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Cablegate: Hiv/Aids in the Drc: An Evolving Epidemic

VZCZCXRO4279
RR RUEHBZ RUEHDU RUEHGI RUEHJO RUEHMR RUEHRN
DE RUEHKI #0066/01 0211705
ZNR UUUUU ZZH
R 211704Z JAN 10
FM AMEMBASSY KINSHASA
TO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/SECSTATE WASHDC 0048
INFO RWANDA COLLECTIVE
SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RHEFDIA/DIA WASHINGTON DC
RHMFISS/HQ USAFRICOM STUTTGART GE
RUEAIIA/CIA WASHINGTON DC
RUZEJAA/JAC MOLESWORTH RAF MOLESWORTH UK

UNCLAS SECTION 01 OF 02 KINSHASA 000066

AIDAC
SIPDIS
DEPARTMENT FOR S/GAC AND AF/C
HHS PASS CDC ATLANTA

E.O. 12958: N/A
TAGS: TBIO CDC AID KHIV SOCI EAID PREL CG
SUBJECT: HIV/AIDS IN THE DRC: AN EVOLVING EPIDEMIC

1. Background note: Embassy Kinshasa recently completed a
Partnership Framework with the Government of the Democratic
Republic of Congo (DRC) and hired a full-time PEPFAR coordinator.
This message provides general information about the HIV/AIDS
epidemic in the DRC. It has been cleared by all PEPFAR team
agencies and sections. End background note.

2. Summary: The DRC has a generalized HIV epidemic, though recent
surveillance study data shows increasing prevalence rates in
various hotspots across the country. High prevalence areas include
8.7% in urban Kisangani, Oriental Province (8.7%) and rural
Kasumbalesa, Katanga Province (16.3). Higher prevalence
populations include the military (11.8%) and sex workers (23.3%).
End summary.

1.2 million Congolese estimated to be HIV positive

--------------------------------------------- -----

3. Almost 1.2 million Congolese will be infected with HIV by the
end of 2010, and almost 300,000 Congolese will be eligible for
antiretroviral treatment (ART) by 2010 according to the UNAIDS
modeling program for HIV estimates (2008 Antenatal Care -- ANC --
Surveillance Report). However, due to resource limitations, only
67,000 HIV positive people will be covered with treatment over the
next five years. The DR Congo 2009 Orphans and Vulnerable Children
(OVC) Rapid Assessment, Analysis, and Action Plan (RAAAP)
Situational Analysis estimates that there are 8.2 million OVC with
over 1 million of these children orphaned due to HIV/AIDS.

4. In 2008, HIV prevalence among pregnant women attending
antenatal care (ANC) sentinel sites in DR Congo was 4.3%, with
prevalence as high as 8.7% in urban Kisangani (Orientale Province)
and 16.3% in rural Kasumbalesa (Katanga Province). Other high
prevalence locations include urban Lubumbashi (6.3%), Mbuji Mayi
(5.8%), and Mbandaka (5.4%); and rural Neisu (5.4%), Lodja (4.8%)
and Kasongo (4.8%).

Estimates of HIV prevalence vary

--------------------------------

5. There are signs that the epidemic may be changing. Although
data from the 2007 Demographic and Health Survey (DHS) suggests
that HIV prevalence may be declining, the recent antenatal
surveillance data, collected annually since 2004, does not support
this conclusion. The 2007 DHS estimates HIV prevalence in the
general population at 1.3%, with higher prevalence among women
(1.8%) and in urban areas (1.9%); however, the 2008 ANC
surveillance data suggests that the prevalence may be higher in
rural sites (4.6% compared to 3.7% in the capital of Kinshasa and
4.2% in other urban areas). Differences in DHS and ANC estimates
are typical due to the different populations sampled. The 2007 DHS
is the first survey of this kind in DRC. The Government of the
Democratic Republic of Congo (GDRC) prefers to continue to use ANC
data to estimate general prevalence. Using ANC surveillance data
for women ages 15-24 as an indicator of where the epidemic may be
focused in upcoming years, high prevalence is in Kasumbalesa
(14.2%), Kisangani -(7.6%), Kasongo (5.4%) and in Lodja, Buta and
Mwene Ditu (5.2%), compared to 2.7% prevalence among 15-24 year
olds in Bukavu, a current USG geographic focus point where overall
ANC prevalence is 1.6%. Bukavu, like Kisangani, is on a major
regional transport corridor and therefore continues to be at risk
of rapid spread of HIV infection.

