HIV/AIDS in the Democratic Republic of the Congo
By Megan Strait '12
LAS 410: HIV and the AIDS Pandemic
Students in the LAS 410 Capstone Course: HIV and the AIDS Pandemic were asked to choose a country and research the circumstances including history, political atmosphere, societal and cultural attitudes/beliefs, economic situation and global influences that have impacted the epidemic in that country. Students then wrote a formal paper detailing the situation, analyzing the information, and providing insight into the AIDS epidemic in the chosen country. The conclusion of the paper was to provide insight as to the future of the epidemic, what needs to be done, and how to go about doing this in the country to improve the HIV/AIDS situation there. I submitted Megan’s paper because her work demonstrates a clear understanding of a very complex issue in the Democratic Republic of the Congo (DRC). Megan was able to apply what was learned in class to develop a meaningful understanding of the situation and the steps that will be needed to combat this disease in the DRC.
-Dr. Ellen DuPré
In the Democratic Republic of the Congo [DRC], one of the poorest countries in Sub-Saharan Africa, 450,000 people are infected with HIV/AIDS, leaving 320,000 orphans, age seventeen and younger, behind (Avert, n.d.). HIV/AIDS is not new in the DRC; in fact, this is where the plague originated in the 1970’s (Avert, n.d.).The disease kills the Congolese people most commonly from the act that creates new life, which makes the disease hard to control. The DRC, already lacking clean water, food, security, and gender equality, is not able to stand up against HIV/AIDS without international aid. Without genuine aid from its own government and from the international community, it will be difficult for the people of the DRC to decrease infection rates or treat the sick. In order for the people of the DRC to effectively fight against the HIV/AIDS pandemic, a strategic response is needed. In order to accomplish this, every aspect of the HIV/AIDS situation in the DRC must be recognized. With knowledge of the history, government, economics, society and culture of the DRC, the global impact on the DRC, and lessons from HIV/AIDS programs in other countries, steps against the HIV/AIDS disease can be realistically developed and put into action.
The colonial history of the DRC is similar to other African countries. The Bantus tribe left Nigeria and settled in DRC in around the 7th or 8th century (US Department of State, Bureau of African Affairs, 2011). Much later in 1885, the Belgian King Leopold II colonized the DRC and made it his own personal possession. The country was then known as the Congo Free State. Soon after, the country became known as the Belgian Congo, since the leadership of the country was taken over by the Belgian government. After several rallies and riots, the Belgian Congo won its independence on June 30, 1960. That same year, parliamentary elections were held. Joseph Kasavubu was elected president and Patrice Lumumba was elected prime minister.
However, a new democratic government did not mean that the people of the DRC were better off. In fact, from 1960 to 1965, the government was in conflict (US Department of State, Bureau of African Affairs, 2011). In 1961, Col. Joseph Desire Mobutu seized the country but soon surrendered it to President Kasavubu. In 1965 Mobutu announced himself as president after he took control of the country. He continued to be president for five years. Later, in 1970, he ran for president unchallenged, and therefore, he was elected. In 1990, Mobutu approved to having the government become a multi-party system. In this government a constitution would be written and elections would take place.
Although Mobutu agreed to this, he did not fully keep his word. From 1989 to 1990, the human rights practices that Mobutu led were highly criticized by the international community. Due to this, the weakening economy, and many domestic protests, Mobutu began to lose his presidential power (Democratic Republic of Congo, 2003). In 1991, soldiers pillaged Kinshasa, the capital of the DRC, to protest their unpaid salaries. In response, France and Belgium sent two thousand troops to aid in the evacuation of the 20,000 foreign nationals who were threatened in the capital city. As a result, in 1992, the Sovereign National Conference took place. Over 2,000 representatives from different political groups attended the event. By the end of the conference, it was decided that the Archbishop Laurent Monsengwo was to be chairman, and Etienne Tshisekedi was to be prime minister of the country. However, this still did not stop Mobutu’s desire for rule. At the end of 1992, Mobutu had created a government of his own, which challenged the country’s new government. In 1994, the two governments merged and became the High Council of Republic-Parliament of Transition. Mobutu became the head of state, while Kengo Wa Dondo became the prime minister. Over the following two years, the planned government elections unsurprisingly were never held.
Unfortunately, government issues were not the only problems arising at this time. In 1994, the warfare and genocide in nearby Rwanda spread into the DRC (US Department of State, Bureau of African Affairs, 2011). This led to the first large war that occurred in the DRC in 1997 through 1998 (Tull, 2009, p. 216). The Armed Forces of the DRC [FARDC] is a group that was created when the Congolese National Congress for the Defense of the People [CNDP] integrated into the DRC’s military. In order to buy weapons, the FARDC illegally obtained and sold the country’s natural resources to other countries. They also committed human rights crimes, such as raping and sexually mutilating civilians and recruiting children to become soldiers (US Department of State, Bureau of African Affairs, 2011).
