Stricken by ongoing political and social instability following an 11-year civil war that claimed over 300,000 lives, and severely restricted by inadequate medical services, Burundi is making remarkable progress in its efforts to provide comprehensive HIV/AIDS prevention and care.

In Burundi, the HIV prevalence is 3.6 percent among the adult population (15 years and above).Life expectancy has dropped to 40 years and some 200,000 children have been orphaned. A Global Fund grant worth up to US$ 4.9 million over the first two years was signed with Burundi on 10 April 2003 for the scale-up of prevention and care. The three pillars of the grant are the holistic care of people living with HIV/AIDS, prevention ofmother-tochild transmission of HIV and capacity- building for the delivery of health services. To date, US$ 4.9 million has been disbursed to the Principal Recipient, the Executive Secretariat of the National HIV/AIDS Council.

The Global Fund’s support has particularly enhanced the government’s efforts to provide comprehensive care, support and treatment for people living with HIV/AIDS. These efforts have taken a complementary approach — supplying not only antiretroviral therapy and drugs for opportunistic infections, but also providing psychosocial support to improve everyday wellbeing for patients and their families. Services are coordinated and delivered by a broad range of stakeholders, including hospitals, social workers, community health centers, local and international nongovernmental organizations, national reproductive health programs and government institutions, as well as private institutions.

Despite some initial delays, which postponed the start of most activities until the second year of the grant’s implementation, the program has begun to show concrete results. Over 1,900 people had been provided with antiretroviral therapy and psychosocial support by the end of 2004.Although this is only 58 percent of the program’s target for its first two years, it represents important progress when measured against the 2003 baseline of 600 people reached and provides a solid foundation for the next phase. This foundation, combined with decreasing drug prices and increasing funding from new donors, has resulted in the country adjusting its overall treatment targets upwards for the coming years.

By late 2004, results also began to emerge from the two other central components of this Global Fund grant. In programs for the prevention of mother-to-child transmission of HIV, antiretroviral prophylaxis was provided to 335 pregnant women living with HIV/AIDS and 220 newborns, representing 88 and 57 percent of the program’s targets respectively. Based on the National Action Plan for 2002–6, the work had initially involved upgrading a pilot site and extending services to two further sites, but has been extended to 11 sites ( Bujumbura and in-country). It also promoted Voluntary Counseling and Testing (VCT) in prenatal consultations, extending services to entire family units, not just to pregnant women.

Grant-funded, capacity-building efforts focused on integrating civil society into programs for health services delivery by building on the experiences, skills and contacts of nongovernmental and community-based organizations and networks of people living with HIV/AIDS. This has ensured that prevention and care interventions are appropriate and accessible to community members, including those who are most vulnerable and often marginalized. It has also formalized the unique role of civil society organizations as the interface between national strategies, medical professionals and people at the community level, improving both the quality and accessibility of prevention and care for communities.

Burundi’s successes with these grant-funded programs is indicative of the multisectoral collaboration — considered by some to be unprecedented in the country’s recent history — that has characterized its program management and enabled it to achieve results despite a background of national turmoil. As Principal Recipient, the Executive Secretariat of the National HIV/AIDS Council expanded its pool of sub-recipients from the originally budgeted six to eighteen, including several from civil society. Since the grant signing, several new donors have started to contribute to the country’s national HIV/AIDS strategy. The broadly representative Country Coordinating Mechanism is working with these donor partners and coordinating the efforts of development stakeholders under one cohesive national disease strategy.