In Burundi, make HIV invisible and live again – Le Monde

An extractor responsible for recovering the genetic material of HIV to perform a viral load measurement at ANSS headquarters in Bujumbura, Burundi, on November 6, 2018.
An extractor responsible for the recovery of HIV genetic material to perform a viral load measurement at ANSS headquarters in Bujumbura, Burundi, on 6 November 2018. Matteo Maillard

Everyone will tell you, it's a world that falters. The reactions are similar: a vertigo, followed by anxiety, a denial, then, sometimes, an opaque anger. Sylvie is no exception. She also went through each of these emotions when she was told that she was HIV-positive.

Presentation of our series Follow our AIDS series, the new weapons of Africa

Detected in 2008, at the age of 30, she was sure to see her life destroyed. Initially, she refused to believe it. For four years. His health in decline, he finally accepted. "I had to continue my life and I wanted to be a mother, so I started taking antiretroviral therapy (ARV) until I had an almost undetectable viral load, She says. Only then did I allow myself to be my first child. " Today, in November 2018, Sylvie has three, all of which are seronegative. In Bujumbura, the capital of Burundi, where he lives, his family life is almost trivial. "I am just careful not to allow other members to use the same sharp devices as me and make them aware of the pathways to HIV infection" She continues.

"Race against time"

If Sylvie was able to regain her life, it is thanks to an important scientific breakthrough: the measurement of viral load. This test, widespread in France and Europe at the end of the 1990s, was not accessible until 10 years ago to the African countries most affected by the pandemic. With two machines, it is able to measure the amount of virus per milliliter of blood and the progression of infection in the body. Above all, it offers an accurate view of the efficacy of antiretrovirals on patients, revealing therapeutic failures, including resistance to certain molecules. This follow-up was impossible with the previous method, which measured the cells that coordinated the immune system but not the rate of virus in the blood.

In Burundi, the OPP-ERA project, supported by the French consortium that brings together Sidaction, Solthis, ANRS, Expertise France, and financed by Unitaid in close collaboration with the Ministry of Public Health and the fight against AIDS, has allowed Installation of four laboratories to generalize the measurement of viral load from 2014. A project also developed in Cameroon, Guinea and Ivory Coast.

Episode 1 Sex and tests for prostitutes in Ouaga

This tool gives Burundi hope to approach one of the three goals of the World Health Organization (WHO) by 2020: 90% of people treated with a sustained viral load. Today, 61,000 patients are treated with ARV, but less than half have access to regular viral load measurements. "We have not yet exceeded 40%, explains Francine Karemera, medical coordinator of OPP-ERA. But if we continue our efforts, it is not impossible to reach 80% by 2020. It's a race against time! "

This delay, the Burundian state is aware. "We have established a mechanism to monitor at-risk populations using these devices to facilitate their access", next Richard Manirakiza, deputy director of the National AIDS Program. declared "Public health problem" in 1983, HIV lost ground in Burundi. In 2017, a national study showed a rate of infected people (prevalence) at 0.9%. But the disease remains important among populations at risk such as prostitutes, homosexuals, fishermen, miners and truck drivers, sometimes reaching a prevalence of more than 20%.

"Deep injustice"

Emmanuel belongs to this category. A 61-year-old truck driver, he learned in 2010 that he had "The illness". His condition was serious. He weighed only 30 kg when it was detected. ARVs saved him from certain death. Today, in the shadow of an HIV service shed in the country's largest hospital, it seems to have regained its energy first. It puts it to the benefit of other patients by tracing them at home when they stop treatment. these "Non-observer" often the call is missing due to lack of money to make the trip. Emmanuel created a mutual fund where each patient pays 500 Burundian francs (0.25 euros) per visit to pay for transport to the less fortunate. But sometimes non-observers abandon treatment with discouragement or skepticism.

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This is the case of Frank, 20, born with HIV: "I was 17 when I was told that I was HIV-positive.It was very difficult to accept.I was wondering for a long time if it was my fault.I felt a profound injustice, so I turned to religion. He said God was going to heal me from AIDS My condition was deteriorating For a year I believed before being admitted to the hospital From now on I take my pills every day. it is HIV that kills but ignorance. "

180 km north-east of the capital, the city of Muyinga extends over rolling green hills. It is in his small hospital that one of the four laboratories of the OPP-ERA project was installed: an extractor responsible for the recovery of the genetic material of the virus and therefore its fixing in the cartridges. The device can also be used to detect hepatitis. Once extracted, the genetic material must be amplified in a 95 ° C thermocycler for one hour and forty eight to make it measurable. If there are less than one thousand copies of virus per milliliter of blood, the patient's load is considered undetectable. It could therefore have unprotected sex and have children without further risk of transmitting the disease.

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Each machine can process twelve samples a day. When there are several, like in the Bujumbura hospital, you can reach 180 a week. "Before the work was much more manual and boring, we did not exceed 30 samples a week", explains Désiré Nisubiri, a technician trained in the project. Having four laboratories in different parts of the country also reduces the risks associated with transport. "Sometimes the blood has coagulated due to the length of the trip or the samples were lost because the trucks were not safe" recalls the dott. Olive Niyonkuru, who is responsible for the HIV service at the Bujumbura hospital.

"Here is the ignorance that kills"

If the province of Muyinga has been selected to establish one of these laboratories, it is because here is AIDS "A big concern"says Dr. Kwanza Georges, responsible for HIV patients at the city's hospital. It evokes the security situation that has seen the creation of refugee camps since 2006, in particular Congolese, but above all, the proximity of Tanzania, about ten kilometers of the city. And like all border areas, the region attracts at-risk populations such as truck drivers and prostitutes.

Nurse Serge Rubeeiry and his supervisor facing the Kinazi health post a few miles from the Tanzanian border, Burundi, November 7, 2018.
The nurse Serge Rubeeiry and his superior in front of the Kinazi health post a few kilometers from the border with Tanzania, Burundi, November 7, 2018. Matteo Maillard

In Kinazi, the last health center before Tanzania, out of 73 HIV-positive patients, 50 are women, including many prostitutes. "It's a poor rural population, says Serge Rubeeiry, a nurse. Sex in the fare appears as a way out. So let's do prevention and distribute condoms. But it happens that the customers, truck drivers, pay better if the women accept without. "

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Manori, 22, speaks in a shy voice. He practiced for four years. Her husband does not know. "I have not done the screening yet but I think I'm exposed so I've come to take post-exposure drugs, She slips. I'm afraid I was contaminated because in the last days I had sex without a condom. My warehouse was sold out and I am very solicited by my clients. It's hard to refuse when you need money. " The nurse tries to convince her to take the test. She refuses, prefers not to know. He looks irritated, shrugs. Frank's words come back to mind. "Here it is not the HIV that kills, but the ignorance." The fight could be long.

This article is part of a series produced in the context of a partnership with Unitaid.

Summary of our series of AIDS, the new weapons of Africa

Matteo Maillard (Bujumbura, Muyinga, Kizani, Burundi, special envoy)

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