The word for HIV-AIDS in Hausa, the language most widely spoken in Niger, means "Welcome to the grave".
This landlocked West African nation is one of the poorest countries in the world, but international donors have made available ample funds to tackle AIDS.
However activists say that the stigma surrounding AIDS and the lack of a clear government policy on extending treatment to the interior mean there are few takers for the testing, counselling and treatment services recently made available.
"We have funds, testing is possible, antiretroviral drugs (ARVs) are available, but people simply don't turn up at the treatment centres," said Abdoulaye Bagnou, a doctor who works as HIV/AIDS advisor to the prime minister's office.
All admit that the social stigma attached to AIDS in this staunchly Muslim and socially conservative country is a major obstacle.
But AIDS activists also blame the government for failing to implement a proper nationwide treatment strategy.
"There is no testing network, no strategy, no nationwide structure," said one humanitarian worker. "Before decentralising treatment you need to locate the patients. If people are not being treated it's because we don't know who or where they are."
The government hopes to put 4,000 people on free life-prolonging ARV treatment, but since it began to supply ARV drugs free of charge in January this year, only 350 people have come forward to receive the medication.
They are grateful for the fact that effective treatment is finally available for the more than 100,000 people living with the HI virus in Niger.
"I used to have to go to Ouagadougou (capital of Burkina Faso, 527 km from Niamey) to buy ARVs," said Issoufou Aboubacar, one of 228 patients registered to receive ARV drugs at a Red Cross outpatient treatment centre for people living with AIDS in Niamey.
But most of the HIV positive people in Niger are still too scared to come forward to seek testing and treatment.
"People don't take tests because of the stigma which is linked to religion, rising fundamentalism and the social status of women," said the head of one non-governmental organisation who asked not to be identified.
Too ashamed to take a test
On the funding front, the picture is rosy.
The World Bank has pledged US $25 million to Niger for 2003-2008 as part of its multi-sectorial action plan to fight AIDS.
And the Global Fund against AIDS, Tuberculosis and Malaria agreed in August 2004 to provide $12 million over two years.
Government officials attribute the lack of enthusiasm for AIDS treatment largely to the fear of taking the test.
"AIDS is still a shameful sickness in Niger," Bagnou said.
Many people living with HIV/AIDS ignored the illness until it was too late, the government adviser said.
"Patients arrive (in hospitals) when they’re terminally ill and are not taken into account in the statistics," he noted.
Patchy testing and the reluctance of people living with AIDS to seek hospital treatment have led to a lack of reliable statistics on the true level of HIV infection among Niger's 12 million people, most of whom are subsistence farmers and nomadic herdsmen.
A 2002 sentinel survey of people tested voluntarily for AIDS put the HIV prevalence rate at 0.87 percent
But in late 2003, UNAIDS estimated that 1.2 percent of Niger's population - 144,000 people - were living with the virus.
That figure will be updated by a new demographic and health survey to be launched later this year.
Semi-arid Niger, which is 80 percent Muslim, is ranked by the UN Human Development Index as the world's second poorest nation. Its women give birth to an average of eight babies in their lifetime - more than anywhere else.
According to Niger's 2002 sentinel survey, commercial sex workers had an average 25 percent infection rate. However, this soared to 50 percent in Dirkou, an oasis town in the desert north on the main trucking route to Libya. Soldiers registered 3.8 percent, truckers 1.7 percent and teachers 1.4.
Few trained doctors and grassroots groups
Until recently, Niger's facilities for treating AIDS were concentrated in the capital. The government only recently began to decentralise testing and treatment to other parts of this vast country, which is three-quarters desert.
Four of Niger's five ARV prescription centres are located in Niamey. The fifth in Galmi, 500 km to the east, near the border with Nigeria, only opened a few months ago.
Bagnou acknowledged that only 30 or so doctors were trained to prescribe ARV drugs and that almost all of them worked in Niamey.
A dearth of grassroots support groups able to back up anti-AIDS work is also holding up efforts to help people living with the virus.
Louis Pizzaro, the local head of the French AIDS organisation Solthis, noted that at Tillabery, a large town on the Niger river, 130 km northwest of Niamey, AIDS orphans had to be placed in the care of a local association working to stamp out juvenile delinquency because there was no local AIDS activist group to look after them.
However, the number of people coming forward for testing and treatment is rising slowly.
Moussa Ide who heads the Red Cross outpatient treatment centre in Niamey, said 2,000 people had come forward for testing so far this year and 14 percent of them had tested HIV positive.
Ide said the day centre was designed to treat 800 regular AIDS patients, but by the end of this year it was likely to have 1,000 on its books
"People are convinced that the care at centre is effective," he said. "The proof is when someone who weighed 80 kilos before falling ill, but weighed only 35 kilos the first time he came to the clinic, then regains his original weight."
Sani, who is on the ARV scheme run by the Red Cross centre, said he felt like a new man.
"People don't even realise I am ill," he said.
"In this country people are automatically accused of having AIDS if they start to lose weight, and then they just fade away and die an early death because of the stigma. ARVs are there to help us and hide our shame."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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