Activists warn against complacency over HIV/AIDS

West Africa’s HIV-AIDS pandemic has often been overshadowed by the higher infection rates in southern Africa. But the World Health Organisation's (WHO) latest global HIV-AIDS update warns strongly against complacency. WHO points out that while infection rates have remained broadly stable in Sahelian countries like Mali, The Gambia and Niger, which all with have prevalence rates of less than two per cent, the figures are markedly less optimistic in Cote d’Ivoire, where adult prevelance rates have been estimated at between 10 and 12 percent. For years the country has been identified as the HIV/AIDS centre of West Africa. While reliable data has been difficult to obtain since the outbreak of a civil war in September 2002, medical experts say there were already over one million people living with HIV/AIDS in Cote d’Ivoire by the year 2000. Cote d'Ivoire - war and stigma Rose Dossou heads the Chigata ("as long as there is life there is hope") organisation in Yopougon, the most densely-populated district of the Ivorian economic capital, Abidjan, which is home to several hundred thousand mainly lower income people. Chigata's main work is with children, both those left as orphans by the loss of parents to HIV/AIDS and those who have HIV/AIDS themselves. Dossou says there are at least 600,000 AIDS orphans in Cote d’Ivoire. She warns that discrimination remains one of the main problems, with families often reluctant to take children in once their parents have died. "It’s often difficult for these families to feed orphans and send them to school," Dossou told PlusNews on the sidelines of a major HIV/AIDS conference in Dakar. "Part of Chigata’s work is to go to see these families in their homes and find out just what kind of help can be given," she said. Dossu warned that children, particularly those with HIV/AIDS, would often be sent back to their home villages, even if there was no one to receive them. Chigata says it needs to follow up on what happens to these children, providing shelter and medical support where it can. One of Dossou’s main concerns at the moment is the impact of the 15-month-old civil war in Cote d’Ivoire. Despite the signing of a peace agreement in January, the country remains partitioned between the rebel-held north, where health services are only functioning at 30 percent of their normal capacity, and the government-held south. She complained that there is little treatment available for most HIV/AIDS patients outside Abidjan. "We need a much more decentralised system for the distribution of antiretroviral drugs," Dossou acknowledged. "The war has left many people unable to get access to treatment because of where they are living." There have been long-running public health campaigns in Cote d’Ivoire aimed at promoting safe sex. Dossou believes they have had had at least some impact, particularly in schools and colleges. "You still find adults often reluctant to use condoms, but the same does not go for adolescents, they see it as normal." Dossou also cites the work done by People Living with HIV/AIDS (PLWHAS) in publicising their status. "They have made themselves very visible, talking about their own case histories. That has encouraged people to understand that you can still live a normal life with HIV. The stigmatisation of people infected is still there, but it is diminishing." Senegal - lessons still to be learned Senegal is often regarded as the West African "success story" when it comes to HIV/AIDS. The government and health organisations ran major prevention campaigns in the 1980s, helping to head off a pandemic. Religious and secular leaders have been widely praised for their pragmatism and foresight, breaching taboos and speaking out on sexual issues. Sex workers have been tolerated but also subjected to mandatory testing. A strong network of civil society groups has emerged, particularly women’s organisations, focusing on HIV-related health issues. These are all factors often referred to when comparing Senegal’s relatively low rate of infection (1.4 percent) with those of other countries in the region. But AIDS campaigners warn against complacency, pointing to clear discrepancies between what is available in the capital, Dakar, and in the interior of the country. Earlier this year one of President Abdoulaye Wade’ senior advisers, Latif Gueye, was dismissed after being accused of involvement in the reselling of antiretroviral drugs back to Europe. Ndèye Dioumel Kebe works for the ENDA-Santé organisation, based in Dakar. Much of her work is with les clandestines, sex workers who operate in secret, are unregistered by the authorities and are exposed to both disease and violence. Dioumel Kebe warned that even among licensed sex workers, those who receive an identification card and go for regular testing, infection rates are at least 14 percent. She said that 80 percent of Senegalese sex workers operate clandestinely and many of them are married women. "Most of them will have done other work, as household maids, or working in shops. Then they get influenced by what they see around them and want to do this," she told PlusNews. "It may be mainly an urban thing, but you will also get young girls in villages ready to sell their sexuality. The main thing is that their families do not know. They can go out at certain hours and come back and look after the rest of the family. But their relatives must ask: where does she get the money for our food and her clothes?" Dioumel Kebe says the authorities are aware of this problem which is hardly new in Senegal, but are not addressing the realities on the ground. "A sex worker can only register at 18. What we see now is that sexual relations are beginning ever younger, at 14, for example," she said. Dioumel Kebe also complained that young sex workers face a lack of reliable information. "They will hear they won’t get a passport if they register, or that their sons won’t be allowed in the army," she said. ENDA tries to offer what support it can to such sex workers. Dioumel Kebe points to a regular pattern of police abuse, arbitrary round-ups and fines, some of which ENDA activists will pay in certain circumstances. "Persuasion always works better than coercion," is Dioumel Kebe’s philosophy.