HIV/AIDS time-bomb ticking away in rebel north

As the only girl in a family of five orphaned by HIV/AIDS, Awa Keita spends the day cooking and cleaning for her brothers and her own baby boy. Four months ago, life took a dour twist for the family marooned in the war-hit north of Cote d’Ivoire. Awa and her son both tested HIV-positive. But like millions of others, they cannot get medical help in territory under rebel control. As the war grinds on, causing more of the poverty that fuels the pandemic and wearing down the few surviving health facilities, an HIV/AIDS crisis looms ahead. "Every day I think about the sickness," 23-year-old Awa says in Senoufo, the language used across much of the dry northern scrublands. "I've cried so much. Often my head hurts and I feel hot." "It is God’s will," she adds, referring to the illness that people here never mention by name. "But I wish I could get treatment." Health services for the more than six million people living in the north all but collapsed after civil war split the country in two in September 2002. Once brisk and busy clinics are a shamble of smashed windows, tall grass, rust and decay. Equipment is creaky, medical supplies are low, government funds have dried up and worst of all, the doctors and nurses have vanished. Like other civil servants, most medical workers stationed in the north fled to the safety of the loyalist south that pays their wages when the conflict broke out. Among the casualties of war were just-opened HIV/AIDS testing and information centres designed to curb the expansion of the pandemic in West Africa's hardest hit nation. Bouake, Cote d’Ivoire’s proudly second biggest city at the time, boasted a freshly-painted AIDS treatment centre at the general hospital, manned by a staff of six offering testing, counselling and prevention. "Nowadays we don’t advise people to take a test," one doctor at the hospital told PlusNews. "What’s the point? We can’t offer them treatment. It’d only bring them despair." NO HIV/AIDS CARE AVAILABLE IN REBEL NORTH Awa’s HIV-positive two-year-old is often feverish and has diarrhoea, she says. A social worker helping the orphans says the boy’s face is puffy, that he looks increasingly unwell. “I get so upset dealing with all this,” said Veronique Dje. "When a child dies, it makes me cry." Awa's own mother died of AIDS two years ago. To survive, she and her son would have to travel 380 km south, across the frontline, to the capital Abidjan. There they would be able to obtain antiretroviral (ARV) drugs that might improve their health and extend their life. A local NGO, the SAS centre, helped steered the family of orphans into school and jobs after the death of their HIV-positive mother. Now it is ready to cough up the 35,000 CFA francs (US $70) needed for their trip to Abidjan. The sum is equivalent to about half the average monthly earnings of Cote d'Ivoire's 16 million people. But in this nation torn by strife between the peoples of the north and south, Awa can’t physically get to the capital to save her life. She has never applied for an identity card, so doesn’t have the ID needed to pass the dozens of roadblocks manned by soldiers and militia groups along the tarred highway that provides the main link between the rebel-held north and the government-held south. Awa thinks her older brother, who has joined the rebels, might just have put away somewhere a receipt for her birth certificate. And Dje, the social worker, says that if they find this document, it might be enough to enable the mother and child to travel safely south. SAS helps to send dozens of people living with HIV/AIDS in the rebel-held north to Abidjan every three months to see a doctor and pick up three months’ worth of ARVs. Every six months they also undergo a check-up. "We’re trying to see if we can send one person down to pick up the drugs for several people at once to cut the costs," Penda Toure, who heads SAS, told PlusNews. The NGO currently assists 800 families, or around 5,000 people affected by HIV/AIDS. It receives help from the UN World Food Programme (WFP), the UN Children’s Fund (UNICEF), CARE, the International Committee of the Red Cross (ICRC) and others. SAS is held up as an example of good practice by many experts because of its global approach to the fight against HIV/AIDS. The NGO ensures schooling for children, work for families and provides counselling as well as treatment and medical support. WAR AND SEX FUELS FEAR OF HIV/AIDS BOMBSHELL Cote d’Ivoire’s HIV prevalence rate is estimated at 7 percent, according to UNAIDS statistics for 2004. The government's own statistics point to a higher prevalence rate of 9.5 percent. But north of the UN-monitored buffer zone that cuts a swathe across the land, the pandemic is believed to have reached alarming proportions. "We risk seeing figures three times the national average here," Toure said, lamenting the international community's failure to deem the looming crisis "an emergency". "There have been no prevention or awareness campaigns since the war broke out, but there is a lot of sexual freedom. People have forgotten HIV/AIDS. The only talk is war, the only concern is to survive. Bringing a soldier home is like winning a trophy." Towns such as Bouake have lost huge sectors of their populations, civil servants, southerners, craftsmen. Instead, troops from the 4,000-strong French peacekeeping force and Bangladeshi or Moroccan soldiers serving with the 6,000-strong UN force haunt the streets and bars. They are joined there by groups of gun-toting rebels. Located on a key transport route linking the Ivorian coast to landlocked Burkina Faso to the north, Bouake boasted a higher-than-average percentage of HIV/AIDS even before the war. Adama Coulibaly, the only nurse left at the now dilapidated HIV/AIDS centre at the city hospital says "the situation's bad. There are more and more infections." Coulibaly was part of the large pre-war staff at the AIDS treatment centre, which serviced a population of 500,000 people. His left side was left paralysed by a stroke, so he hands out test strips and carries out other tasks with his one working hand and the helping hand of a cleaner. Pulling out a sheet of statistics from a desk decorated by a large penis wearing a condom and faded AIDS prevention posters, the nurse says 14 percent of the 195 people who asked for tests in the last half of 2004 turned out to be HIV positive - which is twice the national average. "All I can do is tell people how to avoid transmitting the virus, and refer them to a local NGO. There’s no treatment available here," he said. SEVEN OUT OF 10 VILLAGE CHILDREN POSITIVE The government of Cote d’Ivoire, which has set up a special Ministry to Fight AIDS, is currently undertaking the country’s first nationwide HIV prevalence survey for 15 years. Results of the survey of 5,060 households in both the north and south of the country - covering around 12,000 people - will be available in June, Mamoudou Diallo, the UNAIDS coordinator in Cote d'Ivoire told PlusNews. UN troops will help investigators carry out the survey in the rebel-run north. "I’m alarmed," Diallo said. "The war has disrupted efforts to open new centres, decentralise treatment and train personnel. Prevention campaigns have fallen off." With a million people internally displaced, health services disrupted, people too short of cash to pay for tests, treatment or condoms, and sex work on the rise, it was impossible to get a proper picture without a survey, he said. But in villages 250 kilometres north of Bouake, there was more evidence of an HIV bombshell on the horizon. On a dusty dirt road beyond the town of Korhogo, a handful of Spanish-speaking Catholic nuns running a clinic near the village of Koni reckon the situation is desperate. Alarmed by the dire condition of babies brought into the clinic for help, the sisters from Colombia and Spain decided last July to test 10 toddlers for the virus. "Seven of the 10 tested positive", said Sister Brigida of the Hermanitas de la Anunciacion. All seven of their mothers also proved to be positive, she added. Conditions are tough in the rural north nowadays. Farmers have not been paid for their cotton, their main cash crop, for three years, the rains have been bad, and there is little available cash. Rebels manning roadblocks at every village entrance and exit need food and drink and pester passers-by for cash. Skinny children with distended bellies play in the dust while older ones take turns to draw water at a single pump for a couple of thousand people. There is malnutrition and a lot of young mothers. "On the basis of the symptoms we're seeing, we think there's a huge increase in HIV/AIDS," said Sister Marleny. "But up here in the north there's nothing you can do about it. There are no drugs, there’s no cash. Even if you take the test there’s nothing you can do, except perhaps avoid infecting others."