Côte d'Ivoire

Ivorian war spurs West Africa's AIDS nightmare

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By Matthew Tostevin

BOUAKE, Ivory Coast, Mar 3 (Reuters) - "The girls all love us because of what we are fighting for," laughs Ivory Coast rebel fighter Mantou Cisse, surrounded by young female admirers.

"Worry about AIDS? There is no AIDS in Bouake," he says confidently in a rebel stronghold where young men with guns now lay down the law.

But there is AIDS in Bouake.

In fact it was one of the more heavily affected parts of the West African country before a war blew up last September and changed what was once a haven of stability into bloodshed and chaos.

Now the conflict threatens to encourage the spread of the HIV virus that causes AIDS and put yet another seal on Ivory Coast's hopes of ever regaining its place as a prosperous exception in a region of turmoil and despair.

Just as dangerous, the war could help fan the crisis in a part of the worst affected continent that has so far got off fairly lightly compared to southern or east Africa.

"Ivory Coast was already the country with the highest rate of infection in this region," said Pierre Mpele, the head of UNAIDS for West and Central Africa.

"Crisis situations help to spread HIV/AIDS and if it continues any longer then we fear that we will start to see an impact in the region because of the movements of people."

Ivory Coast, which drew millions of immigrants in search of its relative riches, has infection rates estimated at 10 to 12 percent of the sexually active population.

As Ivory Coast's second city, a crossroads, market centre, garrison and student town, Bouake had more sufferers than most.

In a sign of what is happening elsewhere, efforts both to look after sufferers and prevent the transmission of the virus have broken down.

NO CONDOMS

"There are no condoms in town even if people want to use them and people cannot hold on forever. There is no money for campaigns to persuade people of the dangers," complained Penda Toure, who runs an AIDS project in the city.

Before the war, Toure's Centre for Solidarity and Social Action was helping over 900 families, one or more of whose members was infected. Since the fighting erupted it has only been possible to establish contact with 268.

Most sufferers either fled to the main city of Abidjan or scattered back to their villages and might now be off spreading the virus again -- there is concern that infected prostitutes might have little choice but to sell their bodies again.

"The war is a catastrophe for those of us with HIV," said Sidibe Brahima, a former trader who has known he was infected since 1995, emphasising his point with trembling arms weakened by suffering.

"The people who were caring for us have run away themselves, we have no food, no help."

The sudden breakdown of society in the country of 16 million has created conditions for the virus to spread even if a truce has stopped most of the fighting between President Laurent Gbagbo's loyalists and rebel fighters.

"The crisis makes the young and women particularly vulnerable," said Mpele.

"The health infrastructure is gone in some areas, there is violence, there is an increased likelihood of rape and the behaviour of young people has changed because of the war and has put them at greater risk."

INFECTION NOT A CONCERN FOR MANY

Infection with a virus that could lie dormant for years is not a major concern for people worried about where their next meal is coming from or for fighters fearing that battle might resume at any time.

In Bouake, young women hang out at checkpoints with the rebels, now among the few to have spare money in a part of the country where the economy is stuttering to a halt after five months of fighting and peace talks.

From the west of the country, where the army is engaged in sporadic fighting against two rebel factions and allied Liberians, there have been reports of rapes by combatants on both sides.

Meanwhile, more than one million people have been driven from their homes and now find themselves with little means of support, something that aid workers fear will lead to an increase in prostitution.

That mass dislocation threatens to spread the virus not only inside Ivory Coast, but to less-affected neighbouring countries like Ghana, Mali and Burkina Faso, which suddenly find themselves host to returning migrant workers and refugees.

The lesson from nearby Sierra Leone is a sober one. Before its decade of savage civil war, the HIV infection rate was estimated at below one percent. Now it is thought to be above seven percent in some areas.

"We have the impression here not that we are not going back to zero, but well below zero," said Toure.

Reuters - Thomson Reuters Foundation
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