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 Wednesday 03 October 2007
 
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ART on the frontline

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COTE D'IVOIRE: Access to HIV/AIDS treatment in rebel north precarious

Photo: IRIN
Awa Keita and her youngest son are both HIV-positive but can't get treatment in the rebel-run north
Despite pledges by the authorities in Cote d'Ivoire to assume responsibility for the care of HIV/AIDS patients, nongovernmental organisations (NGOs) say the distribution of antiretroviral (ARV) drugs in the rebel-controlled north still falls mainly on their shoulders.

Although relative peace has returned to the region, the government has lagged in taking over programmes set up by NGOs, delaying the expansion of HIV/AIDS services and compromising the health of patients.

Access to ARVs - which help prolong the lives of HIV-positive people - is crucial in the north, where infection rates are highest. According to health workers in the field, the rate of infection is nearly 10 percent, whereas the United Nations estimates national prevalence at 7 percent. Local authorities place the national figure at 4.7 percent.

Treatment hindered by conflict

Services declined drastically when the area was drained of healthcare workers and services after conflict broke out in September 2002. A study in 2004 by the Swiss Centre for Scientific Research, in conjunction with the University of Abidjan, found that in parts of the north nearly 90 percent of health professionals had abandoned their posts and 80 percent of healthcare facilities were destroyed or looted.

Patients receiving ARVs from the government's National Programme for the Fight Against AIDS were the first to see supplies cut off, and even when the drugs were available at hospitals, many patients could not afford the monthly cost of US$2.

In the absence of coordinated state-run services, NGOs and international organisations stepped in to help treat and control HIV/AIDS, setting up whatever programmes they could.

A five-year US$56 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria at the end of 2003 helped ARV distribution programmes in Man and Danane, near the Liberian and Guinean borders in the west, and in Bouake in the centre of the country. Some organisations also set up mobile medical teams that distribute condoms, offer AIDS tests and treat patients in isolated communities where most health facilities have been abandoned.

Many obstacles remain

Local NGOs say they lack the means to provide comprehensive care. Health workers who stayed or have agreed to return to the north complain about the lack of support by the Ministry of Health and the Ministry for the Fight Against AIDS, and the results are showing.

In the hospital at Man, currently run by the international medical charity, Medecins Sans Frontieres, AIDS has become the main cause of death among hospitalised patients, followed by tuberculosis, the most common AIDS-related illness.

Another emerging problem is the cost of treatment. Most NGOs waived patient fees in light in of the critical situation, but these will likely be reinstated once the state takes over.

Another worrying prospect is that most NGOs are preparing to make way for the government to take over the programmes after the elections, tentatively scheduled for October, but healthcare workers might flee again if the precarious peace in the region crumbles.

The joint study strongly recommends that programmes not be interrupted too quickly. "Considering the efforts already established by NGOs, international organisations and their partners to manage the HIV/AIDS epidemic in the north, it is imperative that these activities continue in the post-conflict period."

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