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CONTENT:

1 - LIBERIA: HIV help at back of queue in war-battered north-east

1 - LIBERIA: HIV help at back of queue in war-battered north-east

ZWEDRU, 22 June (PLUSNEWS) - When doctors testing blood in this remote town in

north-eastern Liberia discover that a donor is HIV-positive, they keep the

information to themselves. There is nothing else they can do.

" Probably about two out of ten donors for blood transfusions are HIV positive

and it's very frustrating not to be able to tell people, " said Karolina

Claesson, the head nurse from the Medecins Sans Frontieres (MSF) Belgium team

that runs Zwedru's main hospital.

" But we cannot do anything because there's no available counselling and

treatment, " she explained.

" Telling them in these circumstances would only make me feel better. They

couldn't do anything about it, they probably wouldn't be able to talk to anyone

about it because of the stigma and they wouldn't suddenly start using condoms

because that would draw attention to themselves, " Claesson said.

With so much of Liberia's infrastructure destroyed during 14 years of civil war,

international aid agencies and the government are focusing on restoring the most

basic of health facilities.

That inevitably means HIV/AIDS support gets pushed towards the back of the

queue.

And Zwedru is no isolated case.

According to Liberia's National AIDS Control Programme (NACP) there is just one

voluntary counselling and testing centre (VCT) outside the capital, Monrovia.

That is in Gbargna, a provincial market town 200 km to the northeast.

" There is a dire need to reach people in rural areas who are HIV positive and

need care and support, " Lwopu Bruce, the number two at the NACP, told IRIN.

" It's a major concern. "

No-one really knows the scale of the HIV problem in Liberia. The latest figure

from UNAIDS puts the prevalence rate at 5.9 percent of the adult population. But

that estimate dates from 2003 when fierce fighting at the end of the civil war

made much of the country inaccessible.

Zwedru was formerly the headquarters of the Movement for Democracy in Liberia

(MODEL), one of two rebel groups that waged war against former president

in this heavily-forested country.

It also lies about 30 km from the porous border with Cote d'Ivoire, which has

one of the highest HIV prevalence rates in West Africa.

" I think the prevalence here is quite high. It's quite close to Cote d'Ivoire,

it's post-war, there are lots of refugees and other people crossing the border,

there are lots of ex-combatants. The prevalence rate here in Zwedru is probably

about 10 percent, " said Claesson.

MSF has been discussing the possibility of setting up services for people living

with HIV/AIDS. But Claesson explained that given the total devastation of

hospitals and clinks during the civil war, MSF had to start off with basic

health treatment in Zwedru for more widespread diseases such as malaria and

tuberculosis.

Even officials from Liberia's national programme agree that HIV/AIDS is not the

number one health concern as the country struggles to rebuild.

" Malaria is the leading cause of mortality in this country, " Bruce, the deputy

head of NACP said.

" Of the US $24 million dollars granted to Liberia by The Global Fund, half of it

has gone on malaria and the rest is split between HIV/AIDS and tuberculosis, "

she noted.

Lack of doctors and nurses

Claesson, in Zwedru, told a similar tale.

" Our biggest problem is malaria, " she said. " MSF has been putting its resources

into the hospital because basic health care is what you need here. It's a

post-war country, there had been no proper healthcare in Zwedru until we came

in. There are hardly any doctors and nurses up here. All the educated people are

in Monrovia. "

It has been almost two years since peace finally returned to Liberia in August

2003. But the capital Monrovia is still without mains electricity and running

water and those in rural areas know they face an even longer wait for public

services to reach them.

" We hope that the moment we have basic health services really working again, we

can start to strengthen the HIV/AIDS programmes, " Bruce said.

But Liberia still has a long way to go before that happens.

If MSF were to pull out of Zwedru, for example, health care in the town would

most likely shudder to a halt. The 2,500 outpatients treated free-of-charge at

the hospital each month would have nowhere to go.

" Money-wise the government is not in a position to run the hospital. They would

not have enough money to pay salaries or buy drugs, " Claesson said.

Until Liberia's health infrastructure has been repaired and funds become

available for testing, counselling and treatment, the fight against HIV/AIDS

will focus on prevention, rather than treatment.

But again, resources are limited.

In Zwedru there are two billboards emblazoned with pictures and slogans

promoting condom use, but the one in the market square has fallen off its hinges

and its message faces the ground.

And talking to local residents, the scale of the task facing AIDS campaigners

becomes clear.

" This sticking to one partner, what's that all about? We go all around here, we

don't stick to one place, we move about, " said one 45-year-old man who would

only give his name as Jalue. " I use a condom in some cases, but sometimes you

like flesh on flesh contact. "

Aid workers acknowledge they have their work cut out, even at the education

level.

" MSF hands out free condoms, but only maybe about five percent of people take

them and I don't know how many of those actually use them, " Claesson said.

There is also a limit to the extent that you can educate people if you can't

offer them more substantial support, she noted.

" You can start to talk to people about sexually transmitted infections and using

condoms, but you cannot go into detail about HIV when you can't follow it up, "

Claesson said. " It's a tough call. "

[ENDS]

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