Roadmap against AIDS needs re-think due to war, poverty

The strategy against HIV/AIDS in Cote d'Ivoire needs to be re-thought because of the effects of the country's civil war and the poverty it brings, UNAIDS country coordinator Mamoudou Diallo told PlusNews. "I’m alarmed," Diallo said. "The war has disrupted efforts to open new centres, decentralise treatment and train personnel. Prevention campaigns have fallen off." Faced by what is widely believed to be the highest prevalence rate in West Africa, the government of Cote d'Ivoire has launched the first nationwide HIV survey carried out since 1989. Diallo said the survey of 5,060 sampled households currently taking place in both the government-held south and rebel-run north would help provide an accurate picture of the situation. It would also pinpoint the effects of war in a country which has seen a million people displaced since the conflict began in 2002, unsafe sexual behaviour on the rise and economic problems surging. The results of the survey are due to be published in June, he added. The HIV prevalence rate in Cote d'Ivoire had previously been estimated by the government and international organisations at 9-9.5 percent. But the latest 2004 figures from UNAIDS, which has revised its statistical data worldwide, estimates prevalence at only 7.0 percent. Diallo told PlusNews that whatever new figure emerges from the current HIV prevalence survey, the roadmap for fighting AIDS in Cote d'Ivoire will need to be redrawn. "The thinking is that we'll be spending international funding on antiretroviral (ARV) therapy for 63,000 people living with AIDS," he said. "First of all, this is an estimate, secondly it's theoretical, it's virtual," he said. "Just how do we get these people to sign up for treatment?" Because of its wealth, the world’s top cocoa producer and West African economic power-house had never spawned the grassroots organisations or local NGOs that now help wage the war against AIDS in other nations . "People used to live well, the economic level was too high," Diallo said. "Now we need to get everyone involved if we want to succeed. We have to get them into health centres, convince them that (ARV) tri-therapy can help people live a longer life." "We have to get people talking to people," he added. Before the eruption of civil war in Cote d'Ivoire over two years ago, international donors pledged US $150,000 to help develop local NGOs, training activists in drawing up and managing projects. "But when war broke out we had to drop development activities and use the funds to deal with emergencies instead," Diallo said, citing blood safety for transfusions as one example. He said it was absolutely necessary to launch mass information campaigns that would help persuade HIV-positive people to sign up for treatment. Simultaneously, testing centres should be set up at public health clinics to facilitate access, Diallo said. It was also vital to bring the problem of stigma to the attenton of laboratory staff and counsellors. "We need to ensure confidentiality as well as provide psychological and material support for people living with AIDS," the UNAIDS official said. "We must provide more than just treatment. We must be able to help people to overcome stigma." The goal of treating 63,000 people in Cote d'Ivoire was established as part of WHO's '3 by 5' initiative - three million people in the developing world on antiretroviral therapy (ART) by the end of 2005. There are no reliable statistics about the number of people currently receiving ARV treatment in Cote d'Ivoire. However 4,159 people were signed up in September for a government scheme under which they paid just 5,000 CFA francs (US$10) for a three month supply of ARV drugs. Diallo said most health facilities had been destroyed in the west of Cote d'Ivoire, on both the government and rebel sides of the frontline, while in the rebel-held north doctors and nurses had fled. Of the 18 state-run voluntary testing centres, only one is located in the rebel north, home to more than six million of the country's 16-million population. Since the fighting formally stopped in May 2003, French troops and UN peacekeepers have maintained 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 Laurent Gbagbo pushes through promised political reforms.