One year on from the Global Gag Rule: The impact in Burundi

A nurse administering a HIV test

Burundi is landlocked between Democratic Republic of the Congo, Rwanda, and Tanzania. Of the estimated 10.72 million population, 67% live below the poverty line.

Association Burundaise pour le Bien-Etre Familial, (ABUBEF) set up in 1991, provides a range of essential services, with a strong focus on HIV. Around 84,000 people are living with HIV in Burundi, of whom 12,000 are children under 14. 

ABUBEF’s focus is on HIV prevention and management: from youth-friendly counselling to programmes to prevent mother-to-child transmission.  

The withdrawal of US funding due to the Global Gag Rule will drastically reduce and, in some instances, close ABUBEF’s vital healthcare services and programmes. It is estimated that loss of funding to ABUBEF through the global gag rule will deny 117,016 people access to safe, sexual and reproductive healthcare. ABUBEF currently supports around 2, 123 people with anti-retroviral treatment, who will be affected by the cuts.

Donavine Uwimana, Executive Director of ABUBEF, “The GGR affects our very existence, with a forecasted funding cut of 39% in 2017 as well as a major decline in the supply of almost all sexual and reproductive health and HIV commodities.”

Putting people first: providing health care despite funding and staff losses in Burundi

  • Esperence is a nurse and pharmacist at the ABUBEF clinic in Ngozi. Due to funding cuts the clinic can no longer afford to supply up to 50% of medicines, some of which are fundamental to patient treatments. “During the project there was always enough medicine for every customer. Good times are unfortunately over”, says Esperence.
    Esperence is a nurse and pharmacist at the ABUBEF clinic in Ngozi. Due to funding cuts the clinic can no longer afford to supply up to 50% of medicines, some of which are fundamental to patient treatments. “During the project there was always enough medicine for every customer. Good times are unfortunately over”, says Esperence.
  • 29 year old Dancil is a single mother to three children. Dancil sells goods at the market and is also a peer educator. "Since I know I am HIV positive and I have started the therapy I become myself again. I want to raise my children, see them grow up. My children come for check-ups regularly. I talk with people on every possible occasion about the services of ABUBEF. I am peer educator as well. I was travelling in the region and spoke about family planning and HIV tests".
    29 year old Dancil is a single mother to three children. Dancil sells goods at the market and is also a peer educator. "Since I know I am HIV positive and I have started the therapy I become myself again. I want to raise my children, see them grow up. My children come for check-ups regularly. I talk with people on every possible occasion about the services of ABUBEF. I am peer educator as well. I was travelling in the region and spoke about family planning and HIV tests".
  • Sada, 64, sells vegetables at the market. Following many illnesses and visits to the hospital it wasn't until she went to ABUBEF that Sada found she was HIV positive. After 3 years of treatment she feels like a new person. "I have regular checks for my immune system. Sometimes I also get food, but most of all I receive psychological support. I meet a lot of people, also HIV positive, I joined a focus group; I make new friends."
    Sada, 64, sells vegetables at the market. Following many illnesses and visits to the hospital it wasn't until she went to ABUBEF that Sada found she was HIV positive. After 3 years of treatment she feels like a new person. "I have regular checks for my immune system. Sometimes I also get food, but most of all I receive psychological support. I meet a lot of people, also HIV positive, I joined a focus group; I make new friends."
  • Justin, 41, sits for a blood test by lab specialist Maurice, 33, at ABUBEF's clinic in Ngozi. Due to budget cuts Maurice now works part time; he also works at the local public hospital. Lost funds also mean less reagents available for his equipment making some tests impossible to continue.
    Justin, 41, sits for a blood test by lab specialist Maurice, 33, at ABUBEF's clinic in Ngozi. Due to budget cuts Maurice now works part time; he also works at the local public hospital. Lost funds also mean less reagents available for his equipment making some tests impossible to continue.
  • Concilie, 51, has worked at ABUBEF for 19 years as a nurse. She sees up to 20 people every day. The clinic can no longer afford the 2 psychologists, 2 nurses and 1 doctor which were previously funded by USAID. Concilie says the focus groups will shut down as they do not have money to fund the clients' travel fees. "The mobile clinic is not working anymore. The mobile clinic was their only chance to stay with the therapy and get regular health check-ups."
