A war that is less than ordinary against AIDS!

[7 December 2005 - 00h00]
[mis à jour le 9 May 2007 à 10h36]

Children, adults and the elderly. The whole village of Dabré, 60 kilometres from Abidjan in the Republic of Côte d’Ivoire, listens religiously to their chief. “We want the children who danced before us to be able to go on living”. With one wave of his hand, he throws away the liquid in the glass he is holding. It is a strong image. “I have just chased AIDS from our village!”

After the symbolic part comes the reality. A village committee to combat HIV/AIDS has been operating since 2002. When Mr Constant, the Chairman of the Dabré Committee, takes to the floor, all fall silent. “Continue to protect yourselves. Wear condoms”, he says to the gathering. Then he briefly reviews the activities carried out since 2002. “Young people are using more and more condoms. Nowadays, we are finding out more and more about this disease”.

It was already a real victory… For in sub-Saharan Africa, unprotected sexual intercourse is by far the main route of transmission of HIV. But this village Committee and its 800 counterparts in the Côte d’Ivoire would never have been set up if it had not been for one meeting. A meeting between the National Rural Development Agency of Côte d’Ivoire (ANADER) and the Merck Sharp and Dohme laboratories. The former is a mixed public/private structure specialised in agricultural engineering. The latter is one of the biggest pharmaceutical groups in the world, involved in research into antiretroviral agents to combat HIV… and in humanitarian work in Africa.

During a congress on HIV/AIDS held in Barcelona in 2002, ANADER realised that there were no programmes to combat this disease in rural areas. Bitterly, its managers launched an appeal. For every year, out of a total work force of 3,500 staff, fifty of them were dying from HIV/AIDS!

A Ministry of AIDS! The two partners joined forces. The laboratory provides support by training doctors for the agency: awareness of the disease and how to treat it. “Now”, says Dr Benjamin Badou from ANADER, “we are pursuing an active awareness-raising policy as regards testing among our agents. If they turn out to be HIV-positive, their treatment is fully paid for by ANADER”.

The two teams have intensified their partnership in the course of meetings and training courses. They produced an application to receive aid from President Bush’s Emergency Plan for AIDS Relief (Pepfar). The project is called “Rapid extension of access to prevention, care and treatment of HIV/AIDS in rural areas”. In fact, 60% of the population of Côte d’Ivoire is rural. Last September, four million dollars ended up in the coffers of ANADER and of its three partners: the Network of Media and Arts Professionals in the fight against AIDS, Population Services International and ACONDA-VC.

While the civilian population is mobilising to an extraordinary extent, the politicians are not lagging behind either. So much so, in fact, that the Côte d’Ivoire is the only country in the world with a ministry dedicated to fighting HIV/AIDS. This initiative was taken by the President of the Republic, Laurent Gbagbo, whose country is one of the most severely affected in West Africa. According to official figures, 7% of the population is apparently affected. In other words, 570,000 cases! Mostly young people, and hence the most active… An additional problem for a country suffering from a latent war.

But it is a country united against the disease. A total of US $ 33 million have been distributed in the Côte d’Ivoire by the Pepfar Fund. A breath of fresh air and a source of hope… As happens all too often in sub-Saharan Africa, there is a lack of resources. “The State spends US $180,000 (per year) treating HIV/AIDS. This is not a lot, but we are a poor country. Therefore it’s thanks to external aid that we can take effective action”, says the Director of the National Programme to Combat HIV/AIDS.

Not every patient can receive treatment. “We give the treatment from a certain level of CD 4 (white platelets which organise the immune system’s response, editor). We are obliged to select patients”. For example, the State, NGOs and specialised agencies consider that treatment is justified for 78,000 patients.
Informing in order to prevent However, at the moment, only 14,000 HIV-positive patients are being treated. The treatment is often badly accepted by the population. “Africans do not like long-term treatments. They are not used to this. Observance is therefore very poor”, says Dr Benjamin Badou. For this year, he deplores the deaths of five ANADER agents caused by the virus. “Yet they were receiving treatment”, he confides.

It’s the same story in Dabré. “In African minds, when you receive a treatment, you expect to be cured”, says Dr Sébré Désiré who is in charge of the Health Centre. “Here AIDS means death, and people cannot conceive of living with the virus”. Two statements that show clearly that fighting HIV/AIDS is not just a question of treatment and the cost of it.

In fact, it is ANADER’s job to work on changing this behaviour. Its agents, who are in permanent contact with villagers, underline prevention and awareness of the disease and of its method of transmission… And the message is getting through. Mainly to young people. “We have understood what HIV/AIDS is and how to protect ourselves”, says Ake, 19 years old. Joseph looks after a stand selling condoms. “We regularly run out of stock”, he says.