The country’s government continued to change. Laurent Kabila named himself president on May 17, 1997 and called the country the DRC. However, the DRC was not solely ruled by Kabila. In fact, the country was split into three sections. One section was governed by Laurent Kabila, the second section by Rwanda, and the third section by Uganda. By 1999, Kabila, Rwanda, and Uganda arrived at a military standstill. The large civil war in the DRC lasted from 1998 to 2003 (Tull, 2009, p. 216). It has been predicted that during the war 3.5 million people died from the warfare, disease, or lack of food (Refugee Council, 2004, p. 4). Also, the war drove an additional 3.6 million people from their homes. Clearly, many civil rights were violated. The United Nations [UN] labeled the resulting situation as one of the world’s largest humanitarian tragedies.
Fortunately, the government began to turn around when Kabila was assassinated on January 16, 2001 by one of his bodyguards (US Department of State, Bureau of African Affairs, 2011). Laurent Kabila’s son, Joseph, succeeded and overturned several of the undesirable policies that his father had created. The situation in the country continued to get better when the Angolan, Namibian, Zimbabwean, and Uganda troops officially left the country by 2003. This is largely due to the UN peacekeeping mission in the DRC that began in 2001. Without the help of the international community, the DRC would most likely be in a poorer state today.
The fighting was not over, though. In August 2008, the CNDP and the FARDC began fighting in Petit Nord, which is located in southern North Kivu province (US Department of State, Bureau of African Affairs, 2011). This violence, which lasted four months, drove 250,000 people out of their homes and caused another 40,000 people to move to Uganda. A large number of people were killed due to the violence. Similar violence still occurs in the DRC at present.
Clearly, the government of the DRC has changed quite a bit over the years. Since February 2006, the country has had a constitution. Currently, the president has broad executive, legislative, and military control, including the power to dismiss and appoint judges. The president is also in charge of a cabinet of ministers, which is presently composed of thirty-seven ministers. At this time, the legislature cannot reverse the decision made by the government by a vote of no confidence. Also, the judiciary is only technically independent. Fortunately, the government is becoming more of a true democracy, as the country had its first democratic, multi-party election on July 30, 2006, which had not occurred in more than forty years. At this election, about 25 million people voted for president from thirty-three candidates.
At present, the DRC seems to be ruled by the most stable government it has seen so far. Currently, Joseph Kabila is president and Adolphe Muzito is prime minister. Other ministers include Alexis Mwamba as the foreign minister, Charles Nsimba as the defense minister, Matata Mapon as the finance minister, and Raymond Tshibanda as the Minister of International and Regional Cooperation. This administration recognized five areas needing attention in the country: education, health, infrastructure, water/electricity, and job generation. Unfortunately, the government was unable to make much progress in the five areas due to the armed conflict in many eastern provinces, which increased the country’s security risk. Additionally, an area that still needs government attention is human rights. Important human rights issues stay in the security services and justice system (The Democratic Republic of Congo, 2003). On a better note, Joseph Kabila has made great progress in founding a traditional government and freeing domestic political activity. He also has made important progress in carrying out economic changes with the World Bank and International Monetary Fund (The Democratic Republic of Congo, 2003).
Although the government has been more stable than ever before, the economy of the DRC desperately needs improvement. Right now, the country has an economic freedom score of 40.7, which makes it the 172nd freest economy (The Heritage Foundation, 2011). This is a 0.7 point decrease from last year, which displays the substantial decrease in the country’s scores for financial freedom and government spending. In comparison to the other 46 countries in Sub-Saharan Africa, the country is ranked 44th; clearly, its score is much lower than the regional mean. This poor ranking is most likely due to the recurring political crises, which have significantly limited economic freedom and propelled the economy into constant poverty. Currently, 71 percent of the Congolese are living below poverty line (CIA, 2011).
Even though there are many factors that explain the poor economy of the DRC, corruption has done the most damage. Corruption in this country is considered rampant (The Heritage Foundation, 2011). In fact, in the Transparency International’s Corruption Perceptions Index for 2009, the DRC ranked 162nd out of 180 other countries. This corruption is clearly shown, since fiscal management procedures are usually ignored and non-mandatory spending is high. This is often due to the public financial management being weak, unaccountable and inefficient. Due to this corruption, a parallel economy has been created. Because the corruption rate is so high, many countries refuse to do business with the DRC.
Currently, according to the central bank, the DRC’s total debt is about 93 percent of the Gross Domestic Product (GDP). Mining is and has been the major source of export income (CIA, 2011). In fact, the mining industry is likely to be the main factor for growth as direct international investment rises (Dagne, 2011, p. 11). Unfortunately, the DRC faced payment balance problems after the significant decrease of world market prices for their main mineral exports. However, the world market prices for minerals began to rise in 2009 (CIA, 2011).
