Your daily Selection of IRIN Africa PlusNews reports, 8/30/2004

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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - ANGOLA: HIV/AIDS plan moving " too slowly "

2 - COTE D IVOIRE: Nurses run checkpoint gauntlet to get medicines for

north

3 - SOUTH AFRICA: Support and strength from The Tree

1 - ANGOLA: HIV/AIDS plan moving " too slowly "

LUANDA, 30 August (PLUSNEWS) - Eight months after its launch, people

living with HIV/AIDS say Angola's programme to fight the epidemic is

inadequate and moving too slowly.

The US $160 million national strategic plan, a five-year collaboration

between the government and the United Nations, is focused on prevention,

building institutional capacity and helping HIV-positive people.

Yet those living with HIV/AIDS in the capital, Luanda, which is supposed

to have some of the better treatment facilities in the country, say the

benefits so far are slim.

Pedro Mande, 26, goes to the government's Clinica Esperanca in the city

centre for his supply of antiretroviral (ARV) drugs, which prolong life

and are provided free as part of the project.

An emaciated Mande picks at the last scraps of fish from his plate with

his fingers. The clinic appears clean, but there is a strong smell of

urine, and flies are a constant irritation.

" I get drugs here, but that is all. Everything else, like this food, I

have to pay for, " he told PlusNews. " The doctor only comes to see me once

every two weeks, so I am never sure if I'm going to get my antiretrovirals

or not. I feel abandoned. "

Mande is too weak to return to his work as a taxi driver. He has no money

and his family has broken ties with him because of his HIV status.

Donations from the local HIV/AIDS charity, Accao Humana, pay for some of

his basic needs but he has to rely on friends to give him a bed for the

night.

" Every time I leave the clinic I have no idea where I am going to end up -

sometimes I sleep on the street, " he said. " If I could live in a proper

house and have proper food, I would grow stronger, but with this life,

without any support, I am only getting weaker. "

Janet Felice dos Santos, who is also HIV-positive, relies on handouts to

get by. Disowned by her mother and living in a roofless room with no stove

or running water, she fears the imminent rainy season will make her and

her three-month-old daughter, Samira, homeless.

While not as sick as Mande, dos Santos visits the Accoa Humana office

often, knowing that from its donations, or the generosity of its staff,

she will be able buy milk for her child.

Fearing prejudice, dos Santos has told only a few close friends about her

condition. " I try not to tell anyone because they will discriminate: they

will not let me drink water from their glass - that would make me feel

very alone, " she said.

Pombal , secretary-general of Accao Humana and coordinator of the

Coalition for the Rights of the HIV positive, said desperate stories were

commonplace.

" This is the reality, " told PlusNews. " The national government plan

is just paper; it is having little practical effect. "

UNAIDS representative Dr Alberto Stella acknowledged the current situation

was far from ideal, but said patient care was the most problematic area

when it came to implementation.

" From the point of view of the patient, the situation is bad - they cannot

see the logistical problems. [Dispensing] antiretrovirals is complex in

terms of the public health strategy and, considering the lack of capacity

in the country, it is not surprising that we have not managed to establish

a network within a year - it will not take less than three years, " he told

PlusNews.

" I appreciate it [treatment facilities for people living with HIV/AIDS] is

not the best. But the level of implementation is not bad for a country

like Angola: in a post-conflict situation and considering the difficulties

we have in an institutional context, " he said, adding that the government

would shortly expand its ARV treatment from 2,000 patients to between

4,000 and 4,500.

With official figures showing that HIV prevalence in Angola is just 5.5

percent, much lower than in neighbouring countries, humanitarian workers

have long emphasised Angola's " window of opportunity " - a chance for it to

take action to curb the spread of HIV/AIDS.

But conditions are ripe for the virus to spread rapidly. Millions of

refugees are returning home after three decades of civil war and there are

fears they will bring HIV/AIDS with them. Coupled with one of the world's

highest birth rates and widespread poverty, a rapid increase in the

pervasiveness of the virus seems inevitable.