Fear of being judged Stigmatisation and discrimination against HIV/AIDS victims are not lessening. A change in mentality is occurring, but too slowly … “A person with AIDS is not an extra-terrestrial”, says Mathieu, annoyed. “This disease is very frightening. Some people do not want to share a meal with a sick person. The village committee is trying to convince the villagers, but there is a good deal of resistance, particularly among the older people”.

That is why few people in Côte d’Ivoire will agree to be tested. “They are afraid”, says the ANADER doctor. Afraid of being judged by their families. Afraid of being excluded…

However, there are plenty of positive testimonials. Like the one about the three HIV-positive women who came to the ANADER headquarters to tell their stories. “When you accept yourself as a carrier of the virus and accept that others cannot accuse you of anything, everything else is alright”, says one. Not one of these women, married to HIV-negative husbands, has been threatened with divorce. Their husbands in fact watch over them tenderly.

ANADER’s objective by 2008 is to raise awareness among 300,000 people, to screen 100,000 and give support to 7,000 vulnerable orphans and children. To do this, over 700 villagers will be trained in prevention. The ANADER officials intend to set up an HIV/AIDS Committee in each one of the 12,000 villages in Côte d’Ivoire. Lastly, over 300 radio programmes and 4,500 announcements will be broadcast in eight different dialects.

Towns and villages on an equal footing! Here everything is based on the oral tradition. Since over 60% of the population is illiterate, information was not reaching rural people. Most young villagers have forged their views about HIV/AIDS thanks to radio and television. “People speak a lot about the disease in towns. But in the country, people do not have access to information”, says Raphaël Agneroh, responsible for the programme at ANADER. “To date, the provision of HIV services is concentrated in urban centres”.

Alongside ANADER, MSD is responsible for training health professionals, not only in Côte d’Ivoire. Since 2002, up to 400 doctors in Rwanda and Côte d’Ivoire have been trained in Europe. The most important thing, perhaps, is that when they returned, they trained other health providers. The same process is under way with social workers who receive communication-oriented training. Then they are asked to encourage people to test for AIDS.

Like the treatment to prevent mother to child transmission provided free of charge by Boehringer-Ingelheim, and the programme for access to health care and treatment by the GlaxoSmithKline Foundation, the Merck Sharp and Dohme teams work closely with civil society and the health authorities.

The example of the Côte d’Ivoire is edifying. Of course, a lot remains to be done to “drive HIV/AIDS out of the country”, in the words of the Dabré chief. The mobilisation in the field is remarkable. Everyone is actively involved: the doctor, the condom seller, the ANADER agent, and the members of the village HIV/AIDS Committees, with no lack of energy, optimism and, above all, coordination. The situation is urgent: up to 50,000 people die each year in Côte d’Ivoire because of AIDS.
SUPPORTING ORPHANS IN COTE D’IVOIRE

Over 14 million children in the world have lost one or even both their parents because of the disease. There are very few national policies aimed at supporting them. In Côte d’Ivoire, politicians looked at this issue. They rolled back their sleeves and got to work. In this country, over 310,000 children under the age of 15 have to face life alone. Projections for the year 2008 even mention the figure of one million orphans.

At the Ministry of Solidarity, Security and the Disabled, a special unit has been set up to deal with AIDS orphans. A project involving up to 6,000 children has been conducted in six pilot centres. Each child received a school kit and food, and psychological and legal aid. “They need help quickly, so we have to work in an emergency situation”, explains Daniel Comet, Cabinet Director. “We are expecting a lot from our partnership with ANADER, for instance to reach the children living in rural areas”.

ABSTINENCE IS NOT PART OF THE LOCAL CULTURE

Abstinence, faithfulness, condoms. That is, in order of importance, the prevention message conveyed by structures receiving aid from the Pepfar Fund. Yes, indeed, abstinence is in first place! In addition, a set of slogans translated into sixteen languages and dialects has been distributed among young rural people. For instance: “Abstain: avoid doubt”; “It’s safer to abstain”, and “Abstinence, my AIDS vaccine”…

Not surprisingly, these messages are not accepted by many people. “I don’t know what abstinence is”, says Jimy (17 years old), in Dabré. “I make love several times a day, like my brothers and the rest of my family”. In the field, this situation has been understood. Field workers have literally turned the triad “abstinence, faithfulness and condoms” on its head, preferring “condoms, faithfulness, abstinence”. Apparently they are being heard. The people in Côte d’Ivoire, who still deride their ancestors, the Gauls, should not therefore have a chance to scoff at Uncle Sam…

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