Clearly, the economy of the DRC is in very poor standing. This greatly affects how the government can financially address the HIV/AIDS pandemic. According to Ms. Kembe, a medical doctor living in the country, merely 6 out of 260 women living with HIV who are supported by National Mothers’ Association to Aid the Dispossessed [ANAMAD] are taking anti-retrovirals (Kimani, 2007). In cities, anti-retroviral drugs are available in a small number of hospitals that are supported by non-for-profit organizations; however, the drugs are typically not available in rural areas. Even if drugs were cheaper, Ms. Kembe believes that there are other obstacles due to poverty. For instance, people who are taking anti-retroviral drugs need to have a healthy diet in order for the drugs to be effective. In addition, a healthy diet is important because the anti-retroviral drugs have significant physical side effects. However, not many can afford food. It is estimated that 70 percent of the Congolese face long term food insecurity. This is mostly due to agricultural pests, the lack of agricultural tools, and constant insecurity. Water is also scarce, especially clean water. In fact, only 46 percent of the Congolese living in towns and 29 percent who live in rural areas have the opportunity to obtain drinking water (HIV in Humanitarian Situations, 2011). Without basic necessities, such as water and food, treating HIV/AIDS is difficult and not as effective. However, currently, there is not enough money from the government and other sources to address this problem.
In general, health care needs more attention from the government. According to Ms. Kembe, mismanagement and corruption led to the deprivation of the health care system. This was the case even before the civil war. Many hospitals lack water, electricity, roofs and windows. Also, the government does not financially support the health care workers (Kimani, 2007). As a result, the Congolese have to pay for health care services (Refugee council, 2004, p. 16). However, many people cannot afford health care or treatment. Since there is a lack of hospitals and health clinics, there is a desperate need for HIV/AIDS education and treatments. A major aspect of society that the government has impacted is employment. After the civil war, there were very few jobs available (Refugee Council, 2004, p.12). Currently, the unemployment rate is low, but the underemployment rate is very high. According to the Organization of Economic Cooperation and Development (2008), the unemployment rate was 8.9 percent and the underemployment rate was 81.7 percent in 2008 (p. 255). Most people rely on subsistence farming to survive. Also, more people move away from their families to work. This is due to poverty and the lack of sustainable lifestyles (Economic Commission for Africa, n.d., p. 10). A very common job in this country is mining. When these workers move away from their families for months or years, they often create new sexual relationships with women in a nearby town or become clients of the sex workers, who usually work by the miner’s single-sex housing (Epstein, 2007, p. 92). Therefore, there is an increased rate of HIV/AIDS infections. These workers can give HIV/AIDS to their new partners, and/or to their old partners upon returning back home.
Similar to other African countries, family is considered the core of the community in the DRC (Refugee Council, 2004, p. 6). Households are often large, since elderly family members are taken care of by the family for the remainder of their lives. Having a “good family” increases a person’s marriage potential. Financial security is a major factor in marriage. Divorce is not common, which is likely due to the strong religious beliefs of the people. Although homosexuality is legal, it is not discussed. It is considered a sin because of religion. Also, homosexuals are ostracized in the community, because it is thought that they bring disgrace upon the family.
Most families have on average four to six children in a household (Refugee Council, 2004, p. 7). All adults in the community act as ‘parents’ for the children. Children grow up learning to live by their traditional family values. These values include respecting elders, morally and materially providing for the family, and properly raising kids. Currently, the DRC is one of the three most dangerous nations in the world to be a child in (Office of the High Commissioner for Human Rights, 2003). This is mostly because violence against children has increased over the years, due to warfare. Children have often been forced to become child soldiers. Around 30,000 children have been used or recruited by armed forces from 1993 to 2003. In the Ituri region of the DRC, many children have been mutilated or barbarically killed. Child soldiers are often even sent to battle without arms. In addition, many female children were given to male children soldiers to rape. If the child soldier did not do as asked, he would be killed. Children were often taken by the armed forces to become sex slaves. Many civilian children are sexually abused or raped by soldiers, as well. Clearly, children have majorly been victims of the ongoing warfare in the DRC.
Since the people who have the highest risk of becoming infected with HIV/AIDS are 20–29 years among women and 30–39 years among men, many children are losing one or more parents to the disease. It was predicted that by the end of 2003, 320,000 kids less than 17 years of age have had at least one parent who has died from AIDS (HIV in Humanitarian Situations, 2011). This disease is clearly significantly affecting the children in this country. Studies have shown that AIDS orphans have a higher risk of becoming infected with HIV/AIDS (Epstein, 2007, p. 214). It is very likely that these orphans will be driven into precarious relationships due to the destitution, abuse, and desertion they face. Therefore, these orphans are practically stuck in a vicious circle; they play a huge role in the rampant HIV/AIDS pandemic.
