Between May and July 2013, Kenyan Jesuit Augostine Ekeno SJ visited South Kivu in eastern Congo to conduct research about sexual and gender-based violence (SGBV), on behalf of AJAN, the Jesuit Refugee Service (JRS) Eastern Africa and the Hekima Institute of Peace Studies and International Relations in Nairobi. The aim of the research is to inform advocacy for survivors of SGBV. Augostine shared some of his impressions with us.

Survivors of sexual and gender-based violence (SGBV) in eastern Congo who contract HIV are often rejected by their families and communities and forced to depend on NGO hand-outs to survive. This is one of the things I learned when I visited the volatile province of South Kivu in mid-2013 to conduct research about SGBV.

“World’s most dangerous place for women”

The Democratic Republic of Congo (DRC) has been described as the “world’s most dangerous place for women” and the “rape capital of the world”. The situation is especially bad in the Kivus, where rape, gang rape and sexual slavery are systematically used as weapons of war. Civilians, especially but not only women, are the hardest hit. The UN estimates that 200,000 women and girls have been attacked in the last 15 years. The alleged key perpetrators are foreign rebel groups like the Forces Démocratiques de Libération du Rwanda (FDLR) and the Lord’s Resistant Army (LRA, Uganda). Congolese militia groups, such as the Maï Maï, as well as the national army are also guilty of such crimes. Most affected are remote villages close to the armed groups’ hideouts. A widespread culture of impunity reigns.

HIV+ survivors of SGBV suffer stigma

Among the many worrying dimensions of rampant sexual violence is the spread of HIV. Those infected by HIV as a result of rape have multiple needs, ranging from medical to psychosocial to legal to economic support, which a host of humanitarian NGOs and other agencies in eastern DRC are attempting to meet in the face of the government’s failure to do so. Compounding the agony of HIV-positive survivors is severe social discrimination, first because they were raped and second because they contracted HIV. Some shared with me how they were rejected by loved ones and by their community, how the absence of critical medical services made them more vulnerable to stigma and discrimination. Such is the extent of the discrimination they suffered that many were forced to migrate from rural to urban areas, such as Bukavu, where they are cut off from relations and neighbours and thus from their support network and possible reliable sources of income.

It is not easy to tell how many women and men are affected because more work needs to be done to establish the number of people infected with HIV as a result of sexual assault. The absence of precise figures presents a challenge to a clear understanding of the problem and to related advocacy efforts.

The direct link between war, sexual violence and HIV

One thing emerged clearly in my interviews: the belief that the rising HIV prevalence rate in rural areas in South Kivu is directly linked to the conflict there, just as widespread reporting of SGBV surfaced with the onset of the war. Dr Dennis Mukwege, chief gynaecologist, founder and medical director of Panzi Hospital in Bukavu, said that before war erupted in 1996, the HIV infection rate in the province of Kivu was 1% and lower in rural than in urban areas – a claim consistent with government statistics. With the explosion of conflict and related sexual violence in rural areas, the rate of HIV shot up from 1% to approximately 6%.

Dr Mukwege and his medical colleagues also attributed the lower prevalence of HIV in urban areas to AIDS awareness campaigns and other preventive measures propagated by faith-based organisations, NGOs and other international agencies operating in the region.

The government failure and NGO efforts to help

The role played by non-governmental and other humanitarian agencies is indeed key. Failed government institutions ranging from hospitals, security organisations, infrastructural bodies and communication networks cripple the delivery of effective services to those in great need. This lack serves to aggravate the already precarious well-being of people living with HIV. Across DRC, and especially in the region, the state offers only minimal healthcare – this in a country where there are 1.2 million people living with HIV.

In such a scenario, HIV-positive survivors of SGBV are often denied the medical services, rehabilitation programs and counselling they need. Some people with HIV said not all health centres in rural and urban areas distribute anti-retroviral drugs (ARVs) while the authorities said people living in urban areas such as Bukavu do have access to ARVS. One thing people with HIV said again and again was that they faced huge challenges to find the money to eat well – a must for those on ARVs – and to buy medicines to treat opportunistic infections.

Most survivors of SGBV admitted to Panzi Hospital want to know their HIV and pregnancy status. Panzi Hospital successfully offers these services through the use of the HIV Post-Exposure Prophylaxis “PEP kit”. Those seeking medical assistance report symptoms like sleep deprivation, hallucinations, prolonged periods of crying and social isolation. However a good number are unwilling to seek help for their psychological problems. Panzi Hospital and other health centres offer counselling but most people from rural areas do not make use of it. Whatever the reason for this, psychosocial support remains critical, especially when someone is diagnosed with HIV.

Economic woes

Economic hardship is another burden that people living with HIV must bear. The fact that women don’t own property in most African contexts makes it tougher for those infected to cope when they are abandoned. Some survivors venture into the few job opportunities available, such as cheaply paid domestic work. But some jobs can be very taxing for a person living with HIV who lacks a good diet and the money to treat opportunistic infections. Circumstances force some to resort to high-risk behaviours like prostitution to survive. The government’s inability to support them means many people must depend on hand-outs from NGOs, including Church organisations, and other humanitarian agencies. Most manage to get by thanks to such support but this can lead to serious problems if and when the agencies close down or shift their operations, as they sometimes do.

The solace of support groups

Those I interviewed said social groups were a great source of solace, offering material aid and moral support. Often located within a parish or urban suburb, they give people a strong sense of belonging and safety, equivalent to what they enjoyed back in their villages. A woman I met in Nguba Catholic Parish, Bukavu, shared passionately and with a deep sense of gratitude how a family in the parish took care of her and her children for years. Another told me she had received help from a Small Christian Community to pay her children’s school fees.

Such help is indispensable for survivors of SGBV, including people with HIV, for whom Bukavu town has become a haven. Fleeing discrimination in their rural homes, they face daunting challenges to survive in urban areas. They need medical and psychosocial support to recover and help to access means of income-generation so that they may rebuild their lives.

For many years, the discussion on the conflict in eastern Congo has concentrated on the conflict between the Congolese army and rebels over control of this resource-rich region, and on the scourge of SGBV. While these are vitally important subjects, I suggest the need to bring on board another more salient impact of the war; the spread of HIV/AIDS, so that infected people in such a poor region will be seriously taken into consideration and if possible given priority.