In-depth: AIDS in Chad - the neglected crisis
Oure Cassoni refugee camp on the Darfur border
JOHANNESBURG, 27 June 2008 (IRIN) - Chad has experienced decades of armed rebellions and weak governments, so a looming AIDS crisis is the last thing it needs.
The West African country
that sprawls across the Sahel is among the world's poorest; its development indicators, especially regarding women, are abysmal. It has less than 600km of tarred roads, only a few hundred doctors, and just 26 percent of Chadian adults can read.
In the area near its eastern border the country hosts 250,000 refugees who have fled the fighting in Sudan's Darfur region, while in the south some 57,000 refugees from the Central African Republic (CAR) have come to seek shelter.
A number of rebel groups are also active in the arid east, and since 2006 have twice reached the capital, Ndjamena. Roughly 180,000 Chadians have been made homeless by the insurgency.
The silent partner of this humanitarian crisis is a potential HIV disaster. The national prevalence rate is estimated at 3.3 percent, but in the south, among both local and refugee populations, it is roughly 10 percent.
"In the south a really serious epidemic is underway," said Loretta Hieber Girardet, senior HIV AIDS advisor to the UN Office for the Coordination of Humanitarian Affairs. "It's a crisis within a crisis."
But, she told IRIN/PlusNews, donors and the humanitarian community have been slow to recognise the link between HIV and vulnerable populations, and are only belatedly scaling up AIDS programming for refugees and displaced people.
"One of the biggest challenges has been the lack of interest by donors to recognise AIDS," she said, because "donors do not see it as a priority" when confronted by more traditional spending demands for refugees, internally displaced persons, and the host population.
Despite the poverty of its people, landlocked Chad is sitting on oil reserves
worth billions of dollars. Production began in 2003 in the south, with the oil pumped through a pipeline to a port in Cameroon - a project financed by the World Bank on the understanding that 70 percent of revenues would be channelled into development programmes.
Oil revenue of US$1.35 billion was forecast for 2008, based on a price per barrel of US$100. The price of oil is currently above US$140 per barrel and could hit US$170. But the government admits that much of its oil windfall will go to buying weapons rather than securing the health of its people. Budgeted spending on AIDS for 2008 has fallen compared with 2007.
Chad's AIDS response
has been fitful and largely dependent on donor grants. In 2006 the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria temporarily froze spending because of the government's lack of transparency in managing the money. The rollouts of antiretroviral drugs and prevention of mother-to-child treatment programmes
have crawled forward.
"We look at a country like Chad and say, 'Three percent prevalence is not a problem'; but it is a problem, because it can grow," said Hieber Girardet.
The right conditions for spreading HIV infection are present: Chad's health care system is demoralised and barely operates in the provinces; in the Muslim north and east of the country, orthodox awareness and prevention programmes
are hamstrung by traditional beliefs.
"For many people here, it is blasphemous to speak of sexuality and AIDS. We are trying to raise alarm bells, but people refuse to listen to us," one AIDS activist told IRIN/PlusNews.
Among the lessons learnt in Chad is that HIV interventions need to be integrated into the broader humanitarian response, and be culturally sensitive, said Hieber Girardet. "Attempts to do AIDS programming such as condom distribution had to be looked at in a different light, as it wasn't working. Camp elders [among the refugees in the east] were offended at the suggestion that any sort of sexual activity was going on," she noted.