Generally, men living in the DRC carry out typical masculine roles. They watch over and protect the family. Also, men give the family services and materials, including clothing, material goods, healthcare and transportation (Refugee Council, 2004, p. 7). Additionally, important decisions are made by the men in the family. Women are supposed to obey these decisions, even if they are unjust.
Women perform many duties for their families. They are expected to provide care for the family and keep the house in good condition (Refugee Council, 2004, p. 6). Women in rural areas have even more responsibility, because they are expected to provide food for the family and complete a majority of the work on the farm/garden. Although women have limited job options, some sell crops and crafts at nearby markets. On the other hand, quite a few women living in urban areas have jobs. They usually work in the service industry at eateries and markets near mine camp sites (Perks, n.d., p. 5). In addition, women aid in the processing and transporting of mining materials (Perks, n.d., p. 12). Women very rarely work as miners (International Trade Union Confederation, 2011, p. 20). In the mining field, men usually get paid 0.70 United States dollars. It is predicted that women get paid much less; however, there is no available record of women’s average pay in service or mining industry. It is estimated that 56.5 percent of women have jobs, whereas 85.6 percent of men do (United Nations Development Programme, 2011, p. 4). Also, education is available for females, but not many attend. While 36.2 percent of males have at least a secondary education, only 10.7 percent of females do. There are fewer females who have received secondary education in the DRC when compared to the overall rate in Sub-Saharan Africa where 22.2 percent of females and 34.9 percent of males have secondary education.
Unfortunately, gender inequality is very prevalent in the DRC. The community in which a woman resides determines how much freedom she will have (Refugee Council, 2004, p. 6). For instance, in rural areas wives need their husband’s consent to pursue an occupation, travel, and finalize transactions. A woman’s behavior is often restricted by social norms.
Since there is such a lack of gender equality, domestic violence is common in the DRC. Records or estimates of the domestic violence that occurs within the country are not available, partly because they are commonly not reported. However, a study performed in 2002 by the Reproductive Health for Refugees Consortium [RHRC] found that in one area 100 percent of women faced domestic violence even when they were pregnant (Immigration and Refugee Board of Canada, 2006). Half of those women experienced marital rape. Unfortunately, domestic violence is not dealt with by the law. In fact, people usually think that domestic violence is a private problem and that it is not appropriate for other people to interfere (Refugee Council, 2004, p. 6).
Currently, the eastern DRC is called the “rape capital of the world” (International Trade Union Confederation, 2011, p. 3). In the short time period between January and August 2007, the UN determined that there were 12,226 people who experienced sexual violence. It is very common for the military soldiers to rape civilians. In fact, during the civil war, soldiers and rebels belonging to various groups used sexual violence against civilian women as a weapon of war (Refugee council, 2004, p. 6). Still today, many women and children are raped, intentionally infected with HIV, kidnapped, and sold into the sex trade. In fact, according to the UN, from October 2002 to February 2003 about 5,000 women faced raped in South-Kivu province. Currently, seven armies are fighting in the DRC. It has been reported that 50 to 80 percent of these armies are infected with HIV (Omwami et. al, 2008, p. 44). These soldiers have also had exposure to several HIV viral strains, making the disease more difficult to treat. However, a study found that in the DRC, Burundi, Sierra Leone, Rwanda, Liberia, Sudan and Uganda, the HIV infection rate only increased 0.023 percent due to widespread rape (Anema et. al, 2008). This finding shows that there has not been a large increase of HIV infection due to rape over the general population, but women should still be concerned about their individual risk of becoming infected due to rape.
Due to gender inequality, many women resort to becoming sex workers to support their families and themselves. In many instances, sex has been essentially the only way women can obtain money and goods (Epstein, 2007, p. 101). A twenty-seven year old women living in the DRC stated, “‘As for me, I have become a sex worker because of the lack of support. If I get another job, I will stop having sex in order to survive. If I do it now, it is to feed my children’” (Olin et. al, 2006, p. 534). HIV/AIDS is very prevalent among sex workers and their clients. A study performed in 2001 showed that 27 percent of sex workers have HIV (HIV in Humanitarian Situations, 2011). Women working in this field have little input on condom use. Men make these decisions in the society (Refugee Council, 2004, p. 7). In many cases, men will pay higher prices for sex without a condom, which is a tempting offer for desperate women. In fact, in Kinshasa 26.5 percent of sex workers stated that they would have sex without a condom for a higher price (Ntumbanzondo et. al, 2006, p. 777). Similarly, cases of transactional sex are also common in this country. Transactional sex is a sexual relationship where women receive money or material goods from their partners (Epstein, 2007, p. 76). Unlike sex work, transactional sex involves strong emotions.
