New efforts show AIDS and HIV treatments can succeed in war zones, where people fear bombs and bullets more than a distant death from disease, non-governmental groups said Saturday.
Ahead of the 16th International AIDS Conference, doctors said outcomes of a handful of treatment programs in countries such as Haiti, the Democratic Republic of Congo and Burundi showed "comparable results" to non-conflict zones.
"It was shocking to learn that people were committed to treatment even in conflict zones," said David Tu of Medecins Sans Frontieres (MSF).
The medical relief organization launched seven pilot programs since 2003 in DRC, Ivory Coast and Burundi to treat 861 patients, and seven more programs in post-conflict countries (2,317 patients) such as South Sudan, Angola, Sierra Leone and Liberia.
"There are stresses and challenges of living in an unstable environment, so it's not unreasonable to think that people wouldn't adhere to treatment, but these were chronic conflict settings where people had become accustomed to relative calm with punctuated levels of insecurity," Tu said.
"They developed a survivor mentality and survival for some meant taking their medicines," he said.
Refugees account for a mere 0.2 percent to 0.3 percent of global need for antiretroviral treatment, noted Gebrewold Petros, a surgeon with the United Nations High Commissioner for Refugees (UNHCR) in South Africa. There are no numbers for internally displaced populations.
But, they are often overlooked because of a misconception that refugees do not adhere to treatment regimes and so "doctors are reluctant to provide them with drugs," he said.
If antiretroviral treatment is interrupted, it is possible patients will develop a resistance to the drug therapy.
There are also constraints to providing health care in war zones in addition to the conflicts themselves such as devastation to hospitals and clinics, damage to roads needed to deliver medicines and other infrastructure, as well as insufficient political will, said Petros.
"Often, people are wrongfully perceived as supporting one side or another in a conflict and so they are not given treatment," he said.
Such populations are often poor and uneducated, and move a lot to avoid violence. There are 107 refugee camps in northern Uganda, which has been embroiled in conflict for more than 20 years.
"Today, they're in one camp. The next, they're in another camp. It's difficult to follow patients," said Elizabeth Madraa of Uganda's Ministry of Health.
Economic migration is equally troublesome. Partners in Health lost patients in Haiti to neighbouring Dominican Republic, said the group's Evan Lyon.
As well, it is often difficult to recruit doctors and nurses to travel to these regions, Tu said.
In Haiti, Partners in Health staff were kidnapped, their vehicles and supplies were stolen and bribes demanded, Lyon said.
To avoid some of these problems, the group delegated most care to locals, he said, which also helped to re-establish health infrastructure and systems.
"By going after HIV, we've seen improvements in primary care," Lyon said.
Governments, however fragile, must also be included in the process to ensure consistency of programs nationwide.
"We've survived 10 regime changes ... (because) the bureaucrats don't change as fast as the politicians," said Lyon.