Many observers worry that the scale of the problem has already been

grossly underestimated.

" The official figure of 5.5 percent is much too low: it only takes [into

account] people who have been tested in provincial capitals and, even

then, it only looks at five of Angola's 18 provinces, " said .

" In my opinion, we are going to be nearer to nine percent [HIV prevalence

rate], " Stella said, referring to the upper end of the statistics' error

margin.

The government, supported by UNAIDS, the US-based Centres for Disease

Control and the World Health Organisation, is beginning a countrywide

survey this week to determine prevalence rates and the number and state of

facilities available to treat the disease. The results are due to be

published by the end of this year.

But even in Luanda, where television programmes, theatre groups and

hip-hop hits spread the facts and dangers of the disease, stigma, shame

and denial are still rife.

The reaction of dos Santos' ex-boyfriend, Samira's father, is typical.

Insisting that she contaminated him, he has refused to take an HIV/AIDS

test or change his sexual behaviour.

" His family does not know, neither does his new woman. She is pregnant now

and she and her baby will probably have the virus too, " dos Santos said.

The national plan and organisations like Accao Humana are trying to fight

the ignorance and stigma around HIV/AIDS, but they fear the situation in

the provinces is much worse - figures from the UN Children's Fund show

almost one-third of Angolans have never heard of HIV/AIDS.

Stella said the national strategic plan was trying to take the problem

into account, but urged the authorities to use the capacity and resources

of the international NGO community and civil society.

" Our big objective now is to increase access and open other centres at a

provincial level. That is not easy, but we and the government are trying

to do something, " Stella said.

But many, like , believe time is running out fast. " It's never too

late to do something, but at this moment the resources do not exist. We do

not have the finances or the materials to lower the prevalence of

HIV/AIDS, " he said. " We need to work harder to produce a good result and

while the government plan is a good one, it is moving much too slowly. "

[ENDS]

2 - COTE D IVOIRE: Nurses run checkpoint gauntlet to get medicines for

north

ODIENNE, 30 August (PLUSNEWS) - Battling your way past rebel and

government soldiers to buy medical supplies does not fall under a nurse's

usual job description. But for Sister lia, trying to treat the sick in

the northern half of Cote d'Ivoire, it is an unavoidable chore.

The world's top cocoa producer has been split in two since an uprising in

September 2002 and aid workers and residents say the humanitarian

situation is deteriorating in the rebel-held north of the country.

Sister lia works in the town of Odiennem which has more than 20,000

inhabitants, and can remember the four months of civil war until January

2003 when her health centre took in the war-wounded round the clock.

" During the crisis we were the only place that was open, " the Italian nun,

who is in her 50s, recalled. " People injured in fighting all over the

region came to us and we worked day and night. "

Now some of those same soldiers man the checkpoints along the 600 km road

from Odienne to Abidjan, demanding bribes or unofficial taxes from nurses

making the journey to get medicines for the already cash-strapped clinic.

" Today we have problems getting medicine. We go to Abidjan but at the

checkpoints we always have to pay. Even though we were there for those

people and have stayed, " she said, the anger rising in her voice.

Sister lia has been in Cote d'Ivoire for eight years and runs the

clinic with another Italian nun. Their former colleagues - a doctor and a

midwife - fled to the southern half of Cote d'Ivoire last October, fearing

for their safety.

The United Nations Children's Fund (UNICEF) estimates that 80 percent of

the doctors, nurses and midwifes in the north have fled since the outbreak

of war.

Sister lia went south to recruit new staff and was taken for a spy by

soldiers as she made the journey. A new doctor has now arrived from

Abidjan but the clinic is still waiting for a midwife and has had to

abandon its monthly visits to small villages in the neighbourhood.

Other obstacles have been thrown in the nun's path.

" For days, we have not have a drop of water or a spark of electricity, "

she explained.

Not an isolated case

The health centre's hand-to-mouth existence is not a rarity in northern

Cote d'Ivoire.

