HIV affects around 110,000 of the Central African Republic’s 5.4 million people.

Bangui, Central African Republic:

Annie struggles to draw breath after speaking and her spindly legs barely support her, but the Central African HIV sufferer continues to defy the debilitating illness.

“I have six children — who is going to take care of them if I die? I must live!” the 37-year-old says, touching her neck which is bloated by swollen lymph nodes.

Annie has received treatment for three days in the only community hospital dedicated to caring for patients at an advanced stage of AIDS in Bangui, the capital of the Central African Republic.

The facility offers hope to those suffering from the incurable illness in the country, which has been racked by near-continuous civil war since 2013.

HIV affects around 110,000 of the Central African Republic’s 5.4 million people, but a lack of testing means many sufferers are not counted.

According to the World Bank, almost 70 percent of the landlocked nation’s population lives below the poverty line.

That makes the cost of a test — typically between 2,000 and 3,000 CFA francs ($3.5-$5) — prohibitive.

“In Bangui alone, the prevalence of the epidemic is two times higher than the national average,” doctor Jennifer Stella says.

She adds that many people remain unaware of their HIV infection, with two-thirds of HIV-positive people already at an advanced stage of the illness when they begin treatment.

“My husband died of HIV, that’s how I knew I was HIV-positive,” Annie recalls.

Sanctuary from stigma

Supported by the charity Doctors Without Borders (MSF), Bangui’s community hospital has 68 beds and a further 15 for intensive care.

Stella manages teams within MSF’s “advanced AIDS” project, which offers emergency care to patients before referring them to health centres where they can receive treatment for life.

In an annex to the internal medicine service, two men wearing yellow rain boots sprinkle chlorinated water as a nauseous odour emanates from blocked pipes. 

Six HIV-positive patients watch them silently. Unknowingly affected by HIV for years, their immune systems are now severely weakened and struggle to fight off infections.

The thin body of a young woman disappears under a white sheet. She no longer has the strength to turn towards her carers.

“Many of our patients arrive in a coma,” doctor Stella says.

“Our death rate is between 10 and 15 percent. Some adults weigh 30 kilogrammes (66 pounds) on arrival and around 70 percent have tuberculosis,” she adds.

Most patients in the hospital have HIV, with large boxes of medicine sitting at the end of their beds distinguishing them from other patients.

They are placed in rooms with others “without it being a problem,” says Stella.

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