Civil war hinders planned expansion of AIDS treatment

Cote d’Ivoire will fail to reach its target of extending anti-retroviral (ARV) therapy to 63,000 people living with AIDS by the end of 2005, since hospitals and health centres have been destroyed by fighting in the west of the country and medical staff have fled the rebel-held north, UNAIDS country adviser Mamoudou Diallo said. "There are so many things to do in this country that the time allowed seems too short to meet the target. We won’t make it," he told IRIN on the sidelines of a UNAIDS meeting in Dakar. Diallo said only 2,300 people living with AIDS benefited from life-enhancing ARV treatment in Cote d'Ivoire at present, even though donor financing existed to provide the drugs at a subsidised price to many more. He said the authorities currently knew of 12,000 people in the country who were in urgent need of the drugs, which improve the health of people living with AIDS and can extend their life. The goal of treating 63,000 people in Cote d'Ivoire was established as part of UNAIDS' "Three by five" initiative. This aims to increase the total number of people receiving ARV treatment in developing countries to three million by the end of 2005. However, Diallo said the disruption of medical services caused by two years of civil war has meant the Ivorian health authorities could no longer reach all those living with AIDS. The conflict had led to irresponsible sexual behaviour and drug abuse which was compounding the spread of the disease, he added. AIDS workers in Cote d'Ivoire told IRIN privately that the government of President Laurent Gbagbo was also making it difficult for them to establish treatment centres in the rebel-held north, where about a quarter of the country's 16 million population live. Diallo declined to comment publicly on these reports. He was speaking on the sidelines of a UNAIDS meeting which confirmed the organisation's decision to move its West African regional headquarters from Abidjan to Dakar in view of continuing instability in Cote d'Ivoire. Last June, the Ivorian government announced plans to slash the price of ARV treatment for thousands of people living with AIDS with the help of a US$14 million grant from the United States. Patients participating in the scheme are now only be required to pay 5,000 CFA francs (US$9) for a three month supply of ARV drugs. "There is no longer a big funding problem in Cote d’Ivoire : the issue is to find the people who are suffering from AIDS and to convince them that they need to be tested, but this is really difficult in such a context,» Diallo said. He said that most of the health facilities in the west of Cote d'Ivoire, on both the government and rebel sides of the frontline had been destroyed by heavy fighting in the area during the first seven months of the conflict. Since then several areas on the government side of the lines have continued to be plagued by outbursts of ethnic violence. Diallo said that although the situation was generally peaceful in the rebel-held north of the country, hospitals and health centres there lacked basic equipment and drugs and many of the doctors and nurses who once worked there had fled. He urged government medical staff to return to the north and west quickly. "The government system doesn’t work in the west, there’s no medical staff and the installations should be restored. We’re in urgent need of personnel to take care of people in these regions," Diallo said. Since the fighting formally stopped in May 2003, French troops and UN peacekeepers have maintain a neutral buffer between the rebel-held north and the government-held south, but the situation remains tense, with the rebels refusing to disarm until President Gbagbo pushes through promised political reforms. "There is violence, there is an increased likelihood of rape and the (sexual) behaviour of young people has changed because of the war. It has put them at greater risk," Diallo said. "People infected with AIDS and others affected by pandemic have been abandoned by those who were caring for them and they are waiting for help," he said. "But we cannot work without infrastructure and without medical workers to prescribe drugs and provide councelling and care." A UN humanitarian mission which toured the north and west of Cote d'Ivoire in mid-August found that most of the inhabitants in the rebel-controlled zone lacked basic health, sanitation, water and education services. It confirmed drugs and equipment had been looted from hospitals and health centres and the system for monitoring the outbreak of epidemics has been paralysed. Cote d'Ivoire has the highest rate of HIV in West Africa, with the Health Ministry estimating that 9.5 percent of the country's population is HIV positive. But Diallo, who took part in the mission, said that in some parts of the north it found the percentage of people living with HIV/AIDS was double the national average. "The situation is very worrying in the north. Iit’s a big threat," he said. "The New Forces (rebel) commanders told us they struggled with drug and alcohol problems,» he said. «They are really concerned about the connection between substance abuse, particularly alcohol and hard drugs, and the associated risk of HIV infection.» According to Diallo, the prioirity was to increase the number of health centres throughout Cote d'Ivoire that were able to welcome HIV/AIDS patients, provide them ARV with therapy and stock the necessary drugs. "As soon as we will have those centers, we’ll be able to determine how many people are in need of care and we’ll provide them with testing, counselling and ARV therapy," he said. For the time being, only nine clinics in the government-held south of Cote d'Ivoire offer specialised HIV/AIDS treatment and are able to prescribe subsidised ARV drugs. Those in the official capital Yamoussoukro and the western town of Daloa are close to the frontline, but there are no so far in the rebel-held north. In Abidjan, the economic hub where about 500,000 internally displaced people have sought refuge, most of the patients at the HIV/AIDS treatment centres are women and children from up-country and strong demand creates frequent shortages of medcines and AIDS testing materials. "In one week, they use often use up their supply of the chemical mixed with blood in AIDS tests that is supposed to last the entire month," Diallo said. He expressed fears about a big increase in prostitution amongst displaced people in the city, who are mostly poor and jobless. He also noted the danger of AIDS spreading more rapidly in neighbouring Burkina Faso, Mali, Guinea and Ghana as a result of more than 500,000 migrants from these countries going home because they now feel persecuted and threatened by the Ivorian government.