    Concilie, 51, has worked at ABUBEF for 19 years as a nurse. She sees up to 20 people every day. The clinic can no longer afford the 2 psychologists, 2 nurses and 1 doctor which were previously funded by USAID. Concilie says the focus groups will shut down as they do not have money to fund the clients' travel fees. "The mobile clinic is not working anymore. The mobile clinic was their only chance to stay with the therapy and get regular health check-ups."
  • A mother and her baby greet a nurse as they leave at ABUBEF clinic in Ngozi.
    A mother and her baby greet a nurse as they leave at ABUBEF clinic in Ngozi.
  • Aisha, 37, sells palm oil, chickens, sometimes bananas in Bujumbura. She has four children. Aisha and her husband are HIV positive and come to the clinic together. "The clinic helps dealing with the illness. They inform and educate us. They teach and make us understand that we don’t have to die fast, that we can have happy and long life, that there is much more of us. Services at ABUBEF are fast, everybody is nice and friendly."
    Aisha, 37, sells palm oil, chickens, sometimes bananas in Bujumbura. She has four children. Aisha and her husband are HIV positive and come to the clinic together. "The clinic helps dealing with the illness. They inform and educate us. They teach and make us understand that we don’t have to die fast, that we can have happy and long life, that there is much more of us. Services at ABUBEF are fast, everybody is nice and friendly."
  • The waiting room at the ABUBEF clinic in Ngozi is always busy.
    The waiting room at the ABUBEF clinic in Ngozi is always busy.
  • A regular at the clinic, Sada, talks with Agathonique the Clinic Manager at ABUBEF.
    A regular at the clinic, Sada, talks with Agathonique the Clinic Manager at ABUBEF.
  • Pre-natal and HIV patients wait outside the busy ABUBEF clinic in Ngozi.
    Pre-natal and HIV patients wait outside the busy ABUBEF clinic in Ngozi.
  • ABUBEF's nurse, Evelyne, talks with Claudine. Due to funding cuts, the clinic can no longer afford a doctor. Evelyne explains how she had to operate to remove a tumour in a clients' breast. "People with HIV would come for a therapy, contraception and regular check-ups in one place but now the services are not integrated anymore, people will not have enough money to pay and they will stop coming," says Evelyne.
    ABUBEF's nurse, Evelyne, talks with Claudine. Due to funding cuts, the clinic can no longer afford a doctor. Evelyne explains how she had to operate to remove a tumour in a clients' breast. "People with HIV would come for a therapy, contraception and regular check-ups in one place but now the services are not integrated anymore, people will not have enough money to pay and they will stop coming," says Evelyne.
  • An estimated 80% of ABUBEFs' clients are poor, marginalized, socially excluded and/or under-served, including young people living with HIV, internally displaced persons, young mothers, sex workers, drug users and street children.
    An estimated 80% of ABUBEFs' clients are poor, marginalized, socially excluded and/or under-served, including young people living with HIV, internally displaced persons, young mothers, sex workers, drug users and street children.
  • Sitting at a table in the corner of a Kirundo bar laughing, a group of women meet to talk about their peer education work for ABUBEF, and daily life in the province. The women are sex workers and didn’t know each other before, but they have become good friends. During the project the clinic supported them with transport fees, textbooks, and workshops as well as free condoms.
    Sitting at a table in the corner of a Kirundo bar laughing, a group of women meet to talk about their peer education work for ABUBEF, and daily life in the province. The women are sex workers and didn’t know each other before, but they have become good friends. During the project the clinic supported them with transport fees, textbooks, and workshops as well as free condoms.
  • Daphrose, 30, is a sex worker in Kirundo. Sex workers often face discrimination in society. They say they feel welcome at the ABUBEF clinic, whose privacy policy and excellent health care is their lifeline.
    Daphrose, 30, is a sex worker in Kirundo. Sex workers often face discrimination in society. They say they feel welcome at the ABUBEF clinic, whose privacy policy and excellent health care is their lifeline.
  • 28 year old Perusi says that often their clients, despite previous agreement, don’t pay them, beat them, rape and run away.
    28 year old Perusi says that often their clients, despite previous agreement, don’t pay them, beat them, rape and run away.
  • Fitina, 32, is a sex worker in Kirundo. Sex work is illegal and the cannot turn to the police; their violators go unpunished.
    Fitina, 32, is a sex worker in Kirundo. Sex work is illegal and the cannot turn to the police; their violators go unpunished.
  • Jasmina, 30, is a peer educator and sex worker in Kirundo.
    Jasmina, 30, is a peer educator and sex worker in Kirundo.
