Your daily Selection of IRIN Africa PlusNews reports, 1/18/2005

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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 - BOTSWANA: Countering stigma isn't easy

2 - COTE D IVOIRE: Condom Cafe at front-line of awareness campaign

3 - GUINEA-BISSAU: First ARVs arrive, but no-one trained to prescribe them

4 - KENYA: Fight against HIV/AIDS bearing fruit, but challenges remain

1 - BOTSWANA: Countering stigma isn't easy

GABORONE, 17 January (PLUSNEWS) - When Tebogo Masilo obtained a bursary to

study archaeology in the United States he was overjoyed, but it didn't

last long. As part of its regulations, the government demands an HIV test.

" The results confirmed that I was positive and I did not get the

scholarship, " Masilo, 24, recalled. " They could not make an investment in

me. "

Despite the existence of anti-discriminatory laws, the Botswana government

introduced mandatory testing for overseas bursary holders about two years

ago, but students wishing to attend the University of Botswana and other

local higher education institutions are not tested.

The move has been criticised by activists, who say it entrenches stigma

and is all the more disappointing from a government that has been so

proactive in the fight against AIDS.

" The argument that mandatory testing is a necessary provision in avoiding

costs incurred by government from students who die abroad, due to HIV,

lost its validity when the government provided free [antiretroviral] ARV

therapy for all Batswana, including those studying abroad, " said Milikani

Ndabe of the Botswana Network on Ethics, Law and HIV/AIDS.

" By rejecting people who test HIV positive, we are saying that they are

outcasts and not fit to be incorporated into society, " noted Dr Dinesh

Patel, a private medical practitioner. " This is not the best way to deal

with the problem. We need a comprehensive policy to help curb the disease,

rather than draw the line between those who have the virus and those who

do not. "

Masilo's problems did not end with the loss of his bursary. He secured

three promising job offers in Botswana, only to have them revoked,

apparently when the employers discovered he was HIV positive - as are

close to 40 percent of all Batswana.

On paper, the Promotion of Equality and Prevention of Unfair

Discrimination Act, promulgated in 2000, outlaws discrimination based on a

person's HIV status.

But, Ndabe pointed out, " what is lacking is a monitoring mechanism " to

give the law teeth. The stigma surrounding the virus also means that some

victims of illegal dismissal have preferred to keep quiet, rather than

attract publicity by challenging the companies concerned.

An initiative to draft a new policy on HIV/AIDS and employment, which will

ultimately form the basis of future legislation, is being undertaken by

the ministries of labour and home affairs, said Ndabe.

In the meantime discrimination persists, and among the hardest hit are the

least-qualified workers and migrant labour. " The practice still continues

in informal sectors, such as domestic employment, " said Oganeditse Marata,

a lawyer based in Selebi Phikwe, a mining town north of the capital,

Gaborone.

Joni, a lawyer with the AIDS Law Project, said an enlightened -

and, in the long run, cost-effective - response from companies would be to

provide treatment and support to their HIV-positive employees.

" Companies can reduce their costs by investing in HIV prevention

programmes designed to reduce the incidence of the disease in their

workforce, " Joni noted.

The insurance industry was also ripe for reform, she pointed out.

Despite a national treatment programme, HIV-positive people are

handicapped when applying for financial assistance. Banks require loan

applicants to hold life insurance policies covering the value of the loan,

but life insurance companies require HIV tests as a prerequisite for

coverage and legally reject those who test positive.

The insurance industry still clings to HIV testing, notwithstanding

anti-discrimination legislation. As in South Africa, insurance companies

want to be exempt, arguing that compliance would cripple business.

" People living with the disease cannot get a home loan to break free from

the discrimination they suffer in their family's homes, " said Mogapi

Dineo, a counsellor at the Kopano Women's shelter project, which caters

for abused women, some of them living with HIV/AIDS.

Most of the residents of the Coping Centre for People Living With AIDS

(COCEPWA) in Gaborone have sought refuge there from the stigma attached to

the disease.

