In the DR Congo, where the national HIV prevalence is around 5%, testing and treatment services are more available in urban than rural areas, despite the latter being more affected by the epidemic. In Bunia and Aru, North eastern DRC, people living with HIV and AIDS (PLWHA) cannot access testing or treatment services unless they travel to Bunia town, some distance away. Discrimination from community members towards PLWHA is further identified as a reason for people not coming for HIV testing, and for discouraging other prevention activities.

The Pan African Institute of Community Health (IPASC) used a participatory reflection and action (PRA) approach with the concerned rural communities to examine and act on negative perceptions within the community around HIV testing and treatment, to support improved demand for and uptake of these services, to make more effective use of available resources and services. The work was implemented within a participatory action research network in EQUINET co-ordinated by Training and Research Support Centre (TARSC) and Ifakara Health Institute.

The process targeted male and female PLWHA aged 20-49 years, male and female adolescents 15-19 years, community and church leaders and community health workers because of their vulnerability and influence on attitudes towards HIV and AIDS. Community level barriers (largely stigma) interfaced with service level constraints to diminish testing and treatment coverage. Both users and providers faced barriers. These related to resources (drugs, transport), while the lack of accessible services was a fundamental deterrent. Leaving treatment to late stages when people are ill made this worse, as people found it difficult to make the long journey at that stage.

While service factors were not been dealt with in the short time of the intervention, there were improvements in social dialogue on treatment and mechanisms introduced to deal with the community level barriers to testing and treatment. Communities are able to make significant changes in barriers to testing and treatment if organised to do so using participatory processes. Community based sensitisers are an important resource in the community and can produce a measurable change in the attitudes that discourage early testing and treatment.

* Cite as: Baba A, Ulola M, Assea M, Ngule D, Azanda N, (2009) ‘Acceptibility and accessibility of HIV testing and treatment services in Bembeyi, Bunia, North eastern DR Congo,’ EQUINET PRA Report 12. Institut Panafricain de Santé Communautaire (IPASC), EQUINET: Harare. April 2009