6. Among women, the highest prevalence is between ages 40-44

KINSHASA 00000066 002 OF 002


(4.4%). For women, those who are the most educated and wealthiest
are at greatest risk (3.2% and 2.3%, respectively) when compared to
the least educated and poorest women (0.6% and 1.2%, respectively).
In relation to marital status, widowed women have the highest
prevalence (9.3%). For men, the highest prevalence occurs between
35-39 years (1.8%), according to 2007 DHS. Risk of infection is
higher among men and women living in urban areas than those living
in rural areas (1.9% versus 0.8%, respectively) according to the
2007 DHS. HIV prevalence is highest for women in Kinshasa (2.3%
compared to 1.0% in the West, 2.1% in the East, and 1.6% in the
Central South). For men, however, the highest prevalence is in the
East (2.1% compared to 1.3% in Kinshasa, 0.5% in the West, and 0.8%
in the Central South). Most At Risk Populations (MARPs) have much
higher prevalence rates compared to the general population
according to Behavioral Surveillance Studies (BSS). For example,
HIV prevalence is 23.3% among sex workers in Lubumbashi (2004) and
11.8% among military personnel (2008).

Tuberculosis (TB) is also a major problem

-----------------------------------------

7. The DRC now ranks 10th among the world's 22 high-burden
tuberculosis (TB) countries. The estimated incidence of TB was 392
cases per 100,000 population in 2007, according to the World Health
Organization. HIV prevalence in adult-incident TB patients is
estimated to be 17% in USG-supported clinics in Kinshasa.

8. An estimated 141,500 HIV+ women in DR Congo delivered 42,450
children infected through mother to child transmission in 2008
(2008 National HIV/AIDS Control Program (PNLS) report). According
to the National AIDS Control Program (PNLS), only 5% of eligible
pregnant women have access to prevention of mother to child
transmission (PMTCT) services according to the 2008-2012 DRC
HIV/AIDS Strategic Plan. Despite up to 88% of women accessing
antenatal care services, PMTCT and counseling and testing services
are minimal to nonexistent.

Demand for counseling and testing is high

-----------------------------------------

9. Demand for HIV Counseling and Testing (HCT) services in the DR
Congo is high; however, the low percentage the population that
knows their HIV status (9% for both men and women) may contribute
to fueling the epidemic (2007 DHS). Fewer than 30% of people
living with HIV/AIDS enrolled in ART programs are receiving some
form of palliative care. Based on the 2008 National HIV/AIDS
Control Program (PNLS) report (published in late 2009), 24,245
patients were enrolled on ART, which represents 40.4% of the 2008
target (60,000 PLWHA planned by the end of 2008 based on potential
availability of resources). Currently, the PNLS estimates that
31,000 people are enrolled on ART, which is only about 10% of those
eligible.

10. Epidemiological information has been used by USG and GDRC in
the development of the Partnership Framework to focus limited USG
resources (specifically PEPFAR funds) on most at risk populations
in selected high prevalence geographic areas within the context of
the DRC National Multi-sector Strategic Plan for 2010-2014. PEPFAR
funding complements considerable resources provided to the DRC by
the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as
the World Bank's Multisector AIDS Program, and smaller
contributions by UNICEF, the Clinton Foundation, and other
bilateral partners. However, current resources are insufficient to
address the country's real needs.
BROCK

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