Inefficient spending hampers HIV/AIDS programmes

Senegal, which now has one of Africa's lowest HIV prevalence rates, could see a rise in infection figures if existing international resources are not used more efficiently, a group of NGOs has found. "Senegal isn't safe from an explosion of the epidemic ... We need to quickly set up programmes targeted at orphans, prostitutes and vulnerable groups," said Daouda Diouf, of the Dakar-based NGO, Enda Tiers-Monde. Enda Tiers-Monde is part of a coalition of five NGOs that last week called for a review of the government's current policies. The group slammed the national AIDS campaign for failing to provide programmes for orphans and sex workers, as well as the absence of testing centres outside the capital. "Now that we have much more resources, we can question the relevance of national strategies to fight AIDS," he said. Senegal is receiving 36.5 billion CFA francs (US$ 74 million) to counter the disease, over a period that ends in 2006, from international donors, including the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. "The programmes are still at a first stage", Ibrahim Ndoye, executive secretary of the National AIDS Council of Senegal (CNLS), told PlusNews. "We made mistakes because we were trying to act quickly, but we're setting things right now." The 2003 sentinel survey of pregnant women showed that the epidemic had stabilised, with around 1.5 percent of the population estimated to be HIV-positive. According to the CNLS, HIV prevalence is not expected to rise over three percent in 2006. But the five NGOs - the National Association to Fight AIDS (ANCS), Enda Tiers-Monde, SIDA Service, Synergy for Childhood (Synergie pour l'enfance) and Africa Consultance International (ACI) - warned that unless the country's interventions were scaled up, this target could not be met. "An average prevalence rate of 1.5 percent is meaningless if the epidemic increases in the regions", said Baba Goumbala of ANCS. The 2003 sentinel survey, released in December 2004, showed that eight of Senegal's 12 regions had a two percent or higher infection rate. The southern Kolda region on the Guinea Bissau border was the worst, with 2.8 percent. Up to 2.6 percent of pregnant women in the market city of Tambacounda, on the road to Mali, were recorded to be living with the virus, compared to only 0.8 percent a year earlier. THE NEED FOR DECENTRALISATION Cross-border travel and trade were causing a further spread of the disease in the country, prompting Senegal to launch a programme to decentralise the country's HIV/AIDS campaign, the CNLS noted, but the five NGOs said decentralising HIV/AIDS programmes was ineffective and dangerous. Diouf of Enda Tiers-Monde complained that the decentralisation scheme had yielded very few regional programmes targeting orphans, sex workers, migrants and homosexuals. "Three billion CFA francs were spent in one year, but only three projects target sex workers," he said. Analysts believe that Senegal's success until now has been due to the government's early response to the epidemic, which saw the first testing centres being set up in 1985. However, the group of NGOs has raised concern about the current shortage of testing facilities. "We don't have sufficient funding to develop more testing centres, although the country has the means. Most Senegalese don't even know whether they're positive or not," said Paul Sagna, director of SIDA Service, which runs six testing centres. Around 20 voluntary counselling and testing centres exist countrywide, 10 of them in the capital. By the end of this year, at least two new centres will be opened in each of the 12 regions, said Ndoye of the CNLS. Senegal was still short of $US 28 million needed to care for vulnerable people, such as orphans, he commented. In 2003, 18,600 children lost one or both parents due to AIDS. In 2010, there will be 40,000 orphans under 15 years of age. Nevertheless, the country will be able to provide antiretroviral (ARVs) drugs to 7,000 of its citizens until 2006. Since the national initiative for ARV access (ISAARV) was created in 1998, 2,700 people have received treatment free of charge - a large number for a West African country. But Fatim Dia of ACI, was critical of the scheme: "ISAARV programmes and mother-child transmission prevention faced enormous difficulties last year, mostly due to shortages in stocks and delays in decentralising treatment," she said. "Lives are being lost because we can't take care of them," said Ngagne Mbaye, who heads the children's NGO, Synergie pour l'Enfance. "It's a funding management problem ... The difficulties we face will increase tenfold next year."