The above reasons make it easy to understand why women and girls are at an increased risk of becoming infected with HIV/AIDS. Out of the 400,000 adults over fifteen years of age who are infected with HIV/AIDS in the DRC, 240,000 are women (HIV in Humanitarian Situations, 2011). Women are much more vulnerable than men, particularly in rural areas. This is mostly due to their low economic status, lack of education, and the high rates of sexual and gender based violence. Clearly, HIV/AIDS can be labeled partly as a “disease of inequality” (Epstein, 2007, p. 102). Gender inequality plays a very large role in the spread of HIV/AIDS in the DRC.
Similar to other African countries, it has been determined that in the DRC the driving force of HIV/ADS is concurrent sexual relationships (HIV in Humanitarian Situations, 2011). Concurrent relationships occur when men and women have multiple partners over somewhat long periods of time. These relationships form a network, connecting many people together. For example, if one person in the network becomes infected with HIV/AIDS, the infection will quickly spread to infect that person’s three partners, and so on. This can be particularly devastating among small villages. HIV/AIDS can enter a village’s network even if only one person has migrated. Migration commonly occurs in the DRC due to the mining businesses.
Similar to other African countries, the prevalence of alcohol consumption is high. According to the World Health Organization (2011), in 2005, 46.7 percent of the Congolese at least occasionally drink alcohol. 32.2 percent of these drinkers are male heavy episodic drinkers. In addition, female heavy episodic drinkers make up 17.5 percent of drinkers. There have been no available studies performed on the effect of alcohol intake on sexual behaviors in the DRC. However, studies of Sub-Saharan Africa show that alcohol is related to sexual behaviors and increases the risk of HIV infection (Kalichman, 2007, p. 146). Heavier drinkers tend to have more concurrent sex partners and not use condoms. Both of these increase the risk of becoming infected with HIV. Alcohol also increases cases of sexual violence, which raises the risk of HIV infection (Kalichman, 2007, p. 147). The relationship between poverty and alcohol consumption has not yet been studied in the DRC. However, in Sub-Saharan Africa, alcohol is more prevalent among people with low economic standing. It is thought that the pressures of living in poverty are motivations to consume alcohol. It is assumed that the DRC is similar to the other Sub-Saharan African countries on this issue.
In the same way, drug use is related to sexual behavior. Since parts of Africa have only recently become an area of drug trafficking, there is not a lot of available information on the issue. Currently, injection drug use is becoming more common in South Africa; therefore, it may be an issue in the DRC in the future (Leggett, 2010, p. 240). Recently, there have been reports of cocaine located in the DRC from the French drug trade (United Nations Office on Drugs and Crime, 2010, p. 91).
HIV/AIDS has clearly affected Congolese society. Currently, it is estimated that of the 66,020,000 Congolese (United Nations, 2011), 1.3 to 6 percent are affected by HIV/AIDS (Refugee Council, 2004, p. 16). Unfortunately, most of these people are ostracized. Religious beliefs about sex and myths are big factors in this. Religion is a very important aspect in the societies in the DRC. Currently, 50 percent of the Congolese are Roman Catholic, 20 percent are Protestant, 10 percent are Kimbanguist, and 10 percent are Muslim (Refugee Council, 2004, p. 10). In addition, another 10 percent hold traditional beliefs. Religious groups are very active in society, as they offer various services, including education and healthcare. According to a majority of the above religions, engaging in sex before marriage is considered sinful. However, there are double standards which make it a social norm for unmarried men to have pre-marital sex. People often assume that those who are infected with HIV/AIDS became infected through sex. This is a huge reason why those living with HIV/AIDS are ostracized. Religion has also impacted the methods of HIV/AIDS prevention programs. Some church leaders are against condom use, because they think that it will encourage the sinful act of pre-marital sex. Therefore, contraception is seldom utilized, especially in rural areas (Refugee Council, 2004, p. 16). Many also believe that by promoting condoms, promiscuity will be encouraged (Epstein, 2007, p. 193).
In addition, myths are a huge reason why there is a stigma concerning HIV/AIDS in the DRC. For example, there is a belief that the HIV/AIDS disease is retribution for violating sexual wtaboos (Olin, 2006, p. 535). Others believe that HIV/AIDS is the result of humans having sex with dogs. According to the leader of a non-for-profit organization, many people do not think that HIV/AIDS is real (Olin, 2006, p. 536). Many also believe that demons and sorcery are common causes of HIV/AIDS. Some think the Caucasians took HIV/AIDS to the DRC in order to establish rule over the Congolese. Since these mythical causes of HIV/AIDS are mostly negative, such as sorcery and demons, many people ostracize those who are living with the disease.
