AIDS prevention measures collapse in rebel-held city

First came the rebel movement. After the Ivorian rebels, the Liberian mercenaries swept in. Now, the western town of Man is bracing itself for another invasion - the HIV/AIDS epidemic. Nobody knows exactly how many people are affected. But everybody agrees that the prevalence rate must be alarmingly high. “It’s so hard to make money here, that for girls, sex has become an acceptable way to earn a living,” said a bartender who gave his name as Jean-Baptiste. “I wouldn’t be surprised if by 2007 or 2008, people perish like ripe fruit,” he said. Located near the Liberian border, 550 km northwest of the economic capital Abidjan, the coffee-producing town of Man is a stronghold of the New Forces rebel movement. After a failed coup in September 2002, the rebels occupied the northern half of Cote d'Ivoire within a matter of days and they are still there. Throughout rebel-held territory, HIV/AIDS is invisible. The crisis has obliterated all awareness campaigns. In Man, there hardly ever were any campaigns to begin with. Although foreign NGOs provide basic health care in Man, they do not test for the virus. They say they are only in Man temporarily and are unable to administer long-term treatment. But the scant data available shows a worrying trend. One of the indicators of the prevalence of the disease is the number of pregnancies. “There has been an explosion of pregnancies among girls between 12 and 19 years old,” said Yssouf Ouattara of CARE, an international NGO which launched an AIDS prevention project in rebel-held territory in April. “Usually, at high schools, there would be two or three girls pregnant at any given time. Now, in one town, we found a school with nearly 80 pregnant girls. The youngest one was 12 years old.” With a US $1 million budget, a condom distribution programme and a programme to help local communities with awareness campaigns, CARE hopes to prevent the further spread of AIDS. “It’s an emergency project,” Ouattara said. “Stabilisation is the best we can hope for.” It will not be an easy task. The main problem with towns in rebel-held territory, including Man, is the all-too-powerful military. Most important economic activity is controlled by the rebels and the population is obliged to live from hand to mouth. The only people with easy money to spend are rebels, soldiers, and peacekeepers. “Girls are attracted by them like bees to a honey pot,” said Ouattara. “When they don’t get paid for sleeping with them, they’ll get a meal, drinks or some kind of present. Basically, it’s a form of prostitution.” Man has had its share of men in uniforms since the failed coup two years ago. Gangs of unruly Liberian fighters terrorized the town until the rebels decided to kick their former allies out in a bloody clean-up operation in May 2003. Soon after, soldiers of the French peacekeeping force moved in. And soon, the UN will dispatch Bangladeshi troops to patrol alongside the French. “When the Liberians were here, they would pick out girls in the nightclub and say: come or I shoot you,” said a 22-year-old girl who gave her name as José. “Today, there are men ready to offer 20,000 CFA francs (US$ 37) to a girl to sleep with them without a condom. Some girls think that’s great. If I say to them it’s plain stupid, they reply that I am jealous.” She added that many other girls have a fatalistic attitude towards the disease and won’t use a condom even if it’s free. “I know plenty of girls who say: you’ll die when you have AIDS, and you’ll die when you don’t have AIDS. It doesn’t matter.” One girl who asked not to be named told PlusNews that soldiers from the French peacekeeping force had filmed prostitutes while having sex with them. To their embarrassment, the girls are recognizable. Copies of the film are allegedly sold in town, she said. Colonel Henri Aussavy, the spokesman for France's 4,000-strong peacekeeping force in Cote d'Ivoire said the reported existence of such videos was simply rumour. "This rumour has been circulating for months, but we have never had a casette in our hands or the slightest proof that such videos exist," he told PlusNews. Nevertheless, it would come as no surprise that French troops in Man had been misbehaving. Twelve of them were arrested and sent back to France to face court martial last month for stealing money from a bank in the town they were supposed to be protecting. Medecins sans Frontières (MSF), which has been running the public hospital in Man since the collapse of health care at the start of the conflict, also fears that the epidemic is spreading rapidly across the western region. “We believe that it’s a very important phenomenon here, although we have no precise data,” said Djimadoum Nadjinangar, an MSF doctor. MSF carries out blood transfusions which require testing for HIV. The tests are usually done on the parents or siblings who accompany the patients to give blood. “This is not a risk group at all, and we already have a prevalence rate of 14 percent,” said Nadjinangar, pointing out that soldiers, truck drivers, and prostitutes are the prime risk group. MSF programme director Yves Richard added that the main cause of death of patients was, in medical terms, “the suspicion of AIDS and tuberculosis”. All medical care is free, and the population of Man is grateful for that. But MSF does not offer testing because it does not know how long it will stay in town. Antiretroviral drugs which can improve the health of HIV-positive people and enable them to live longer, require medical supervision over a long period of time. Medically, it is unethical to tell people they are HIV-positive and then not provide any treatment, Nadjinangar said. He tells people they have “an illness that is very difficult to treat” when he strongly suspects AIDS, he said. “When we’ll know for sure that MSF is staying in Man, we’ll set up testing and treatment, but first and foremost, research should be done on the prevalence rate,” he said.