Low HIV prevalence not a problem? Think again

Coverage of Aids in Africa typically focuses on the dire situation in countries south of the Sahara, which are home to almost two thirds of people infected with HIV globally, according to the Joint United Nations Programme on HIV/Aids (UNAids).

But what of the countries that lie further north and along the Mediterranean? In the case of one of these nations, Algeria, concern about the pandemic is mounting — even though statistics suggest little cause for alarm at first glance.

Figures posted on the UNAids website from the end of 2003 put adult HIV prevalence in Algeria at less than one percent — 0,1% to be exact. According to data from the Ministry of Health, Population and Hospital Reform, the number of HIV-positive people in Algeria was last month estimated at 20 000 — this out of a population of almost 33-million.

However, the latest Aids Epidemic Update, issued last month by UNAids and the World Health Organisation, notes that “Algeria recorded twice as many new HIV cases in 2004 (266 diagnoses) compared with the year before. This might herald a surge in the country’s hitherto small epidemic, which is still inadequately surveyed.”

This statement echoes the sentiments of Ouzariad Boualem, a doctor who works for the National Committee for the Fight Against Aids, who says that HIV statistics “do not accurately reflect what’s really happening” as infected people rarely visit the appropriate health facilities. The actual numbers, he adds, may be ten times as high.

In part, the reluctance of Algerians to confront Aids has been ascribed to fear of condemnation under Islam, the country’s main religion.

“A youth with Aids is very poorly viewed, because Algerian society believes he’s transgressed the teachings of Islam which prohibit sexual relations before marriage,” says Mouloud Muadhan, an Islamic preacher from the coastal region of Tizi Ouzou.

The extent of the stigma surrounding Aids was further highlighted by an HIV-positive man who said: “When I first heard about Aids, I thought it was just a joke. Now that I have the virus I live in constant fear, and I know many people who refuse to even talk about it,” he said.

Matters have scarcely been improved, say government officials, by the confusion arising from contradictory figures on HIV from various government departments that deal with Aids, and poor co-ordination between organisations fighting HIV.

As the 2005 Aids Epidemic Update notes, “Modes of transmission are unknown for almost three quarters of the 1721 official HIV diagnoses made by end-2004, making it difficult to pinpoint the routes of transmission…”

In addition, the administration bemoans a lack of international assistance in curbing the spread of HIV.

A detailed study of all Aids cases is presently underway, which should provide a more reliable picture of the extent to which the virus has taken hold in Algeria. Pending the results of this study, one trend that is clear relates to the link between HIV and prostitution — particularly in the south of the country, where infection rates appear to be substantially higher than elsewhere.

According to the Aids Epidemic Update, “The highest infection levels recorded to date have been among sex workers: 1,7% in Oran, in the north, and as high as nine percent in Tamanrasset, in the south, where it has risen sharply from the two percent found in 2000 …”

A young prostitute from the capital, Algiers said that “Many customers prefer relations without protection, just as a ‘matter of taste’, they say. Such demands sometimes force us to yield to their wishes, exposing us to the disease.”

Similar words came from another sex worker. “Sometimes they just don’t want to listen,” she noted. “They arrive overexcited and want to satisfy themselves in complete abandon.”

The use — or not — of condoms is also related to the fees that clients are prepared to pay.

The Aids Epidemic Update further notes that “military personnel and migrants” also appear to be more likely to contract the virus in Tamanrasset. Overall, the majority of infections seem to take place during heterosexual intercourse.

In an effort to broaden the fight against Aids, Amar Tou — the Minister of Health, Population and Hospital Reform — announced last month that 42 new testing centres would be opened in Algeria during the first four months of 2006. Six centres have already been set up, providing a service that is voluntary, anonymous and free.

“We are going to make sure that each wilaya [prefecture] has its own testing centre,” said Tou. There are 48 wilayas in Algeria.

Care for people who are battling Aids-related diseases is also provided free of charge, at public hospitals. Ali Ibrir, vice president of Izuran Tmurt, an anti-Aids group, estimates that almost 2 000 people are currently in need of treatment. According to the health ministry, about 20 cases of full-blown Aids are recorded each year.

In addition, an Aids prevention and awareness campaign was held in Algeria during November and December last year, when posters and publicity flyers were distributed throughout the country. — IPS

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