" The society thought that we had got the virus because of being

promiscuous. My family isolated me after I went public about my status, so

I decided to come to COCEPWA, " said Alice Moema.

She believes that the only way to fight AIDS in Botswana is to build a

movement of people living openly with the virus.

" People are now somehow very scared because of this situation, and we can

understand it. If people are going to be encouraged [to come out], they

have to have the support, " Moema remarked.

" It is time that men and women in the first world, who are HIV positive,

start establishing partnerships - just like governments do, " she said. " To

me, that's the most practical way to eliminate stigmatisation and

discrimination. "

[ENDS]

2 - COTE D IVOIRE: Condom Cafe at front-line of awareness campaign

ABIDJAN, 18 January (PLUSNEWS) - At the Condom Cafe in Abidjan, customers

don’t get after-dinner mints with their bill. Instead they leave with an

AIDS goodie bag, complete with red ribbon, a leaflet about the disease and

a free condom.

The cafe, known by the locals as Kpote Kiosque, has been serving up snacks

and safe sex for the last three years in Adjame, a run-down suburb of Cote

d’Ivoire’s main city Abidjan.

From the outside it looks like any of the open-air 'maquis' restaurants

found on many a street corner in the city. The only hint of anything out

of the ordinary is a faded red ribbon painted on the roof.

Once inside, however, the décor starts to offer more clues.

Dotted between the regular adverts for Coca-Cola and Flag beer hanging

from the ceiling, empty condom packets sway in the breeze. Stacked up in

one corner of the counter are wooden penises. And painted across the bar

is the slogan " Don't have a condom? Keep your pants on. "

Kpote Kiosque is not just about free condoms. It aims to raise the

public's awareness about HIV/AIDS via its trained team of young waiters

and waitresses, some of whom are HIV-positive themselves.

It also provides an informal setting for young people to seek advice about

testing and treatment.

" You don't feel like it's being forced in your face. It’s a very relaxed

atmosphere, " said one customer, who gave his name as Herve.

And even for those who know all there is to know about HIV/AIDS, there is

still a reason to come - to help raise funds for grassroots AIDS projects.

" Everyone's a winner. We eat the great food and they get much-needed

cash, " Koua, one 27-year-old diner, said between mouthfuls.

" It's not a case of making a one-off donation and that's that. Each time

you are hungry, you have the chance to help, " the bank clerk, who works

round the corner and is a regular customer, told PlusNews.

The small café, which pulls in an average of 70 customers every lunchtime,

has been such a success that it is about to be copied in three other West

African countries.

But it is in Cote d’Ivoire, which has the highest prevalence rate in West

Africa, that the fiercest fight against the epidemic has to be waged.

The last government survey put the prevalence rate at 9.5 percent.

However, after almost two and a half years of civil war, many health

workers fear that the disease has made much greater inroads.

<b>Cutting through misconceptions</b>

Debunking the myths, tackling the taboos and educating people about how to

protect themselves is a crucial part of the fight against HIV/AIDS here,

and a visit to the café at the end of the lunchtime rush shows why.

A group of builders have polished off the last of their food, oblivious to

the theme of their chosen cafe. When the free condoms arrive with the

bill, eyebrows are raised.

" People are always saying 'Use condoms and you won't get AIDS' but people

are using them and the AIDS problem is getting worse. I think it's maybe

got something to do with the condoms, " one of the men remarks to the

waiter.

The waiter, cracking jokes as he goes, explains condoms do protect you

against HIV, but problems can still arise if people fail to use them

properly.

According to the café’s manager, Olivier Kouassi, it's a scenario that is

played out regularly.

" People are often surprised when we put the condom on the table. Some even

get embarrassed and try to knock it onto the floor. But in the end, it

usually arouses their curiosity and sparks a conversation, " he told

PlusNews.

" And that's the key thing - we need to get people talking about this, " he

added.

The scale of the AIDS problem in Cote d'Ivoire is something that has

touched Kouassi personally. One of his best friends died of AIDS in 2004.

