Health workers report increased willingness to take HIV tests

More people in the landlocked desert state of Niger are volunteering to undergo testing for HIV/AIDS as acceptance and understanding of the disease improves, according to health workers in the capital, Niamey. "The image of AIDS has changed. People no longer associate it with death, weight loss, incurability," Doctor Kadidiatu Gouro, the director of the Anonymous and Voluntary Testing Centre (CEDAV) in Niamey told IRIN. CEDAV is the only specialist testing centre in this poor West African country of 11 million people. Gouro and her colleagues from the local non-governmental organisation Living Better With AIDS, have been running the testing centre since it was set up in January 2002. They have received support from Lutheran World Relief in the United States and from the governments of France and Niger. CEDAV set an initial target of testing 3,000 people for HIV/AIDS each year. It is on track to reach this for the first time in 2004. "We knew it was an optimistic target in a country where voluntary testing had not been implemented before and where people were reluctant to go for screening," Gouro said. But she added that the response so far had been encouraging. "The number of screening tests has steadily risen. Last year, 2,500 people underwent HIV testing. In the year to date, nearly 1,500 tests have already been carried out. With seven more months to go, last year's figure could easily be passed in 2004," Gouro told IRIN. She stressed that greater awareness about the disease was helping more people to recognise that they should take a test. "People undergo HIV testing for various reasons - because their spouse has died of AIDS, because they have had risky relationships or because they are developing infections or symptoms typical of someone with HIV," Gouro said. Most accept the outcome of the test quietly and philosophically. "Contrary to what one would think, most of the time, people simply accept that they are HIV positive. They rarely deny this fact or even cry," Gouro said. She described the reaction of one recent patient, a girl who learned she was HIV positive. She didn't break down. She just wanted to know how best she could manage her illness. "At first, the young girl kept silent," Gouro said. "But then she looked at me and smiled. ‘So, what should I do now ?’, she asked me. She showed a great deal of courage and resignation." CEDAV has 16 counsellors - including doctors, psychologists, social workers, nurses and people living with AIDS. They work in shifts to provide support for people coming for HIV testing. Gouro also recalled the case of a 30-year old woman whom she called Hadiza. Her husband had died from AIDS three months earlier. Gouro had to break the news that Hadiza too was HIV positive: "She accepted it as God’s decision. She said it was a disease caught within her conjugal life, she did not get it through prostitution or anything else, so she accepted it," Gouro explained. Upon arrival at CEDAV, candidates coming for an HIV test fill in anonymous screening forms marked only with only an identification number and the name of the adviser that will look after their case. That adviser then explains the screening process, giving the patient all the information he or she might need on HIV in a bid to strengthen their resolve to take the test, whatever the outcome. When CEDAV first opened, the screening process took a week. However, during the past six months, a rapid testing system has been introduced where patients receive their results within 15 minutes. If the result is positive, the test is followed up with another more thorough test to confirm the result. The patient is then given counselling. This involves giving advice on various issues, including the use of condoms and the monitoring of the opportunistic diseases that may arise as a result of being HIV positive. Those who so wish are referred to the Support and Information Counselling Cell (CESIC) of Niamey General Hospital, where they can receive further specialist medical treatment and psychological support. Opportunistic infections there are tracked and treated free of charge, subject to the availability of the necessary drugs. However, the hospital does not offer anti-retroviral therapy, given the high cost. Patients seeking anti-retroviral drugs must pay the full commercial price for them from their own pocket. A national survey conducted in 2002 concluded that Niger had an HIV prevalence rate of 0.87 percent - lower than most countries in the region. It indicated that about 80,000 people in Niger were living with HIV or full-blown AIDS. As in most African countries, the survey noted a particularly high incidence of HIV infection among truck drivers, commercial sex workers, prison inmates and migrant workers returning from countries with higher prevalence rates. At CEDAV, only six to seven percent of those undergoing a screening test prove to be HIV positive. Gouro puts this relatively low rate down to the fact that her patients are often simply taking a precaution because they are aware that they have exposed themselves to possible infection. "I had had an unprotected sexual relationship during a working visit to a neighbouring country and afterwards I was worried," said Issa, a civil servant, as he emerged from an HIV test at the centre. "As soon as I had an ordinary headache or diarrhoea, I thought about that sexual encounter I and wondered whether I had caught AIDS," he told IRIN. "But thank God, it was a false alarm!"