Clearly, the HIV/AIDS epidemic in the DRC is a large, complex issue. The government is not able to financially assist in the HIV/AIDS crisis due to corruption and lack of spending money. Fortunately, the international community has been of some help. In 2008, the CNDP, led by Laurent Nkunda, was much more powerful than the Congolese army. Soon before the CNDP reached Goma, they proclaimed a unilateral cease-fire (US Department of State, Bureau of African Affairs). In response, the United States, UN, and European Union [EU] collaborated to create strategies for long-term peace and pursue loyalty to prior agreements. However, this process was slow-moving. Also, the UN peacekeeping mission in the Democratic Republic of Congo [MONUC] has been ridiculed as one of the international community’s least successful peacekeeping services (Tull, 2009, p. 215).
By 2003, there had not been direct bilateral aid given to the DRC’s government from the United States (The Democratic Republic of Congo, 2003). However, the USAID’s program provided a total of 102 million dollars. This money was utilized by international and regional non-for-profit organizations that put the aid towards a variety of relief and developmental endeavors. Although at the time the government of the United States did not financially provide for the prevention and treatment of the HIV/AIDS epidemic in the DRC, they did and still do support the intermediate government and encourage civil rights, democracy and concord in the country. In addition, ever since the crisis in the DRC began, the United States has engaged in a diplomatic strategy in order to support security and development in Africa. Currently, the United States seeks to encourage secure, progressing, and democratic countries. The United States hopes to eventually work with these countries to attend to stability interests in Africa, and acquire economic relations that are mutually favorable.
More recently, the EU is one of the most significant players in the country. They have helped with the security of the DRC. For example, in 2003 and 2006, the EU led two effective military undertakings. At the time, the UN was the only other external player in the country (Gregout, 2009, p. 237). Like many other international organizations and nations, in order for the EU to intervene in a crisis, the result needs to be advantageous for the EU (Gregout, 2009, p. 241). Before August 2009, the United States had only given a tenth of the assistance that the EU gave (Gregout, 2009, p. 239). In addition, when the EU conducted a military mission to the Ituri area in the DRC, the United States did not want to directly and militarily join in the affair. This shows that at the time the United States did not see an advantage in providing assistance to the DRC.
However, the government of the United States has recently become a financial supporter for the DRC. The United States President’s Emergency Plan for AIDS Relief [PEPFAR] provided 75.1 million dollars to the Democratic Republic of the Congo to support the fight against HIV/AIDS in 2007 through 2008 (United States President’s Emergency Plan for AIDS Relief, n.d.). PEPFAR’s support in the 2010 fiscal year made a large impact: 1,3000 people infected with HIV/AIDS received anti-retroviral treatment, 1,8000 orphans and vulnerable children received support, 247 HIV infections in infants were avoided, 126,700 HIV positive and pregnant women received services, and 243,700 people received counseling and HIV testing.
Later in August 2009, Secretary Clinton attended a press conference with Foreign Minister Alexis Thambwe of the DRC. At this event, Secretary Clinton stated “the [DRC], its government, and the people face many serious challenges, from the lack of investment and development to the problem of corruption and difficulties with governance to the horrible sexual and gender-based violence visited upon the women and children in the country” (Dagne, 2011, p. 13). Clinton then promised Thambwe that the United States would assist the DRC as they tackle those issues (Dagne, 2011, p. 13). The Obama Administration was very generous, as they requested to give 213.2 million dollars for the 2011 fiscal year and 230.8 million dollars for 2012 fiscal year (Dagne, 2009, p. 13). Although the above international financial aid is not directly given to fight against the HIV/AIDS pandemic, this support will make a difference in reducing gender inequality, providing schools and healthcare, and decreasing the military’s violence towards civilians. This progress should decrease the spread of HIV/AIDS and increase the prevention and treatment of the disease.
Additionally, in 2008, China contributed greatly to the DRC’s economy by signing a mining and construction agreement with their government (Dagne, 2011, p. 12). Organizations from the international community also provided financial assistance. In 2009, the DRC gained 12 billion dollars in debt relief from the International Monetary Fund (CIA, 2011). Also, the World Bank has given 6,044 billion dollars to the DRC since September 1963 (The World Bank, 2011). This money has been directed towards water, education, health and social services, transportation, and governance. Again, even though this money is not given directly to the HIV/AIDS cause, it will improve other factors, which will in turn improve the fight against HIV/AIDS.
However, it is always uncertain how governments and organizations will use this money. Since the government of the DRC is very corrupt, part of the financial aid given to the government has most likely been misspent. This situation has occurred in many African countries that are ruled by corrupt governments, such as Uganda and Kenya (Epstein, 2007, p. 207). Unfortunately, many people, especially government leaders, view the HIV/AIDS pandemic less as an awful plague and more as a chance for growth and career development (Epstein, 2007, p. 206). In order for the HIV/AIDS pandemic in the DRC to be rightly addressed by the international community, the government and organizations must be kept accountable. Perhaps, the governments and international organizations giving financial aid should create jobs that will focus on traveling to check up on the government of the DRC and the organizations. The government and organizations should be expected to send back reports and receipts, showing how the financial aid is being spent. Otherwise, the financial aid may be going to waste. The international community should ensure that the people who need the money receive it.
