way in Burundi.” But she is clear why she became involved in HIV:
“I lost both my parents to Aids: my father in 1985, my mother in 1991. She was dying at the time I left medical school in 1990. It was very hard for me to be graduating as a new doctor and be unable to do anything for her. I decided to do my best for people with HIV.”
‘Doing her best’ involved spending hours of unplanned, unpaid time counselling HIV-struck friends and patients: “It’s not easy in my country. I can’t say doctors don’t care, they do, but they don’t have time. People with HIV deserve one, two hours to discuss it. So they’d call on me at home in the evening.”
In 1993 she joined the INSS (Institut National pour les Seropositifs et les Sidéens - National Institute for People with HIV and Aids). This is Burundi’s biggest HIV service organisation, based in the capital Bujumbura, though there are others elsewhere in the country. Marie-Josée reckons something like 60 per cent of INSS staff have HIV themselves and the organisation is currently able to provide HIV treatment for just 600 people.
 photo: gus cairns |
She witnessed the near-miraculous effects of ARVs first in 1997, when two friends who were fortunate enough both to have good incomes and relatives in the USA had them sent over from US doctors, based on medical pleas written by Marie-Josée.
“One is dead now,” she says. “But the other did so well that in 2000 I told her, ‘It’s better to stop treatment for a while rather than beggar yourself by paying US$750 a month.” (In Burundi, a good graduate salary - say, for a doctor - is $50 a month).
In 2002 a CD4 count for her friend turned out to be alarmingly low and she went back on treatment. But this time, owing to the global drive to lower drug prices, the same regime cost only $30 a month - “though that is still the monthly average wage in Burundi.”
But her strongest memory of being outraged at the global injustice of treatment inequality was when she went to Belgium in 1998 for a TB conference. “I met a doctor who gave me some fluconazole for free. It is so cheap there. I took it home and saved the lives of some children desperately ill with meningitis - some with just one tablet. But in Burundi that tablet costs $4.”
One reason Marie-Josée is such a passionate supporter of ‘multinational’ initiatives like the Global Fund is that she knows that the supply of ‘bilateral’ money - where one country, or group of countries like the EU, keeps firm hold of the purse strings - can suddenly dry up when the politics change.
“Between 1995 and 1997 all the bilateral funding for HIV in Burundi stopped because of the civil war. How can you stop funding such a vital need just because you disapprove of a country’s government? Yes, some money would go into the pockets of militiamen, but some could still get through.”
How did INSS keep going?
“We got some funding from two institutes, the AEDES Institute in Belgium and SIDAction in France. That funded 100 of the 150 free treatments we can provide (the other 450 pay). For the other 50 we scratched around. We put on a gala evening.”
A stereotypical vision of a tin-shack African town is replaced in my mind by a Fitzcarraldo-like opera theatre in the heart of the bush. “Are there enough rich people in Bujumbura?”
“Yes,” she smiles. “The key was to believe there was money there, and of course, we found it among all the UN peacekeepers and workers stuck there who have nothing to do with their big salaries.”
So what did you do? A concert? “No. An African fashion show.”
There’s a gleam in her eye. She was also one of the models. “We raised enough to put 20 people on treatment from that one show.”
She’s still angry about the strings placed on Aids funding by bodies other than the Global Fund. “The World Bank gave us $36m but said, ‘You can’t buy generic ARVs, you have to buy from the big pharmaceutical companies.’ That would cost $60-$100 a month so we could only treat a half to a third of people for the same money.”
“And the UK’s Department for International Development (DfID) offered us $6m - but only to spend on prevention. DfID don’t want to hear anything about treatment - they think we’re incapable of managing it.
“I said to them, ‘Spending money on treatments is the most efficient way of spending HIV money’. Prevention cannot absorb all that money because you cannot reach all the people. Burundi is still a country in civil war. You can’t get around. To do prevention work in villages, you’d need helicopters!”
Whereas when sick people are desperate enough, they will come for treatment, she says, war or no war.
Marie-Josée fears a repeat of the Rwanda genocide in her own country. “There were rebels fighting in Bujumbura the day I left. People can’t get across the city. Now all the telephone lines have gone down: only mobiles are working.”
This is another reason, she says, why independent bodies like the Global Fund, working directly with NGOs, may just get money through in situations of chaos. “Our politicians are too taken up with their own security, their policing, their legitimacy, to worry about HIV at all. They have promised elections in 18 months but I can’t see the war stopping to allow them.”
Given this grim situation, what does she think of people seeking asylum in Europe to get HIV treatment? And as a skilled professional, has she ever thought of joining the ‘African brain-drain’ herself?
“No,” she says, emphatically. “I advise people thinking of doing that, that life in the North is very difficult. I show them all the social problems they will face. I know enough Africans living in Europe to see the big difficulties they have in their social life.
“This is mainly because they have no one to tell about their HIV. Africans who come to Europe for HIV treatment solve their health problem, but they get another one: isolation.
“In our culture you cannot live alone. Africans always have their mother-in-law, their cousin, their uncle, their child to talk to. Here? No one. So I understand, but I always say to people it is better to try to get treatment back home.”
Marie-Josée is spending a month in France with her two daughters. Then it’s back to Bujumbura, and trying to get Aids drugs to more of Burundi’s 90,000, in the middle of a war zone. Maybe the UN peacekeepers would like another fashion show...