A mid-August visit by a United Nations humanitarian team found that most

inhabitants in the rebel-controlled parts of the country lacked basic

health, sanitation, water and education services and recommended that

government workers and civil servants return to the northern and western

reaches of the country more quickly.

UNICEF says drugs and equipment have been looted from hospitals and health

centres and the system for monitoring the outbreak of epidemics has been

paralysed.

Public hospitals in the north can only guarantee a minimal service and

while humanitarian organisations like the International Committee of the

Red Cross and Medecins Sans Frontieres are trying to plug the gaps, it is

not enough.

The main hospital in Bouake, the largest city in the rebel-held sector,

can only deal with the most urgent, life-threatening cases. No x-rays can

be done in Odienne so patients have to travel more than 200 km to Korhogo,

the second biggest town in the north. And in rural villages, many health

centres have had to shut their doors.

In June, the European Union stumped up 3.5 million euros (US$ 4.2 million)

to re-equip health centres in 25 districts affected by war, which were

mainly in the north of the country.

But one northern district health director told PlusNews at the time that

because the government was no longer paying for the upkeep of health

services in areas outside its control, he would have to sell some of the

drugs being provided through the grant in order to cover basic operating

costs.

The UN mission has called for more funds.

" Investment in the health sector is very important, " Abdoulaye Mar Dieye,

the mission leader and UN Humanitarian Coordinator for Côte d’Ivoire, told

reporters in Bouake.

" People are being urged to do what they can to solve the problem of war

but if we don't sort out the problem of HIV/AIDS or the problems with

drugs then it will all be for nothing, " Mar Dieye added.

Cote d'Ivoire has the highest rate of HIV in West Africa, with the health

ministry estimating that 10 percent of the country's 16 million population

is HIV positive. But in some northern areas, the UN mission said, the

percentage of people living with HIV/AIDS was double the national average.

Bad sanitation breeding disease

Water-borne diseases like typhoid are also a problem in a region where the

UN says many people do not have access to clean drinking water because

village pumps are badly maintained. Blocked drains and rubbish dumped with

abandon are aggravating the water problem, residents say.

" About 80 percent of our patients since April are believed to have typhoid

but we don't have the means to test them, " Sister lia said.

And malaria rates are running high, with the rainy season creating a

breeding heaven for mosquitoes. Medecins Sans Frontieres estimates about

50 percent of sick children are suffering from the life-threatening

disease.

The New Forces (FN) rebel group says the government in the south cannot

afford to ignore the north's problems.

" Health and sanitation issues need to be taken seriously. The risks are

not limited to our region, " the FN's human rights officer Mamadou

Coulibaly told reporters

" We're seeing a resurgence of diseases we'd managed to conquer and some of

them could reach the south, " he added, without giving details. " We want an

appeal to be launched for all doctors to come back. The very fabric of the

health system is deteriorating. "

But some residents say the rebels themselves are to blame for the

miserable conditions in which people in the north are forced to live,

whether it be avoiding malnutrition or dodging stray bullets.

With many of their husbands unemployed after businesses were crippled by

the rebellion, the main struggle facing the region's women is how to feed

the family.

The World Food Programme hands out food rations and is also providing

seeds to enable a degree of self-sufficiency in the future. But times are

still tough, say some residents.

" It's been so hard since the crisis, there's not enough food, " 21-year-old

Tene Coulibaly, who lives in Korhogo, told PlusNews.

And then there is the sporadic violence, like the fierce clashes between

rival rebel factions in Korhogo in June, which makes life dangerous for

ordinary citizens trying to eke out an existence.

" There are often stray bullets, " said Fatoumata Coulibaly, a 30-year-old

mother of five who lives in a village outside Korhogo. " Some even make it

into the house and could end up on your bed. But the FN are not bothered

about the population. "

[ENDS]

3 - SOUTH AFRICA: Support and strength from The Tree

ILLOVO, 30 August (PLUSNEWS) - About 300 women and their children gather

every Wednesday beneath a large tree just outside Illovo on South Africa's

KwaZulu-Natal south coast to support and encourage one another in the figh

t against HIV/AIDS.