  • Yvonne, 40, was diagnosed with HIV 22 years ago. "I was lost and lonely. Until I got to the ABUBEF clinic. I take my pill every day and I am a living example of having a good life even with a previous death sentence." For a long while Yvonne was the only person in Kirundo wearing an ABUBEF t-shirt and publicly speaking about HIV. She likes being a peer educator and she knows she is a great example.
    Yvonne, 40, was diagnosed with HIV 22 years ago. "I was lost and lonely. Until I got to the ABUBEF clinic. I take my pill every day and I am a living example of having a good life even with a previous death sentence." For a long while Yvonne was the only person in Kirundo wearing an ABUBEF t-shirt and publicly speaking about HIV. She likes being a peer educator and she knows she is a great example.
  • Suavis, 29, is a sex worker in Kirundo.
    Suavis, 29, is a sex worker in Kirundo.
  • Student members of the health club at Murama Civil Engineering High School in Kirundo. The health club began with ABUBEF's support two years ago. Peer educators receive training about disseminating information to their fellow students. In the last two years there has been a 60% reduction in the number of students leaving school.
    Student members of the health club at Murama Civil Engineering High School in Kirundo. The health club began with ABUBEF's support two years ago. Peer educators receive training about disseminating information to their fellow students. In the last two years there has been a 60% reduction in the number of students leaving school.
  • Headmaster, Mduwamahoro Marc, is one of the staff mentors at the health club at Murama Civil Engineering High School in Kirundo.
    Headmaster, Mduwamahoro Marc, is one of the staff mentors at the health club at Murama Civil Engineering High School in Kirundo.
  • Staff mentor, Rukanka Madeleine, is a maths and physics teacher at Murama Civil Engineering High School in Kirundo.
    Staff mentor, Rukanka Madeleine, is a maths and physics teacher at Murama Civil Engineering High School in Kirundo.
  • Gapipi Pastuer, 42, is a French teacher and mentor at Murama Civil Engineering High School in Kirundo.
    Gapipi Pastuer, 42, is a French teacher and mentor at Murama Civil Engineering High School in Kirundo.
  • The staff team believe they have a crucial role to play as mentors alongside students at Murama Civil Engineering High School in Kirundo.
    The staff team believe they have a crucial role to play as mentors alongside students at Murama Civil Engineering High School in Kirundo.
  • Reverien Nsengiyumva, 20, is a student and peer educator in the health club at Murama Civil Engineering High School in Kirundo. Together with Maria Diella Bintanimana,19, and Piece Mary Irakuze,17, they help their friends understand their bodies, emotions and advise them to visit the clinic whenever they need help.
    Reverien Nsengiyumva, 20, is a student and peer educator in the health club at Murama Civil Engineering High School in Kirundo. Together with Maria Diella Bintanimana,19, and Piece Mary Irakuze,17, they help their friends understand their bodies, emotions and advise them to visit the clinic whenever they need help.
  • Student mentors, Reverien Nsengiyumva, Maria Diella Bintanimana and Piece Mary Irakuze.
    Student mentors, Reverien Nsengiyumva, Maria Diella Bintanimana and Piece Mary Irakuze.
  • Students from across the school join in the health club sessions.
    Students from across the school join in the health club sessions.
  • A group of young girls in the health club session.
    A group of young girls in the health club session.
  • Before the health club, teenage pregnancy was a huge problem. Today, they have meetings and workshops and also invite church representatives, to talk about sex education.
    Before the health club, teenage pregnancy was a huge problem. Today, they have meetings and workshops and also invite church representatives, to talk about sex education.
  • Headmistress Chantal Keza and French teacher Jean Claude Ndayishimije at Municipal Lycee of Nyakabiga in Bujumbura are also mentors. Every Friday medical staff from ABUBEF Clinic of Bujumbura come to do volunteer HIV testing for the students. Peer educators also perform small drama acts and answer questions about contraception.
    Headmistress Chantal Keza and French teacher Jean Claude Ndayishimije at Municipal Lycee of Nyakabiga in Bujumbura are also mentors. Every Friday medical staff from ABUBEF Clinic of Bujumbura come to do volunteer HIV testing for the students. Peer educators also perform small drama acts and answer questions about contraception.
  • ABUBEF mobile clinic staff talk to students about volunteer HIV testing at Municipal Lycee of Nyakabiga school in Bujumbura.
    ABUBEF mobile clinic staff talk to students about volunteer HIV testing at Municipal Lycee of Nyakabiga school in Bujumbura.
  • ABUBEF's midwife, Desire Manirakiza, takes the names of students as they wait their turn for the HIV test at Municipal Lycee of Nyakabiga school in Bujumbura.
    ABUBEF's midwife, Desire Manirakiza, takes the names of students as they wait their turn for the HIV test at Municipal Lycee of Nyakabiga school in Bujumbura.
