LUANDA, 25 June (IRIN) - Angola's civil war, which has isolated thousands of communities from the outside world for long periods over the past three decades, might also have prevented the rapid spread of HIV/AIDS across the country.

Dr Luisa Brumana, an epidemiologist coordinating the UN Children's Fund HIV/AIDS programmes in Angola, told IRIN that official statistics on the prevalence of HIV/AIDS - which stand at a relatively low 3.4 percent -could be explained in two ways. "In terms of the conflict, this probably helped because it has limited the free circulation of people and goods for some time. This might have created a sort of enclave in which the virus did not spread as much as in neighbouring countries," she said.

"Still, the other side of the story is that, being a country at war, there has been a history of big movements of troops in and out of the country. This is normally a big risk factor for the increase of the prevalence and we do not have accurate statistics," she added.

Brumana said Angola's 26-year war, which had displaced about a third of its approximately 12 million people, had made it impossible to determine the impact HIV/AIDS was having on the population. She and other activists told IRIN they believed the prevalence rate was much higher than the official 3.4 percent, and that the lack of information was making it difficult to design appropriate awareness and education programmes.

The official statistics were based on a sample of blood donors in Luanda, Angola's capital, during 1999. During the same period, an HIV-positive prevalence of 19 percent was recorded among tuberculosis patients in the city and a prevalence of 19.4 percent among sex workers. In the northern province of Cabinda, where the only other set of tests were conducted - among blood donors and tuberculosis patients - the prevalence rate was almost double that for the rest of Angola. Brumana said it was possible that the movement of troops and people between Cabinda and the neighbouring Democratic Republic of Congo (DRC) had contributed to the higher HIV prevalence in that province.

"The statistics which are available do not come from good and reliable epidemiological surveillance. They are based on sero-prevalence studies, so it is (immediate) information only. Of course the prevalence is higher in specific risk groups, for example sex workers - and this follows the trend all over the world - but we do believe this data does not reflect the real situation in the country," Brumana said. In fact, she added, UNICEF had increased its resources and appointed her a year ago because it believed the situation to be "alarming and important".

Antonio Coeiho Neto, executive secretary of the Angolan Network of AIDS Service Organisations (ANASO), an umbrella body to which about 29 NGOs belong, agreed, saying it was possible that HIV/AIDS was a much bigger problem. "Due to the war in the country, many places are inaccessible to NGOs. We work only in areas which are secure." Almost 80 percent of the organisations affiliated to ANASO work only in the capital Luanda.

The social attitudes that activists encounter among people indicate that several factors besides the war will eventually impact on the success of any meaningful campaign to stem the spread of AIDS.

Some research among the youth, according to Brumana, showed that even when there was a high level of awareness - in Luanda for example - this did not translate into positive behaviour. It was still common for young people to have more than one sexual partner and the use of condoms was still low. In addition, many youth still felt they would never contract AIDS, that it only afflicted westerners and the very poor.

Neto said a feeling of uncertainty as a result of the war had also prompted people to ignore the spectre of AIDS. Brumana agreed. "Young people here have only seen war, except for a few short spells. This is interesting because it has led to an attitude of 'why should I care about anything'. Increased instability increases this kind of attitude."

Umberto Rupino, who heads People Living with HIV/AIDS, the only NGO of its kind in Angola, told IRIN that his one-year-old organisation had about 350 members across five provinces - Cabinda, Benguela, Huambo and Namibe. Thirty-three-year-old Rupino, a psychologist who graduated in Russia, decided to launch the organisation with a few friends after he was diagnosed HIV-positive almost two years ago. Married with two children - who are not HIV-positive - it took him three months to tell his wife, a law student. She was later diagnosed HIV-positive too.

He said he decided to go public and to help others because of his own experiences: he discovered he was HIV positive when he applied for a job and was given his results with no counselling at all. Then, after telling a friend, the news spread to students at the school in which he was teaching and he was forced to leave.

"It was very difficult, telling my wife and others, because in Angola there are no conditions to say openly to people that you are infected. There is no pre-counselling or post-counselling when tests are done and this is one of the services we offer as an organisation. We are also campaigning to have these services provided at the public hospital in Luanda, where testing takes place at the moment," he said.

While his students and friends had eventually come to accept him, the stigma attached to HIV/AIDS meant that many others were not so lucky, Rupino said. Interestingly, the majority of people who belong to People Living with AIDS, are all professionals. Rupino said doctors, lawyers, teachers and businessmen were among the group, but not all of them wanted their HIV status made public. In a country where AIDS is still referred to as the "slimming sickness" in some regions, he said, many were scared of rejection by their families, friends and work colleagues.

Neto said that in addition to social stigmas and cultural dogmas, illiteracy and poverty provided government and non-governmental activists with a massive challenge. Angola's government adopted a national strategy to deal with HIV/AIDS over a year ago, but according to news reports and official documentation, has been battling to extend its campaigns and projects outside of Luanda city. With its administrative network all but destroyed in the war, the government cannot use schools and clinics to disseminate information the way other southern African states have done. It has collaborated with UNICEF, the UN population fund UNFPA, and other organisations working in the field, but its own strategy has not yet borne fruit.

The government has also not yet taken up recent offers to buy cheap anti-retroviral drugs from various pharmaceutical companies and generic drug manufacturers. Rupino said even though the government assisted members of his organisation to obtain treatment and drugs in South Africa - about US $15,000 for about a year-and-a-half of treatment -access to cheap drugs was a major problem in Angola. "We have been talking to the government about this. At the moment it is not possible for people to get any kind of affordable treatment here in Angola. If by the end of the year, we see no change, we will intensify our campaign and lobby government much more loudly," he said.

In the meantime, as much as possible is being done to increase awareness and not all the signs are negative. According to Brumana, limited experience gained from the field in the past year showed that intensive campaigns among the youth, with greater youth participation, could indeed deliver results. A pilot project set up by five young women in the southern Huila province had shown progress and provided hope for similar work in Luanda, Huambo in the central highlands, and Benguela on the Atlantic coast, she said.

"We are seeing the changes in Huila, where we can start progress evaluations. In the beginning the five young girls who started the NGO were going out into the field. Then we opened a youth centre. Now many youth and others, come to the centre for information," she noted.

However, Brumana said much more work needed to be done. Even though the government had defined fighting HIV/AIDS as a priority about a year ago, she said, "there is still a huge gap between the fact that they are aware of the problem and their capacity for reaction".

Angola she said, is where South Africa - which has one of the highest infection rates on the continent - was 10 years ago. "So basically we are saying that this could be the next war for Angola because if all of us do not do something immediately, then in 10 years, whatever the social, political or economic situation may be, this could be the big problem. Then you have to fight a new war," she warned.