There are many specific ways in which the government should spend the financial aid to best prevent HIV/AIDS infections and to promote and provide treatment with anti-retrovirals. Education and awareness is a key part of reducing the rate of HIV/AIDS infections. However, there are many obstacles in the way. Recently, the US Department of State predicted that there is 65 percent literacy in the local DRC language (Refugee Council, 2004, p. 11). Since the literacy level is not very high, posters, newspapers, magazines, and books cannot be the only form of HIV/AIDS education and awareness. In addition, television and Internet use is scarce. However, in this country, radios are commonly listened to in order to receive public information (Refugee Council, 2004, p. 13). Radio broadcasts would be an effective mechanism for HIV/AIDS education and awareness if the broadcasts were performed in all of the languages in the country, which are French, Lingala, Kiswahili, Kikongo, and Tshiluba (US Department of State, Bureau of African Affairs, 2011). The education would have to include information on the following: how the disease is spread, how to prevent infection (such as abstinence, condoms, reducing partners, not sharing needles and so on), how alcohol and drug use may increase the risk of becoming infected, the importance of gender equality and community support, and how the disease knows no barriers.
At first, it may be difficult for the Congolese to respond and discuss the HIV/AIDS pandemic. It has been noted that Congolese living in the United Kingdom feel uncomfortable discussing sex, which may apply to the Congolese still living in the DRC (Refugee Council, 2004, p. 16). Sex is considered a taboo topic, mostly due to religion. However, if constant education and awareness about HIV/AIDS continues, the topic will hopefully become less taboo. Sports stars, celebrities, and community leaders, including religious leaders, should embrace discussing this topic on the radio, which would reduce the stigma associated with the disease. Then the public would feel much more comfortable about discussing the pandemic. If the community is not willing to discuss the HIV/AIDS epidemic, infection rates will be hard to reduce and the stigma associated with the disease will increase.
In order to prevent the spread of HIV/AIDS, organizations need to give out information on prevention, transmission of the disease, and the treatments available. These organizations need to be small and community-based. Most of the people working in the organizations need to be members of the community themselves. People are more likely to trust those who they can relate to. For example, if the organizations members were white Americans, the Congolese people may not trust the organization due to the rumor of Americans giving them the disease in the first place. If community leaders became involved in these organizations, the people would be more likely to trust the organization. As a result, people would trust the information supplied by the organization and those who are infected would be more willing to reach out for their help. It would be beneficial if these organizations develop small group meetings for those who are affected by the HIV/AIDS and for those who would like to know more about the disease. This would help develop social cohesion and allow people to find community support.
Additionally, peer education is also very important. These educators need to be relatable to the audience to be the most effective. Educators also need to be passionate about fighting against the disease, as they will need to be available during and outside of work hours because people may feel more comfortable approaching educators individually on their own time. Companies can make positions for peer educators, as the result will be mutually beneficial (Dickinson, 2009, p. 44). Other peer education programs have made an impact on reducing HIV infections. For example, a youth program in South Africa called DramAidE used peer education in a school-based drama, and as a result, found increased condom use (Harrison, 2010, p. 323).
Both condoms and abstinence need to be promoted as prevention methods for reducing HIV/AIDS infection. However, it must be stressed that condoms are not fully reliable; they do break and tear. In addition, female condoms should be as equally promoted as male condoms. A major complaint for male condoms throughout Africa is that they are too tight and uncomfortable. On the other hand, female condoms are loose, thus more likely to be comfortable for the male involved. People should be able to receive condoms from organizations or peer educators. Organizations should also be prepared to develop needle exchange programs, since intravenous drug use may eventually become more popular.
Religion is a huge aspect of Congolese societies and many religious leaders are against condom promotion. In order to address this issue, organization leaders, humanitarian workers, and international figures need to meet with the religious leaders in every community. They need to explain and convince the religious leaders that all people are sinners, and even if some people have sinned and have gotten the disease as a result, their lives are still worth saving. Jesus strongly informed the public of the importance of loving one another as neighbors. Shouldn’t Christians and Muslims follow His word? Religion plays a huge role in society; therefore, the religious leaders and groups need to come together and fight against the HIV/AIDS pandemic. Even if these religious leaders do not agree, condoms should still be used as a prevention method. After a few generations, religious leaders will most likely become more comfortable with the idea of condom promotion.
In order to decrease the HIV/AIDS infections purposely being spread by the Congolese military, the government should give the military specific civilian duties. These duties can be similar to the duties of the National Guard in the United States. For example, the military can dig wells, which would also increase the availability of clean water in the country. The military can additionally build homes, schools, and business/organization buildings. They could build housing for mining families, which would decrease the extra sexual relationships that mining workers often have otherwise. This would most definitely decrease the spread of HIV/AIDS. With this construction labor paid for by the government or international aid, mining companies would most likely agree to this option. The mining companies would still need to pay for the building materials, which is reasonable. By giving the military a sense of purpose, they would be less likely to create their own purpose (Omwami et. al, p. 43, 2008), which in the DRC involves attacking and raping certain racial and ethnic groups in the country. Overall, the Congolese military has the potential to improve many aspects of the DRC’s society, health, and well-being.