  • A young girl has the finger prick test by staff from the ABUBEF mobile clinic at Municipal Lycee of Nyakabiga school in Bujumbura.
    A young girl has the finger prick test by staff from the ABUBEF mobile clinic at Municipal Lycee of Nyakabiga school in Bujumbura.
  • Students are given a finger prick HIV test by staff from the ABUBEF mobile clinic at Municipal Lycee of Nyakabiga school in Bujumbura.
    Students are given a finger prick HIV test by staff from the ABUBEF mobile clinic at Municipal Lycee of Nyakabiga school in Bujumbura.
  • Students wait for their HIV test results outside the ABUBEF mobile clinic van at Municipal Lycee of Nyakabiga school in Bujumbura.
    Students wait for their HIV test results outside the ABUBEF mobile clinic van at Municipal Lycee of Nyakabiga school in Bujumbura.
  • Students wait for their HIV results. The school is proud to take part in the health club and HIV testing project which was introduced in the school only one semester ago, encouraging students to ask for information and seek support.
    Students wait for their HIV results. The school is proud to take part in the health club and HIV testing project which was introduced in the school only one semester ago, encouraging students to ask for information and seek support.
  • A peer educator talks to students during a health club session at the Municipal Lycee of Nyakabiga school in Bujumbura.
    A peer educator talks to students during a health club session at the Municipal Lycee of Nyakabiga school in Bujumbura.
  • Students listen during a health club session at the Municipal Lycee of Nyakabiga school in Bujumbura.
    Students listen during a health club session at the Municipal Lycee of Nyakabiga school in Bujumbura.
  • Midwife Desire Manirakiza checks Mshirimana Florence, 22, who is in labour with her first child at ABUBEF clinic in Bujumbura.
    Midwife Desire Manirakiza checks Mshirimana Florence, 22, who is in labour with her first child at ABUBEF clinic in Bujumbura.
  • Midwife Desire Manirakiza, takes a well-deserved break at the ABUBEF clinic in Bujumbura.
    Midwife Desire Manirakiza, takes a well-deserved break at the ABUBEF clinic in Bujumbura.
  • Claudine Nshimirimana, 21 with her second child at ABUBEF clinic in Bujumbura.
    Claudine Nshimirimana, 21 with her second child at ABUBEF clinic in Bujumbura.
  • Claudine, Piece with her friend, and Josiane Kayezu, wait for appointments at the ABUBEF clinic in Bujumbura.
    Claudine, Piece with her friend, and Josiane Kayezu, wait for appointments at the ABUBEF clinic in Bujumbura.
  • Midwife, Regine, does a post-natal check on Piece's newborn baby.
    Midwife, Regine, does a post-natal check on Piece's newborn baby.
  • Josiane, 34, finishes her check-up with midwife Regine at ABUBEF clinic in Bujumbura.
    Josiane, 34, finishes her check-up with midwife Regine at ABUBEF clinic in Bujumbura.
  • Lab technician Nahimana Godefroid at the ABUBEF clinic laboratory.
    Lab technician Nahimana Godefroid at the ABUBEF clinic laboratory.
  • Burundian musician, Lolilo Simba and his wife Loliane, 22, say it is "because of ABUBEF we have a baby, our wonderful son Salum. This clinic is important not just to us. It does a lot of good for all the community of Bujumbura.” Loliane had experienced three miscarriages before getting pregnant for a fourth time. "I want to share the story of the help we received here in ABUBEF. I am sure it is because of the perfect customer care and wonderful people that work here.”
    Burundian musician, Lolilo Simba and his wife Loliane, 22, say it is "because of ABUBEF we have a baby, our wonderful son Salum. This clinic is important not just to us. It does a lot of good for all the community of Bujumbura.” Loliane had experienced three miscarriages before getting pregnant for a fourth time. "I want to share the story of the help we received here in ABUBEF. I am sure it is because of the perfect customer care and wonderful people that work here.”

ABUBEF provides services to a range of clients including people living with HIV such as pregnant women, internally displaced persons and sex workers. The impact through funding losses affects service provision – including safe delivery for HIV-positive women, and a reduction in medical staff and drugs and commodities available.

IPPF is trying to find alternative funds to fill the gaps – a combination of long- and short-term measures to avoid closures and reductions in services.

Donavine explains how far-reaching the impact is for ABUBEF: “Almost all contraceptives, HIV reagents, STI drugs, antiretroviral and consumables for HIV management are procured through UNFPA, USAID and US-financed government programmes, which will be affected by the GGR,” she says.

IPPF visited several ABUBEF run projects at risk of closure across Burundi that included a centre in Kirundo for vulnerable women such as sex workers and survivors of gender-based violence.  And in Ngozi, an HIV clinic that provides mobile clinics, and a maternity ward with a focus on the prevention of mother-to-child transmission.