Just this month, he took another cousin to get tested.

The Kpote Kiosque where he works is the brainchild of an Ivorian

non-governmental organisation, Ruban Rouge (Red Ribbon). Buoyed by the

cafe's success, the group are about to open a branch in the Abidjan suburb

of Niangon.

<b>Model for other countries</b>

And the venture has captured the imagination further afield too, with

Kpote Kiosques set to be unveiled in Senegal, Niger and Benin by March.

The Paris-based aid agency Equilibres & Populations, which helped Ruban

Rouge get the first cafe up and running, is footing the bill and

co-ordinating the regional pilot programme which will run until the end of

2006.

The overall start-up budget for the four new cafes is around 300,000 euros

(US $393,000). That includes money to look at the impact each

establishment has on the local community, something which has only been

done on an anecdotal basis at the original cafe in Adjame.

" We've had people coming into our main clinic, and when they were asked

where they'd heard of Ruban Rouge a few of them mentioned the cafe, " said

the group's president Marius Boka. " But we've not kept figures on it. "

Aurelie Gal, the project co-ordinator for Equilibres & Populations, says

the regional project will go one step further by keeping track of which

customers go on to seek advice at a clinic or get tested. It will also

track public perceptions in the neighbourhoods where the cafes are based.

" In urban areas ... circumstances can encourage people and especially the

young to adopt a sexual behaviour that carries certain risks, " Gal told

PlusNews by phone from Paris.

Fifteen to 24-year-olds currently account for half of all new HIV

infections, according to JADE, the regional youth network to which the

African groups managing all four of the planned new cafes belong.

" Local youth associations are often the catalyst for innovative

preventative initiatives, " Gal explained. " And the fact that the Kpote

Kiosque structure generates its own revenues, means the association can

continue to run its projects in the long-term without having to depend on

outsiders. "

The Kpote Kiosque in Adjame, for example, not only makes enough money to

pay the rent, the bills and its staff's wages to keep the interactive

awareness campaign running. There is also a small profit at the end of

each month.

While 70,000 CFA ($140) a month might seem paltry by western standards,

Ruban Rouge's chairman explains how the money allows them to pay for

antiretroviral (ARV) drugs for hardship cases who end up at the group's

clinic.

The cost of three months of ARV treatment in Cote d'Ivoire was slashed to

just 5,000 CFA ($10)last year, so via the Kiosque, the group can pay for

treatment for more than 40 people every year.

If the cafes in the big cities of Dakar, Niamey and Cotonou can repeat the

success of the original fast food and free condom formula, smaller towns

across Senegal, Niger, Benin and Cote d’Ivoire could soon see a branch

springing up on their doorstep.

And Equilibres & Populations say Chad, Mali, Guinea and Togo might provide

fertile ground for a second wave of expansion.

Back at the original Adjame branch in Abidjan, manager Kouassi, has just

one word of advice.

" You need to have plenty of condoms. Sometime the idea almost works too

well, " he laughed. " We give people one and they want the whole packet. "

[ENDS]

3 - GUINEA-BISSAU: First ARVs arrive, but no-one trained to prescribe them

BISSAU, 18 January (PLUSNEWS) - A first consignment of antiretroviral

(ARV) drugs for people living with AIDS has arrived from Brazil for

distribution free of charge to people living with AIDS in Guinea-Bissau.

However, local doctors and nurses have not yet received training in how to

use the drugs and will be reliant on medical manuals to learn how to

prescribe them.

The first consignment of 170 kg of ARVs provided by Brazil under an

agreement to help control AIDS in Guinea-Bissau, was delivered by

Brazilian foreign minister Celso Amorim during a brief visit to the

capital Bissau on Saturday.

Guinea-Bissau's health minister Odete Semedo said distribution would begin

immediately and the drugs would be offered free of charge. She declined to

say how many people would benefit from ARV treatment, but estimated there

were nearly 43,000 HIV-positive people in this small West African country

of 1.3 million inhabitants.

