Hazardous sex and no AIDS treatment in frontier trucking town

Truckers from all over West Africa converge daily on this bustling frontier town, where several hundred of prostitutes wait to greet to them in roadside bars and crowded brothels, where gaudy neon lights flash a welcome.

AIDS is rampant in this epicentre of the sex trade in Niger, where heavy trucks jostle for road space with camels, donkeys and motor-cycle taxis.

But the town's medical facilities are limited and efforts to control the disease here are still in their infancy.

A study of 114 local prostitutes conducted in 2003 showed that 60 percent of them were HIV-positive. But local doctors told IRIN there was no point in telling the sex workers of Birnin-Konni they had AIDS since there was little they could do to treat them.

"We don't encourage them to find out whether or not they are HIV positive, our approach is only based on a quarterly health check which allows us to detect syphilis and urinary infections, said Yahaya Issoufou, the head doctor at Birnin-Konni's government hospital.

"It is no good telling you that you have tested HIV-positive, because we can't help you if you have," Issoufou continued. "It is like telling you that you are in the terminal phase already. We would simply hasten the decline."

As a result, many sex workers in this cross-roads town on the Nigerian border have stopped going to the local hospital for treatment and the number of people asking for AIDS tests there has plummeted.

At "Le Campement" one of a dozen busy brothels in Birnin-Konni, Imostate, a 24-year-old prostitute on the run from the imposition of Islamic Shari'ah law in her home state in northern Nigeria, explained why.

They don't tell us what is wrong with us"

"When we go to the hospital, they don't tell us what is wrong with us, they just give us a list of medicines to buy," she told IRIN, as she sat in the shade of a tree, waiting for the night shift to begin.

"Why don't they tell us what our illness really is?" piped up her friend Soyaba, a pretty 22-year-old girl from Niger with beauty scars on her temples and forehead. "Even if it is AIDS, we want to know!"

At night, punters pack into the brothel's large courtyard striking deals with the girls before disappearing with their chosen partner into one of the surrounding rooms, illuminated by garish green, yellow and pink neon lights.

But during the daytime, the sex workers of "Le Campement" lounge around and relax.

Sitting with her friends in the shade of the tree, Fatima, a plump 24-year-old woman from Niger, said she had stopped going to the hospital altogether.

"We noticed that they always gave us the same stuff…cotrimedazole, methonidazole and jantamycine," Fatima said, reeling off a list of treatments for venereal disease.

"But now, whenever we get skin infections or abcesses in the vagina, we don't bother going to the doctor," she added. "We just buy Nifluril or other medicines that we find in the stalls of street vendors."

The sandy streets of Birnin-Konni are full of petty traders selling packets of assorted medicines smuggled in from Nigeria alongside packets of cigarettes and cheap Chinese torches.

Landlocked Niger, which is one of the poorest countries in the world, launched a campaign last year to distribute life-prolonging anti-retroviral (ARV) drugs to people living with AIDS.

Until recently, these were only distributed free-of-charge to 300 people living in the capital Niamey, 417 km to the west of Birnin-Konni.

But this cross-roads town, which sees trucks heading north across the Sahara desert to Algeria and Libya and south to the Atlantic ports of Lagos and Abidjan, recently came within closer reach of effective AIDS treatment.

Not much enthusiasm for AIDS testing

Doctor Abdoulaye Bagnou, the government top advisor on AIDS and sexually transmitted diseases, said the people of Birnin-Konni could now pick up ARV drugs from a recently established AIDS treatment centre at Galmi, a small town 50 km to the east.

The facility was opened in the town's Christian missionary hospital earlier this year as part of a drive to decentralise AIDS treatment in Niger and Bagnou said 35 people there were already receiving ARV treatment.

Issoufou at the government hospital in Birnin-Konni, said he had been referring patients to it for the past month.

A national study carried out in 2002 shows an overall HIV prevalence rate of 0.87 percent in Niger - equivalent to 80,000 people in this mainly desert country of 12 million.

But the same survey showed a much higher infection rate of 25 percent among prostitutes. And health workers estimate there are at least 500 of them in Birnin-Konni.

The United Nations Children's Fund (UNICEF) set up a voluntary AIDS testing centre in the town two years ago as part of an initiative to reduce mother-to-child transmission of the disease.

Doctor Thalcienne Ddihokubway, a UNICEF official connected with this programme, said it had enabled some people living with AIDS in Birnin-Konni to receive treatment for opportunist infections connected with the decline of their immune system, even though they could not get ARV drugs.

But Doctor Issoufou said local people who feared they might have AIDS, appeared to be losing faith in his hospital's ability to help them.

He noted that about 20 women per day came to the hospital's HIV testing centre when it first opened in 2003, but the number of people turning up there had since dwindled to between five and 10 per day.

"If the number of women agreeing to be tested is going down, it is simply because we can't provide them with the necessary treatment," he said. "Any woman who tests HIV positive is left to her own devices."

Although treatment for AIDS remains woefully inadequate at Birnin-Konni, some progress has been made on the prevention side in conjunction with Niger's national union of truck drivers.

Use a condom or forget it

The European Union has financed an AIDS awareness and condom distribution campaign, "Aids on the move", implemented by the US non-governmental organisation CARE, that has succeeded in making both truck drivers and sex workers more aware of the need for protected sex.

The truck drivers have been briefed to pass the message on to thousands of seasonal migrant workers who flock into Birnin-Konni's lorry park looking for transport south towards Cote d'Ivoire.

And the sex workers have become so condom-conscious that they sometimes gang up to expose and harass a punter who refuses to wear a sheath.

At "Le Campement," Mariama, a 35-year-old sex worker, proudly flourished a packet of 72 condoms.

She said she had bought it from a nearby kiosk run by the Niger Association of Truck Drivers for the subsidised price of 1,250 CFA francs (US $2.50).

"Say a client comes into the room, and he pays 1,000 CFA ($2) for the ride," Mariama said.

"I give him the condom and will even put it on him if I need to. If he refuses, he only gets half his money back. And if he won't agree to that, I keep the lot. If he wants to make a fuss about things, we argue. But in the end he is the one losing out."

Rakia, a young colleague who looked half her age, agreed.

"Sometimes we get together and beat up a customer who refuses to wear a sheath," she said as a group of other girls listening in on the conversation nodded in agreement.

"Since I received awareness training, it is a sheath or nothing," Rakia said. "That also has the advantage of protecting us against other sexually transmitted diseases."

It sounds good in the clear light of day.

But later that night Mariama, with several drinks inside her, could be seen chatting up a client at a nearby bar.

She held a cigarette in one hand and a bottle of Conjoncture - a local brand of beer - in the other. Soon the couple headed off, arm in arm towards the brothel, with tipsy Mariama unsteady on her feet.

"It is difficult to believe right now that she is going to remember to use a condom before they get down to business," remarked Ibrahim Adama, an outreach worker of the local CARE programme, as he looked on.