As the Democratic Republic of the Congo (DRC) confronts its 17th and fastest-growing Ebola outbreak, a troubling warning is emerging from community networks in Ituri province. These networks, which support people living with HIV, are reporting an unexpected number of deaths among people living with HIV. 

The Africa Centre for Disease Control and Prevention (CDC) and UNAIDS are working with national authorities to verify these reports. But the message is already clear: while Ebola is claiming headlines, another health crisis could be unfolding in its shadow.

This is a lesson Africa has learned before. Epidemics do not only kill through infection. They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care.

Falling clinic attendance

For people living with HIV, continuity of treatment is not optional. Antiretroviral therapy must be taken consistently to keep people healthy and prevent drug resistance. When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases.

That is why the current Ebola outbreak demands a broader response than Ebola control alone.

The warning signs are already visible in Ituri. Clinic attendance is falling. Laboratory and health system capacity is being redirected toward Ebola. Insecurity is limiting outreach efforts. At the same time, previous cuts to health, HIV and community programmes have reduced response capacity when it is needed most.

This matters because HIV remains a significant public health issue in the province. According to the DRC’s latest Demographic and Health Survey, an estimated 1.9% of the population in Ituri is living with HIV, representing thousands of people who depend on uninterrupted access to treatment, care and support. 

HIV cannot be treated as a secondary concern during an Ebola emergency. For those affected, it is a matter of life and death.

The good news is that solutions already exist.

Community-led organizations

Across Ituri, community-led organizations are helping to prevent a wider health crisis. Supported by repurposed funding from UNAIDS and working alongside local authorities,  a national network of people living with HIV (UCOP+), and a national civil society consortium (ANORS) are tracing people who have stopped attending clinics, connecting them to care, and ensuring access to multi-month treatment supplies.

 In Bunia and other heavily affected health zones, they are also combating misinformation, reducing stigma and referring people with warning signs of Ebola to treatment centers for testing.

These efforts demonstrate a key lesson from Africa’s public health experience: communities are not simply beneficiaries of health programmes. They are essential to the response.

People living with HIV and their organizations have spent decades building trust, reaching vulnerable populations and supporting treatment adherence. During emergencies, that trust becomes a critical public health asset. 

Community networks can identify people who have dropped out of care, deliver accurate information, support referrals and help maintain essential services when health systems are under strain.

Yet these networks remain underfunded, only reaching only a fraction of those who need them.

The DRC government’s decision to provide free healthcare during the Ebola response was an important step. The challenge now is ensuring that this commitment translates into reliable access across affected communities. 

Free healthcare must include uninterrupted HIV prevention, treatment and care. Policies alone will not save lives if medicines do not reach patients and community responders lack the resources to do their work.

The experience of Esther Nyamungu, a community worker in Bunia, illustrates what is possible. Living with HIV herself, she contracted Ebola and survived. She attributes her survival to seeking treatment early and remaining adherent to her HIV medication. Her story should not be the exception. It should be the norm.

Too often, disease programmes are treated as separate silos. But patients do not experience health challenges one disease at a time. Someone with HIV who contracts Ebola requires integrated care.

Clear nationally agreed clinical pathways, including early HIV assessment and testing during Ebola treatment, can help prevent avoidable deaths and improve outcomes for both conditions.

The DRC’s shift toward a village-centred and community-led Ebola response offers a valuable opportunity. Existing networks of people living with HIV can strengthen disease surveillance, support treatment continuity and help deliver accurate information to communities. But if we expect them to play these roles, we must provide adequate training, protection, and financing.

Maintaining essential health services

The country’s revised multisectoral Ebola response plan provides a platform for action and a direct call for partner support. We know what works. Multi-month dispensing of HIV medicines, community-led service delivery and strong referral systems prove effective in maintaining care during crises. The real challenge is implementing these approaches at scale and funding them adequately.

This is ultimately a question of priorities. Saving lives from Ebola and maintaining essential health services are not competing goals. They are part of the same mission.

If we focus solely on Ebola, we risk losing lives to preventable interruptions in HIV treatment and other essential services. If we protect both, we can emerge from this crisis with stronger, more resilient health systems and healthier communities.

The DRC has the expertise, the leadership and the community networks needed to achieve both objectives. What is required now is the political will and financial commitment to ensure that no one is left behind.

When Ebola strikes, HIV care cannot stop. Lives depend on it.

Dr Jean Kaseya is the Director-General of the Africa Centres for Disease Control and Prevention.

Winnie Byanyima is the Executive Director of The Joint United Nations Programme on HIV and AIDS (UNAIDS).

Dr Samuel Roger Kamba is the Minister of Public Health in the Democratic Republic of Congo.

 

 

Image Credits: Alexis Huguet/MSF, Benekire/ UNICEF, DRC Health Ministry, Africa CDC, UNAIDS.