GUINEA: HIV gains overshadowed by dependence on donors

Conakry, 25 November 2008 (PlusNews) - Five years ago, antiretroviral (ARV) treatment in Guinea cost US$100 per patient per month; today, thanks to a large injection of donor cash, ARVs are now freely available in government hospitals.

HIV testing services are being rolled out across the country and an estimated 8,000 people are on ARVs.

Patients no longer need to travel over 700km to the Senegalese capital, Dakar, to have their CD4 count measured to determine the strength of their immune system because hospitals in the Guinean capital, Conakry, and regional centres are now equipped with CD4 machines.

"Things have improved greatly over the last few years," said Mamadou Alimou Diallo, secretary general of REGAP+, a network of people infected and affected by HIV/AIDS.

This is largely because of two large international donors: the World Bank, which gave Guinea a $20.3 million grant in 2002 from its Multi-Sectoral AIDS Project (MAP), and the Global Fund to fight AIDS, Malaria and Tuberculosis, which has given the country two grants totalling $30 million.

"Funding allocated by the State is insufficient; all our programmes are heavily dependant [on external support]," said Djélo Barry, of the national AIDS control council, CNLS. "The State is always involved, but the amount is [around] 20 percent, [compared] to 80 percent from donors - this should be the other way round."

In 2006, 96 percent of the $25 million spent on combating AIDS came from external partners, according to a progress report presented by Guinea as part of monitoring its commitment to fight AIDS, made in 2001 at the UN General Assembly Special Session (UNGASS).

Depending so heavily on donors can have drawbacks. When the Global Fund suspended its grants to Guinea in 2005, and again in 2007, over a lack of transparency in allocating money, no new patients were enrolled in ARV programmes for several months.

After changes in the Country Coordinating Mechanism (CCM) – the body responsible for overseeing the utilisation of Global Fund money - the grants were reinstated, but not before it had become evident how vulnerable Guinea's HIV programmes were without external support.

The World Bank's MAP finishes at the end of 2008 and it is unclear whether it will be renewed. In terms of its national strategic framework, Guinea will need an estimated $240 million between 2008 and 2012 to fight the pandemic.

"The State has a huge responsibility; if we start to invest in training and in health centres, a whole process is put in place," said Franck Bossant, head of mission for Médecins Sans Frontières-Belgium in Guinea.

If things aren't working at the end of the chain, the whole structure is at risk of collapsing. Donors will not be involved forever.

"This creates expectation and hope, but if things aren't working at the end of the chain, the whole structure is at risk of collapsing. [Donors] will not be involved forever."

A "two-headed" AIDS programme

Guinea's HIV fight has also been hampered by poor coordination within the national AIDS programme. CNLS is responsible for coordinating the campaign at national level, but experts say it lacks the capacity to do so efficiently, and has so far failed to form a smooth working relationship with the Global Fund's CCM.

"The Ministry of Public Health is the principal recipient of Global Fund grants ... but the body in charge of managing this funding [CCM] does not have any operational link with CNLS," the UNGASS country progress report noted.

"There is certainly a national authority [CNLS], but it doesn't have the required resources to guarantee its coordination role in the national response," commented Marcos Sahlu, UNAIDS country coordinator in Guinea.

The CNLS's Barry admitted that the "two-headed" nature of the country's HIV fight was "a problem that we have not been able to overcome".

Experts say the government needs to be more engaged in combating HIV if further gains are to be made. Despite recent progress, 42 percent of health districts did not have HIV testing centres by June 2007, while only 44 of the 496 national-level health centres were providing prevention of mother-to-child transmission by the end of 2007. In 2006, only 52.6 percent of donated blood was tested for HIV.

Chronic political insecurity continues to complicate the rollout of HIV services, while a lack of trained medical and administrative staff means the decentralisation of services has had to be put on hold.

The last demographic and health survey, in 2005, put Guinea's HIV prevalence rate at 1.5 percent, but a 2007 survey found that the infection level among miners, truck drivers, fishermen and security forces ranged between 5.2 percent and 6.5 percent, and among sex workers was as high as 34.4 percent.

ail/kr/kn/he

Theme (s): HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]