Doctor concerned by high HIV prevalence rate in forgotten northeast

Olivier Oura is the only trained doctor available for Ivorians living with HIV/AIDS around Bondoukou, and he's worried that poor security and communication in this northeastern corner of Cote d'Ivoire may have landed it with the country's highest HIV prevalence rate.

"Look. In 2002, Bondoukou region had a prevalence rate of 11 percent. That's the second highest in the country and substantially higher than the capital Abidjan, which was 7.4 percent," Oura told PlusNews, flicking on a computer and pulling up a screen of data.

He barely finishes his sentence, before the electricity cuts out and the screen goes blank.

The figures date back to a national sentinel survey from the year war broke out in Cote d'Ivoire and the country ended up split in two after a failed rebel attempt to topple President Laurent Gbagbo. The line dividing the government-run south from the rebel-held north runs straight through the Zanzan region of which Bondoukou is the capital.

"I think that today the figure could actually be much higher when you take into account the effects of the war particularly in the rebel controlled area, the fact that we have very open borders with Ghana and Burkina Faso and the persistence of traditions such as polygamy," Oura sighed.

Bondoukou town remains under government control but the region's second-biggest town Bouna, 150 km to the north, is run by the rebels and as such is cut off from all state administration and health services.

Up in the rebel-held town, there are no sensitisation campaigns to warn people of the dangers of HIV and AIDS.

"This is a major problem in an area that has two open frontiers with Burkina Faso and Ghana," Oura said.

Even simple preventative measures like condoms are hard to come by, let alone more expensive treatment.

"People have no access to treatment in Bouna. They can't even buy condoms. I am the only doctor responsible for HIV and AIDS and to see me they have to pass through all the road blocks along the way which adds a lot of expense and hassle," Oura said.

"I have only one patient who travels down from Bouna every three months to see me and collect his antiretroviral (ARV) treatment. I don’t know how he affords it," the doctor explained.

Problems Exacerbated By War

Rebel and government troops maintain checkpoints on both sides of a buffer zone, patrolled by United Nations peacekeeping forces to keep the warring sides apart. Fighters on both sides are notorious for charging levies and fines on passengers and vehicles for spurious reasons.

The pervasive military presence, no matter the allegiance, poses other headaches for health workers trying to contain the spread of AIDS.

"There's generally a higher HIV rate among soldiers than other members of the population and you know how they are - in the open-air snack bars all the time, a woman on their arm," Oura said.

Even before the trappings of war were thrust on this region of Cote d'Ivoire and its subsistence farmers, poverty made the fight against AIDS trickier. But the conflict has made life more difficult, even in the government-run areas.

"Many families have swollen to take in relatives from the north who have been displaced by the war stretching budgets," said Oura.

Fatou, not her real name, is one of the doctor's patients who is struggling to pay for treatment. She has never been to school and now, guessing her age at about 30, she makes her money as a petty trader selling cooking ingredients: oil, tomatoes, stock cubes and chillies.

"I used to be happy with the money I made, but it's not really enough to pay for the medicines. Every month I have to beg money from my father, but he is old and has nothing either," she told PlusNews.

Fatou was married when she was about 14 and had her first child within a year of being married. Her husband died of AIDS about five years ago.

"She has at least identified that she is HIV positive, there are many more that we don't know about who are not getting any treatment and are perhaps not aware of their status," explained Oura.

Fatou is also rare, the doctor says, in that she has told her parents of her HIV status and they have not rejected her.

"Here the stigmatisation surrounding the virus is a major problem. I have some 30 people receiving treatment but hardly any of them have told their families of their status," he said.

Fatou remembers when she was about 13 and her father negotiated with a man more than twice her age. He would eventually become her husband. His death would make her an AIDS widow.

"I was the first wife. But he took three others - all younger than me. Two of them are already dead," said Fatou in Malinke, which is widely spoken by traders across northern Cote d'Ivoire and much of the Sahel region.

Traditional Practice Of Polygamy Also Increasing HIV Infections

She does not blame her husband. She says that despite him being much older than her, they never had a cross word and anyway, he was away from Bondoukou a lot.

"He used to drive the big lorries to Abidjan and up to Burkina Faso or Niger. Once he was away for a whole year, another time, five months," she said softly.

According to the local tradition, Fatou and the other wives continued to live in their fathers' home after they were married, with their husband splitting his time between the four women when he passed through town.

As far as she knows, he didn't have any other wives in any other towns. But she can’t be sure.

Oura says that this local custom is helping to spread the HI virus.

"It makes it very easy for a man to take more than one wife, as he does not have to provide them with a home once they are married as in other areas where polygamy is practiced," the doctor said.

On Fatou's lap sits her youngest child, swinging his legs. He's five years old and HIV positive too. It costs her 22,000 CFA (US $45) for three months' worth of treatment for them both. Though blood tests are free at a facility three hours drive away in Bonguera, transporting the samples there is not.

And it's not just the cost of the medicines, that Fatou has to worry about.

"If you are HIV positive you need to eat correctly, but you need money for that too," Oura said.

The United Nation's World Food Programme (WFP) does offer some assistance providing basic food rations to diagnosed HIV patients, but the doctor says it is not enough.

Fatou, who has a slight build, admits buying meat for her and her children is something of a luxury and she worries for the health of her HIV positive son in particular.

As for the future, Fatou wants to be able to keep scraping together enough money to stay on the ARVs. Without them she knows she will not have much time and she wants to see her two eldest daughters, who are not HIV-positive, finish school.

"I want things to be different for them," she said.