Several doctors and nurses from Guinea-Bissau were due to visit Brazil to

receive training in antiretroviral therapy last year, but they have not

yet left. Semedo said local medical staff would therefore use manuals sent

with the first consignment of drugs to determine who should receive ARV

drugs and in what dosages.

Costa Ribeiro, executive secretary of the Associacao Nova Vida (New

Life Association), a self-help group for people living with AIDS, said he

was overjoyed by the arrival of the drugs.

" Our hopes have been raised a great deal by the the arrival of these

medicines, but we still don't know how they are going to be distributed, "

he told PlusNews.

The association, created in 2002, claims 245 members, including health

minister Semedo and other well-wishers who are not themselves HIV

positive.

It meets twice a week at an AIDS testing and counselling centre in Bissau,

but Costa Ribeiro said that so far the association had not received any

financial support from the government.

Until now, antiretroviral therapy has not been available at all in this

former Portuguese colony. However, some people living with AIDS have

obtained treatment in neighbouring Senegal, where ARV drugs are prescribed

free of charge to those who need them by the government.

Costa Ribeiro complained that many people in Guinea-Bissau still refused

to take AIDS seriously. " The worst thing is that some people don't believe

in the existence of the disease. There are even doctors who doubt its

existence, but they should know that it really does exist and there is no

lack of proof that it does, " he said.

[ENDS]

4 - KENYA: Fight against HIV/AIDS bearing fruit, but challenges remain

NAIROBI, 18 January (PLUSNEWS) - Kenya's campaign against the spread of

HIV/AIDS is bearing fruits, but more needs to be done to help those

vulnerable to infection and those affected by the disease, a top UN

official said.

" Kenya has made good progress in the fight against AIDS - infection rates

are falling, " Piot, the executive director of UNAIDS said during a

joint news conference in Nairobi.

Kenya's success, he added, was partly due to " strong leadership within the

government " . Calling for better coordination of efforts by the government,

donors and the civil society, he noted that that 1.2 million Kenyans were

living with the virus.

" Many people are dying and for every adult who dies, many children are

left behind, " Piot said.

Kenya has 1.8-million children orphaned by the epidemic, according to

Linah Kilimo, the minister of state for home affairs. The HIV prevalence

rates declined from 13.6 percent in 1997 to 7 percent in 2004, according

to official figures.

During his two-day mission in Kenya, Piot, who was accompanied by senior

officials from the World Bank, Britain's Department for International

Development (DFID) and the Norwegian foreign ministry, met with government

officials, civil society representatives and other donor agencies to

discuss ways to strengthen the response to the country's HIV/AIDS efforts.

" Opportunities include ensuring that prevention efforts targeting young

people, and in particular young women, are scaled up to ensure further

declines in HIV prevalence, " the mission said in a joint statement.

Suma Chakrabarti, DFID's permanent secretary, emphasised that what Kenya

had achieved was " progress and not victory " , adding that the government

needed to take a more vocal approach in relations with donors.

" The government should be in the lead with the donors supporting them and

not the other way round, " said Chakrabarti.

Piot told reporters there was a need to ensure that funds earmarked for

the anti-HIV/AIDS campaign were kept in " one basket " to minimise the

possibility of national priorities being disrupted by funding shortfalls.

There was also a need to ensure that prevention and treatment programmes

complement each other, while making provision for the increasing number of

children orphaned by AIDS, he noted.

Kenya's health minister, Charity Ngilu, said that 240,000 HIV positive

Kenyans were in need of antiretroviral (ARV) treatment, adding that the

government was making efforts to increase the number of patients receiving

the drugs from a current 24,000 to 95,000 by the end of the year.

Her ministry, Ngilu added, would soon hire 4,000 extra health workers to

help administer ARVs to those who needed them, so as to help slow down the

rise in the number of orphans.

Kilimo said that her ministry's policy now was to encourage communities to

take care of orphans and vulnerable children. " We need to support

communities to take care of their orphans, " she said.

[ENDS]

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