The tree has witnessed uncountable stories by women who were once victims,

but are today empowered and knowledgeable about the epidemic.

It all started in 1996 when Jackie Branfield, an HIV/AIDS counsellor and

social worker from neighbouring Amanzimtoti, decided to do something about

the large numbers of women in the Illovo district who were being beaten up

because they were suspected of being HIV-positive.

The area around Illovo is deeply rural - most of the women knew little

about the pandemic, and even fewer were aware of their human rights.

In the mid-90s, Branfield met three destitute HIV-positive women who had

been ostracised because of their status. She went with them to the tree,

away from the curious stares of the community, to talk to them about the

virus, how it is transmitted, and about their rights.

The three women knew others who had suffered similar abuse, and the

initiative snowballed. Branfield has involved a number of voluntary

counsellors to assist and now has a register of more than 500 women who

regularly attend sessions at what has become known simply as the " The

Tree " .

Women living in remote rural areas cut off from public transport, or

unable to afford minibus taxi fare, walk up to three hours to reach the

meeting place, explained Sweetness Somi, one of The Tree's voluntary

helpers.

" When I attended The Tree for the first time, everyone was lost in the

mist - nobody knew anything about HIV/AIDS, " she recalled. Since then the

situation has changed and every week the women receive education about the

virus - transmission, prevention and positive living.

" We teach, help and respect each other, " added Somi. " We have nothing much

in life, but together we are strong. "

Since no one learns well on an empty stomach and hunger is often seen as a

more immediate problem than HIV/AIDS, there is soup and bread for the

women and their children. Branfield and her team also organise food and

clothing donations.

" Jackie is like a mother to us, " said Ladyfair from Illovo township, an

unemployed single parent of two daughters and a granddaughter who has been

attending The Tree since 1998. " If there is someone who didn't get

anything that day, if there hasn't been enough for everyone, Jackie will

take off her own shoes and give them to this person. "

A nurse and other volunteers sit on a patch of grass beside the tree and

examine adults and children, treat sores, wounds and other minor injuries

and illnesses in what is commonly called the Tree Clinic.

Cyril Mvuni from the African Christian Democratic Party - one of the first

men to support the group - assists women with filling out and following up

on grant applications. The local politician, who sees himself as " the link

between the people and the government " , said he submits more than 30

applications for women from The Tree every week.

The initiative also recognises the link between HIV/AIDS and abuse, rape,

domestic violence and child molestation, and helping to report cases to

the police and social workers has become an increasingly important task of

The Tree team and the women.

The power of this fairly basic type of support structure is not to be

underestimated. In the past, the police had often sent away women

reporting cases of domestic violence, said Branfield, but now officers

were helpful when they heard that the woman belonged to The Tree. " They

know that - otherwise, 300 women will march in front of the police station

and demand their rights, " she added.

One of the original three women who helped launch The Tree is Khulelaphi

from Sqhingini, a rural village north of Illovo. In 1996, Khulelaphi was a

domestic worker and single parent with eight small children she could not

clothe and hardly feed. She claimed she was paid with food instead of

money.

Khulelaphi's children were in a wretched state, and medical examinations

later found that some had been abused by neighbours while she was at work.

Khulelaphi became The Tree's first major case. Branfield counselled the

woman and her children, brought them to a medical clinic and then to a

police station to report the abuse, and arranged a meeting with a social

worker, as well as food and clothes.

" I realised that there are many more woman like this and that something

had to be done to help them, " said Branfield.

Some people in the community did not like Khulelaphi involving social

workers and police in " their " affairs and burned down her house. Since

then she and her children have been living with a neighbour, as they do

not have the money to rebuild.

Nonetheless, Khulelaphi said her life has improved tremendously since she

attended The Tree for the first time. She has a job that enables her to

feed her family and she knows about AIDS, abuse and how to protect her

children. " Jackie and The Tree helped me so much. They gave me hope to

live, " she said.

[ENDS]

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