Niger
Niger recognises failure in fight against AIDS

afrol News, 2 November - "Niger's response to date to the HIV/AIDS pandemic has been slow, weak, uncoordinated and, at best, only marginally effective," a government paper recognises. Various efforts since 1987 had not prevented a rapid spread of the disease, and now, up to 5.5 percent of pregnant women (in Tahoua) are HIV positive.

According to a paper by the Nigerien Direction of the National Programme to Fight AIDS (PNLS), the government was looking back at a "poor performance" in its AIDS campaigns during the last 15 years. The PNLS paper sums up the past and present in Niger's fight against AIDS while defining a new and "broad-based multisectoral" HIV/AIDS Programme for 2002-2006.

Explaining these general failures to fights HIV/AIDS, the Directorate especially blames poor organisation. In October 2000, government had moved the National HIV/AIDS Program out of Ministry of Health and attached it to the Office of the Head of State, both to demonstrate high level commitment to the Program as well as to improve Program coordination and performance. 

- While the intention was good, and the need for improved performance clearly justified, the result was less than satisfying, the paper admits. "Key technical staff and technical functions were moved out of Ministry of Health and into the President’s office, which would have been better left in a technical Ministry (e.g., epidemiological surveillance, procurement of drugs, contraceptives and other medical/laboratory consumables)." 

This had left the Ministry of Health, a most important player in the Program, "incapacitated and demoralised." Roles and responsibilities were never clearly defined or adequately discussed with the multiple stakeholders at all levels of government and in civil society; and the location of the Program in the Office of the President "did not give it the needed flexibility to carry out an effective coordination function and to be truly operational." 

Prevention failed
There were also many technical reasons for the uncoordinated projects since 1987 not to have an effect. With regard to AIDS prevention, communication for behaviour change had not been adequately designed and targeted to specific, high-risk populations. Inadequately tailored messages, where they do reach people, had been inconsequential in changing behaviour. Condoms were in very short supply throughout the country. 

Blood transfusion was the national and regional hospitals and in some district hospitals, but ruptures in essential supplies occur and donors are not informed if they test positive for HIV. Health workers were not provided with sufficient training or materials to prevent their exposure to HIV positive patients and there is a need to design and implement transmission prevention in other workplaces, such as barbers and those that practice excision. 

Availability of voluntary testing services is limited to Niamey, the capital. There is as yet no activity to prevent mother-to-child transmission and there was "an urgent need to prepare guidelines and a program for the integration of this activity into maternal and child health services."

Also the treatment and care of HIV/AIDS patients has been "inadequate". This was mostly due to poor supervision and training of staff, high cost of care and treatment, lack of a national policy on care and treatment of HIV/AIDS patients and on related laboratory services and great difficulty on the part of health staff in informing patients of their HIV positive status. 

Ignorance and sociocultural norms and pressures had undermined considerably the organisation and implementation of preventive activities. This included the "low status of women, risky sociocultural practices, such as excision, early marriage, sexual taboos, fundamental religious beliefs that resist critical preventive strategies, such as the use of condoms and sex education for youth." 

High risk behaviours were therefore still common. The paper names practices such as "multiple sex partners, unprotected sex, and widespread prostitution, encompassing professionals as well as informal/occasional prostitution."

The results have been an elevated HIV prevalence. A thorough epidemiological survey on HIV/AIDS in Niger is currently being carried out, but existing statistics already indicate that HIV prevalence has grown rapidly in the country over the last decade. Seroprevalence rates for pregnant women are known from some major urban centres, and indicate an all over HIV prevalence between 2 and 6 percent. The highest numbers have been measured in the district of Konni, which is on the border with Nigeria.

New efforts
The Directorate is now embarking on a US$ 22 million programme for the period 2002-2006, which is aimed at repairing some of the described ills and create clearer responsibilities. The programme, adopted by the Nigerien government in May, is to "scale up, expand and improve prevention activities in an effort to lower the risks of transmission," according to the paper.

Apart from reorganising the coordination of the fight against AIDS, many structural problems lay ahead. Niger is the world's second poorest country and the health infrastructure - in particular basic mother and child health indicators - are among the worst in the world. 

A strong health system is however recognised as "the foundation for sustained success against HIV/AIDS." The health system bears significant responsibility for care and treatment, plays the pivotal role in many preventive activities, and endures the greatest impact of any sector on its staff and operations. Therefore, the Nigerien government envisages a general strengthening of the Ministry of Health and the entire health sector.

The government programme to fight HIV/AIDS currently is under-financed, according to the Directorate. The Nigerien government, which has allocated only US$ 2 million for this ambitious project, is currently applying for World Bank funds to finance the missing US$ 20 million of the four-year programme.

Sources: Based on Nigerien govt, World Bank and afrol archives

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