New survey expected to show much higher HIV prevalence rate

SIERRA LEONE: New survey expected to show much higher HIV prevalence rate

FREETOWN, 17 Feb 2005 (PLUSNEWS) - Sierra Leone has announced plans to launch a nationwide HIV/AIDS survey in the next two months following widespread indications that the real rate of HIV prevalence is four or five times greater than the official government estimate of less than one percent.

Health officials and groups believe the actual rate is much closer to the West African average of five percent.

"We plan to carry out a national survey in March or April to determine the real AIDS prevalence rate in the country," Brima Kargbo, who heads the government's National AIDS Secretariat, told IRIN.

Exact figures have been difficult to establish in this West African country which is still recovering from a decade-long war that officially ended in January 2002.

The conflict caused the death of more than 20,000 people and displaced half of Sierra Leone's five million population from their homes. Health clinics and hospitals throughout the country were wrecked and ceased to function.

The government presently estimates the overall HIV prevalence rate at 0.9 percent of the adult population. This ranges from 2.1 percent in the capital Freetown to 0.7 percent in rural areas outside the capital. Altogether, 45,000 people are thought to be HIV positive.

The problem is that these figures are derived from a health survey carried out in 2002 by the Sierra Leone government and the Center for Disease Control and Prevention, a US government public health agency, in the chaotic aftermath of the civil war. Large parts of the country remained inaccessible at the time.

Initial results of the 2002 survery, based on a study of 2,412 blood tests collected in urban areas such as Freetown, Bo and Kenema indicated that 4.9 percent of the population was living with HIV/AIDS.

However, several months later, following new tests on the samples by a second laboratory in the United States, the figure was revised to 0.9 percent.

Leopold Zekeng, coordinator for the UNAIDS programme in Sierra Leone and Liberia, said a new survey was urgently needed to provide "baseline information" for assessing the impact of projects already under way and for mapping Sierra Leone's future HIV/AIDS control strategy.

"All the ingredients are in place for the epidemic to explode: it's a poor country, there are refugees and displaced, unemployed youth, a lot of sex workers, a low literacy rate and limited condom use," he said.

Recent studies on pregnant women and other sectors of the population point to a much higher prevalence than the 2002 survey data suggests. Aid workers say this is not surprising in a country where thousands of women were raped by pro-government militia or by rebels of the Revolutionary United Front (RUF). Huge numbers of foreign peacekeepers were subsequently deployed across the country and played their own part in spreading the virus.

The Global Fund to Fight AIDS, Tuberculosis and Malaria cites what it describes as more reliable statistics based on a 2004 study of pregnant women. That estimated a national figure of 3.4 percent, which rose to five percent in Freetown.

A 2003 pilot study of 347 women in Freetown carried out as part of a separate inquiry by Ramsy, an independent local laboratory, showed a rate of 4.6 percent, said Ramsy staff member Issatu Wurie.

Catharina Coppens of the Dutch branch of the medical aid organisation, Medecins sans Frontieres (MSF) believes that is a figure which is closer to reality. Her organisation offers technical support to hospitals in the northeast districts of Magburaka and Kambia.

"Of the 700 people tested in Kambia in the last six months, the prevalence rate was slightly higher than five percent," she said. "But the majority of people being tested were women who came for prenatal care or for voluntary tests. They were not people among groups most at risk."

Kambia district on the border with Guinea was badly hit by the war. Its infrastructure was destroyed and part of the population fled across the border.

In Magburaka, which was invaded by rebels but where less people were displaced, the rate is at around three percent, on the basis of tests taken in clinics, Coppens said.

But Kargbo, the head of the National AIDS Secretariat, argues that estimates based on tests in individual clinics are not necessarily representative of the situation nationwide.

"Prevalence is not determined by the number of HIV cases we do see in our health facilities," he told IRIN.

Kargbo said Sierra Leone was slated to receive US $8.5 million from the Global Fund. The World Bank contributed $15 million to the Sierra Leone HIV/AIDS Response Project (SHARP) in 2002 and is currently backing several projects offering treatment to people living with HIV/AIDS.

"In 2002, when the World Bank 2002 project was launched, infrastructures were destroyed, as a pilot, the emphasis was put on infrastructure and prevention," Kargbo said. "This time, in the second phase, once we see what we can do, the emphasis might be on treatment".

In Freetown, less than 100 people currently are on antiretroviral (ARV) drugs, but the government last month launched a programme to distribute ARVs to 300 people, using its own funds.

The US $180,000 one-year scheme is being run by a local NGO, Sierra Leone Treatment Action Group (SILTAG). Its president, Robert Willoughby, also believes the official estimate of a 0.9 percent HIV prevalence rate is way to low.

"If I take into account the number of cases I see in my clinic," the doctor said, "I would estimate prevalence in Sierra Leone at between three and four percent."


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