No money to finance AIDS survey, no treatment outside Monrovia

Health officials know that AIDS is a serious problem in Liberia, but the government has no money to conduct a proper HIV prevalence survey and specialist treatment for the disease is only available in the capital, Monrovia. Doctor James Duworko, the head of Liberia's National AIDS Control Programme (NACP) told IRIN that the government was providing life-enhancing antiretroviral (ARV) drugs free of charge to 369 people living with AIDS through three privately run hospitals in Monrovia. But elsewhere in the West African country, which is emerging painfully from 14 years of civil war, there is only one HIV testing centre, in the northern town of Gbarnga, and no specialist treatment is available. "There are people with the virus in rural Liberia, but the ARVs can not be administered to them there, because there are no qualified doctors up there and the technical equipment required to determine when an affected person should take the drugs is also not available," Duworko said. "There is only one VCT [voluntary counselling and testing centre] in rural Liberia which is in Phebe hospital in Gbarnga, Bong Country," the doctor added. "This worries the NACP, because many people living in other counties do not know their status," he went on. "All of the VTCs are in Monrovia." UNAIDS estimates the HIV prevalence rate in Liberia at 5.9 percent of the adult population. But that figure dates from 2003 when an upsurge in fighting at the end of the civil war made most of the country inaccessible. An earlier study from 2002, estimated a prevalence rate of 8.2 percent, but until a more reliable survey can be taken of people throughout the country, no-one will know for sure. Duworko said the NACP wanted to carry out a sentinel survey of pregnant women tested voluntarily at antenatal clinics, but so far it had no funds to do so. At present, two church-run hospitals in Monrovia, Saint Joseph's Catholic Hospital and ELWA Hospital, dispense ARV drugs, along with the Firestone Medical Centre near the city's international airport. This services the staff of Liberia's largest rubber plantation. "Those three hospitals have the trained doctors and the technical capacity to administer ARVs," Duworko said. But specialist AIDS treatment, indeed medical treatment of any sort, is very difficult to obtain in the interior, where nurses and doctors earning official government wages of less than US $20 per month are reluctant to be posted. Medecins Sans Frontieres (MSF) Belgium reported in January that there was a drastic shortage of trained medical staff outside Monrovia. "Healthcare, already scarce in the main cities, hardly exists at all in the remote areas of the country," it said in a report. "Today, there are only 30 Liberian physicians working in a country of more than three million people." The situation within Liberia is complicated still further by a mass return of refugees and internally displaced people to remote villages in the interior which is currently under way. An estimated 350,000 Liberians fled abroad during the civil war and a further 300,000 were internally displaced at the time it came to an end. Most ended up living in a string of camps around Monrovia.