Nouadhibou, a busy port in the desert north of Mauritania, is a crossroads for fishermen, mine workers and clandestine migrants heading towards Europe, but efforts to combat AIDS in this melting pot of humanity are still in their infancy.
The government's National Council to Fight AIDS (CNLS) only established a presence in this city of 100,000 people last year and Nouadhibou has yet to open its first AIDS testing centre.
Open discussion about AIDS within the town's socially conservative community is difficult. And social taboos against sex outside marriage in Mauritania's staunchly Islamic society mean that condoms are handed out furtively by groups of activists, rather than being sold openly in shops and pharmacies.
But Nouadhibou, situated on the border with Moroccan-ruled Western Sahara, is overflowing with uprooted people and single men and women seeking to improve their fortunes. Even many of those who are married are a long way from their husbands or wives at home and are easily tempted into prostitution or casual affairs.
Local officials reckon that 20 percent of the population consists of migrants from other West African countries, who have got stuck in Nouadhibou while waiting for a fishing boat to take them clandestinely to the Canary Islands or a truck to take them further north across the desert to northern Morocco, from where they could attempt the much shorter sea crossing to mainland Spain.
About 1 percent of the population of Nouadhibou is HIV positive, according to a sentinel survey of pregnant women tested in maternity clinics in 2001. That is low by African standards, but nearly twice the official prevalance figure of 0.57 percent for Mauritania as a whole.
Nonetheless awareness and prevention campaigns are still very limited in scope, according to local AIDS activists.
Local people living with AIDS must travel nearly 500 km south to the capital Nouakchott to obtain antiretroviral (ARV) therapy to improve their health and prolong their lives, they noted.
And the awareness of AIDS among fishermen, many of whom spend up to 45 days at sea on ocean-going trawlers between trips ashore remains extremely low.
Mauritania may be a huge and sparsely populated desert, but its coastal waters are rich in fish. Most of the nation's deep-sea fishing fleet is based in Nouadhibou, which is situated in a huge bay protected from northerly and westerly gales and from the huge waves that often roll in from the Atlantic Ocean.
But fishing activity comes to a government-imposed halt for two months of the year during the fish breeding season. That is when the fishermen come ashore for a long holiday and are most at risk of catching HIV.
“We are particularly worried by the upsurge of marriages during the two month-long closed season for fishing in September and October,” explained Abdoulaye Ba, who works for an AIDS control campaign in Nouadhibou run by two non-governmental organisations (NGOs); Adid and the Africa 70 Network.
“There is a boom in weddings during this period, but these tend to be unions between husbands and wives who don’t know each other very well and this obviously presents us with a high-risk situation,” Ba said.
Passing migrants settle down
Formerly known as Port-Etienne in its French colonial past, Nouadhibou is one of the busiest ports in northwest Africa.
The harbour not only hosts a large fishing fleet, it also exports iron ore, brought by train from the mines of Fderik and Zouerat, 600 km inland.
The fact that Nouadhibou is within a few days sailing by fishing boat from the Canary Islands attracts many Africans seeking to to make a fresh start in Europe by the back door.
However, the dreams of many of them have faded and they have settled down in Nouadhibou to take jobs in the local fish processing plants and other service industries.
Many of the migrants are from countries far to the south and are Christian. They constitute a community apart from the staunchly Muslim Mauritanians, many of whom are fair-skinned and more Arab than black in appearance.
“We have to reach these people and ensure that we do not stigmatise anyone by talking about AIDS,” explained Salamata Sow, the regional delegate of CNLS. “I was able to meet them thanks to the church priest during a mass. He is considered as a leader of public opinion among them and was able to introduce me to the leaders of their community”.
One health worker who prefered to remain anonymous said a recent study showed that the sex workers in Nouadhibou came from more than 10 different countries, including Senegal, Ghana and Morocco and were living in all areas of the town.
“Some came here to find work on the basis of the city’s reputation as an economic dynamo. Others just wait to get on a boat,” explained Djibril Diallo, an AIDS awareness trainer with the organisation SOS Pair Educateur.
There are no cinemas or nightclubs in Nouadhibou, so entertainment once the sun goes down becomes a private matter.
The town has a reputation within Mauritania for loose morals. Humanitarian workers say this is a compelling reason to take solid action against HIV/AIDS there to prevent it from becoming a much bigger problem in the country as a whole.
A rash of billboards on Nouadhibou's sandy streets warning people about the dangers of AIDS shows that an information campaign is already on.
Cooperation between the United Nation Population Fund (UNFPA) and the Lutherian World Federation led to an AIDS awareness campaign being conducted among 50 sex workers in Nouadhibou in 2003. The partnership also trained 30 local teachers and held meetings with 63 imams to discuss the dangers of AIDS and ways of controlling the disease.
Fishermen want information
But Sow, the local head of the government campaign against AIDS, said she recently realised that the awareness message was still not reaching the fishermen.
“During our last visit to the port in December, we were bombarded with questions and had to spend six hours answering them instead of the two we had planned,” Sow said.
“Some of them had never heard about AIDS,” she added.
Sow pointed out that there was also a need to inform fish sellers and other women working in the port about the pandemic.
Government officials play down suggestions that CNLS has tended to neglect Nouadhibou, despite the town's large number of population groups that are highly vulnerable to AIDS.
“We might have faced some difficulties when we started our project, but Nouadhibou is a priority because of its socio-economical importance, its cosmopolitan population and its particular geographical situation,” said SNLS executive secretary, Doctor Abdallah Ould Horma.
Sow took up her job as the head of CNLS activities in Nouadhibou in October 2004 and the town's first public AIDS testing centre is due to open in September.
“We must face the problem on a long-term basis,” explained Doctor Djahfar Cherfaoui, the chief medical officer of Société nationale industrielle et minière (SNIM), the state-run company which runs the local iron mining industry.
SNIM, which has 1,500 employees, is Nouadhibou's largest employer and a major contributor to Mauritania's export earnings. The company set up a committee to fight AIDS within its labour force in 2002 and has trained 12 percent as peer educators to inform their colleagues about the disease.
Free condoms are distributed at the pharmacy of the company hospital, but voluntary testing for AIDS among its employes is still rare. Most of the tests that are performed are simply carried out to confirm cases of AIDS that are already suspected.
Cherfaoui stressed that the SNIM's own efforts had to form part of a wider campaign against AIDS if they were to be successful.
“We will have wasted our time increasing awareness among our 1,500 workers if nothing is done about the other vulnerable population groups in the town, such as the fishermen," he said.
Sow of the CNLS made a special plea for female condoms to be made freely available, especially to Nouadhibou's large community of sex workers.
“We lack feminine condoms which have been requested by the prostitutes," She said. "They prefer to use them rather than male condoms."
Male condoms are available, but since it is difficult and embarrassing for most Mauritanians to buy them openly in chemist's shops, a more discreet and informal distritution network has been set up.
“Youngsters are ashamed. That’s why I started to supply them with the help of an NGO," said Moustapha, the young manager of an internet café in Nouadhibou. "It is easier for them to come to me.”
Many local AIDS activists are concerned about the imminent opening of a new tarred road linking Nouakchott to Nouadhibou. Its inauguration later this year will complete the final link in a new trans-Sahara highway, running down the West African coast from Tangiers in Morocco to Dakar in Senegal.
The new 470 km road will boost trade and economic activity, but also the number of travellers circulating between Mauritania, Morocco and Senegal.
Local NGOs and the CNLS are already preparing for the opening of this new transport corridor. They are looking to set up a series of new AIDS awareness campaigns targetted at truckers overland adventurers.