Gender equality needs to be promoted in order to decrease the spread of the HIV/AIDS pandemic in the DRC. Organizations and community leaders need to educate both men and women on the importance of gender equality and women’s roles in the family and society. Women should be given more job opportunities. Even in rural areas, women can be taught how to make crafts that they can sell. This would reduce the number of women who resort to sex work, which would decrease the spread of HIV/AIDS. In addition, women should be given the right to discuss sex with their partners or husbands. If a woman wants to wear a condom, she should be allowed to say so and refuse sex without a condom. This is especially important for sex workers. Also, if having children is a goal for the male partner or husband, they must understand that women have the right to protect their own bodies. Having children is an issue that concerns both male and female opinions and rights. Women should not be oppressed, but valued; without women, society would fall apart. Men need to see that they will benefit from giving women rights, so that they are more willing to respect women and not be violent towards them. Education needs to include the above values in order for HIV/AIDS prevention to be effective. In order for these changes to occur, women need to have female support groups, either in the community or in organizations. By standing together against inequality and sexual abuse, they can make a difference in other families and communities as well. These gender equality laws not only need to be written, but also enforced.
Also, health care services in the DRC need to be made affordable for those who need it. Health care facilities and equipment need to be replaced and improved. Additional training about HIV/AIDS should be given to health care professionals as well, to help them assist patients and help themselves cope. In order to make treatment available and affordable, the international community and the UN need to demand that the Western pharmaceutical companies sell drugs at a reasonable price that people in developing countries can afford. This is a human rights issue. If the companies refuse, then governments with financial aid should be allowed to set up companies to produce generic forms of these drugs. Without this process, treatments will not be affordable and available for the many poor people who desperately need them.
Additionally, basic necessities need to be provided to the Congolese in order for treatment to be effective. More water wells need to be dug and more education on farming provided. Without water and nutritional food, immune systems cannot function properly. With clean water, women can more safely formula feed their infants if they are infected with HIV/AIDS (Linkages Project, 2004, p. 9). Also, since breastfeeding uses a lot of energy, formula feeding may be beneficial to the mother. Therefore, formula, important instructions, and needed materials should be provided by health clinics and not-for-profit organizations. Overall, when people are less worried with survival due to the lack of water and food, they will be able to be concerned with HIV/AIDS infection. They will then be able to put their efforts into preventing themselves from acquiring the disease.
Since orphans greatly contribute to sustaining the HIV/AIDS epidemic by becoming stuck in a circle of poverty and risk behavior, proper care for orphans must be given. This could lead to great job opportunities for women and men across the country, which would decrease unemployment. These orphans need guidance to improve their futures and decreasing their risk of becoming infected with HIV/AIDS. Some of the financial aid for the cause of HIV/AIDS needs to go towards orphan care, so that orphans can have more access to food, water, and other basic necessities. Currently, Grannies a Gogo is a not-for-profit organization in South Africa that provides personal support and money to grandmothers that are caring for AIDS orphans (Grannies a Gogo, n.d.). Creating a similar not-for-profit organization or welfare program to financially support these grandmothers would significantly decrease the orphans’ risk of becoming infected with HIV/AIDS, due to the care and guidance they would receive from the grandmothers.
International aid is very important in fighting against the HIV/AIDS pandemic in the DRC. The government cannot afford to assist much. Not only organizations and governments, but individuals across the world can make a difference in fighting the HIV/AIDS epidemic in the DRC. Organizations like KIVA allow individuals to give a loan to another individual or group in the country (KIVA, n.d.). This loan can enable a Congolese to start businesses. For example, a loan would give women the opportunity to have a different profession than sex work, which would decrease the infection rates of HIV/AIDS. Although it is often forgotten, an individual can make a huge difference in the world. Many organizations offer individuals these opportunities. It is very important that individual people, as well as organizations and governments, seek to make a difference in the HIV/AIDS epidemic in the DRC.
In the end, there are many steps in several aspects that must be performed in order to effectively fight against the HIV/AIDS pandemic in the DRC. A key aspect in this fight is social cohesion, which can develop by having small groups meetings and by community leaders’ influence. Also, without financial support from organizations, the international community, and individuals, these steps cannot occur. However, if nothing is done, the HIV/AIDS pandemic will continue to spread rampantly in the DRC, which will be regrettable. Realistically, the HIV/AIDS rates of infection and mortality can decrease in the DRC with patience, hard work, and courage.
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