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West Africa Fears AIDS Increase Due to Civil Wars - 2004-07-09


Three West African countries recovering from civil war: Liberia, Sierra Leone and Ivory Coast, are trying to contain a possible rise in HIV/AIDS due to the conflicts. Governments are receiving millions of dollars in international donor money to combat the deadly disease. It is difficult to tell whether they are succeeding because there are no official statistics and remote areas remain hard to reach.

A baby cries at a U.S.-funded center to stop mother-to-child transmission of HIV/AIDS in Abidjan.

Ivory Coast is one of 12 African countries that benefit from President Bush's five-year, 15-nation, $15 billion AIDS initiative. The money has also helped lower the price of anti-retroviral treatments.

Before Ivory Coast's first coup in 1999, statistics indicated that about 10 percent of the population had AIDS, the highest official percentage in the region.

But now, the head of emergency programs in rebel-held areas for the U.N. children's agency, Alphonse Toko, believes the rate could be much higher.

He said that the situation in northern rebel areas in Ivory Coast where recent statistics on AIDS have not been obtained is extremely worrisome, because of what he calls social and moral decay since the start of the insurgency in late 2002.

A cease-fire now holds between the army and rebels, but because the peace deal has yet to be implemented, most government services have yet to resume. Without schools or government jobs, many girls and young women have turned to prostitution, sometimes getting paid as little as 40 cents for their sexual services, less than the cost of a condom.

In the center, west, and north, there is little health infrastructure that remains operational. An HIV-positive activist, Drigone Bi, is setting up a program called Peace and AIDS.

He said that as soon as peace returns, he hopes the government will send most of its AIDS money to high-risk areas. Other activists criticize the government for stalling and for allowing different ministries to squabble over who controls spending the funds.

Liberia, which is coming out of 14 years of fighting, has just received a pledge of $7 million to aggressively combat HIV/AIDS over the next two years. The money is being promised by the private-public partnership Global Fund and will be managed by the United Nations Development Program.

The head of Liberia's National AIDS Control program, Tanu Duworko, welcomes the infusion of new money, because he believes the rate of infection has risen well above the official estimated rate of eight percent.

"I mean the poverty levels have risen," he said. "And then all of the factions used rape as a weapon. So we expect that. That's the reason why we as a program are hoping that we can get funding and technical support."

The U.N. peacekeeping mission in Liberia says overall rates of infection could be as high as 25 percent. But it will be at least six months before surveys can make an accurate assessment.

In neighboring Sierra Leone, a study carried out by the World Health Organization (WHO) several-years ago found that nearly a quarter of the men applying to become cadet officers were HIV positive. Among commercial sex workers the level was 60 percent.

The head of the country's AIDS response group, Brima Kargbo, disputes such high numbers, but concedes there are no reliable statistics yet.

"The issue of data collection is still an issue because people have been tested," he explained. "Some of the information is not central. These are just ad hoc surveys that were conducted, and it is very difficult for you to interpret these figures because it does not give a fair representation of the entire country."

Mr. Kargbo is leading teams of social health workers to remote regions, promoting abstinence and the use of condoms, which are called bulletproofs. But he says some people are very difficult to reach because of the crumbling infrastructure. This has also been the case in Liberia.

A Geneva-based West Africa expert at UNAIDS, Roger Ntounga, says it is crucial to teach displaced people about HIV/AIDS before they return to their villages.

"The priority has to go to specific groups, let us say the displaced persons," he said. "Those have really been fragilized by the situation, so you need to have specific interventions with those populations and in the same time continuing what we are doing for the rest of the population."

AIDS experts agree that post-conflict periods can actually be more dangerous for the spread of HIV than during the fighting, because roads reopen, refugees return to their families and economic conditions remain precarious.

West Africa has always had lower prevalence than east and southern Africa mainly because the disease arrived there later and by then prevention messages were already circulating. But the challenge there is to keep the rise of the deadly virus in check.

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