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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

      

AIDS/HIV IN SIERRA LEONE: THE KILLER IS ALREADY IN OUR MIDST

http://www.focus-on-sierra-leone.co.uk/AIDS_Comment1.htm

 

NOW, at last, we can openly discuss it. HIV/AIDS is no longer a taboo subject in Sierra Leone. There are believed to be tens of thousands of our citizens carrying the HIV/AIDS infection. It is conservatively estimated that in 1999 over 8,000 people died from full-blown AIDS. Now we are told that a significant proportion of recruits in the new Sierra Leone army and large numbers of former and possibly current members of the peacekeeping ECOMOG/UNAMSIL contingents in Sierra Leone were, or are, carriers of HIV. Some people have speculated further that a similar situation exists among the rebel army and in rebel held areas.

The killer disease has certainly arrived, and has been in Sierra Leone for a long time.

Focus on Sierra Leone will be quick off the mark. But in doing so, we have to confess a sense of shame and failure in having had to wait this long to comment publicly on the incidence (or not) of AIDS in the country. We would be less than truthful to say that we did not suspect it all along. Rumours have been circulating for some time and have intensified in the last five years, that the disease was fast becoming the country's number one killer. Both official secrecy and a disarming fixation for Sierra Leoneans to appear ‘holier than thou’, i.e. it can't happen here, had conspired to discourage public discussion of the subject till now. 

 

The truth is that Sierra Leoneans in general have kept quiet about the incidence of this affliction in their midst for a long time. Few have been brave enough to raise public alarm over it. But if ever there was a good case for openness with the public, this is one that has been begging persistently for the voice and utterance of the experts' tongue. It is only through experts that the lid of official secrecy can be removed from the festering cauldron harbouring the dreaded killer disease.

Although one has occasionally heard some medical doctors privately express their concerns about the spread of the disease, the average Sierra Leonean has been led to believe that the many deaths occurring in their midst, which are painful (especially for the victim’s relatives) to watch and have been preceded, in most cases, by the physical wastage and progressive emaciation of the victims, were caused by diarrhoea, pneumonia, malnutrition, hunger, worries, etc, etc. The 'A' word was never mentioned openly, even when post mortems in some cases allegedly attributed the cause of death to AIDS.

We do not possess any expertise on HIV/AIDS but we will nonetheless join others to initiate the process of creating awareness of its presence among our citizens. Thank God, someone has kindly obliged. The article in the UK Guardian newspaper (see below)

War injects Aids into the tragedy of Sierra Leone

James Astill in Freetown
Guardian

Saturday May 12, 2001

Britain's efforts to rebuild the Sierra Leone army are being seriously threatened by the spread of HIV/Aids, with a test sample indicating that as many as two of every three SLA soldiers could be infected with the virus, according to an unpublished UN report.

The study, expected to be released in two weeks, suggests that in conditions created by a 10-year civil war Aids has exploded in Sierra Leone. It raises the prospect of west Africa becoming as serious affected as south and east Africa.

According to the report, commissioned by the World Health Organisation (WHO) and Sierra Leone's health ministry, 1,000 of 1,500 male Sierre Leonean soldiers and would-be recruits sampled in the past three years tested positive for HIV.

But because many of the men in the sample were sent for testing only after showing symptoms, the infection rate of the army as a whole could be substantially lower. Even so, it is believed to be many times the national rate, which is just below 3%.

Major James Samba, chairman of the HIV/Aids committee for the armed forces - established by the Sierra Leone army (SLA) and a British army medical team working alongside it - estimates that between a quarter and a third of the 12,000 men in his country's army are HIV positive.

"History is littered with examples of armies falling apart for health reasons, and at this early stage the health of the SLA is fragile," Colonel Kevin Beaton of the Royal Army Medical Corps said in Freetown yesterday. "It's a problem we're struggling to come to terms with. There could be a substantial number of deaths around the corner."

Distracted by a war which has twice overrun the capital, Sierra Leone has no national Aids policy; it has received almost none of the £350m earmarked by the World Bank to combat the virus in Africa.

"We've done absolutely nothing, we have no policy. It's a disaster," Maj Samba said. "There will have to be a continuous high level of army recruitment because of this disease".

A year ago, the UN Aids agency said less than 3% of Sierra Leone's 5m people were infected, making it one of Africa's least infected countries. West Africa, with the exceptions of Ivory Coast and Nigeria, has been the last corner of sub-Saharan Africa relatively unscathed by the Aids epidemic. Whereas more than a third of Botswanans are HIV positive, and up to a quarter of Kenyans, west African countries such as Niger, Mauritania and Senegal have infection rates hovering around 2%.

But the fortunes of war in Sierra Leone - more than half of the population is displaced or has fled to neighbouring countries; and the rebel army uses rape as a weapon - may have changed the imbalance.

The war has also brought thousands of peacekeeping troops into Sierra Leone. Heavily infected states from which they have been drawn include Zambia, Kenya and Nigeria.

One study found that of 800 of these troops tested for Aids (mainly Nigerians), 700 proved positive - though again, the test was given only to those soldiers showing symptoms.

Nobody knows what the Aids level is among the rebels. But Major Olu Cleeve, chief medical officer at Freetown's only military hospital, which until recently had no electricity or running water, let alone Aids drugs, believes the infection rate among the rebels is unlikely to be lower than the army's. "Frankly, I don't suppose they care about such things."

As for non-combatants, "Aids in the civilian population could be on a par with the army", Maj Samba said. "There is the possibility of seeing the same situation here as in east or south Africa." The French agency Médecins Sans Frontières has reported that of 1,862 women abducted during the Revolutionary United Front's offensive on Freetown in January 1999, 55% had been repeatedly raped.

which appeared on Saturday, 12 May 2001 could not have been better timed. It provides an opening salvo to more open discussions of the matter now and in the months to come. It explicitly, and candidly for the first time, describes the situation in the country and raises important issues for the government of Sierra Leone, civil society and the international community, which has been the dominant player since 1997. We also understand that a more detailed report is soon to be released by the UN.

In fact, our own research shows that, quite aside from the article in the Guardian, there had already been information at the end of 1999, which indicated a serious trend pointing towards creeping dangers for Sierra Leone with regard to the HIV/AIDS infection. This information-see below

 

DATA AS AT END 1999

Estimated number of adults and children living with HIV/AIDS

These estimates include all people with HIV infection, whether or not they have developed symptoms of AIDS, alive at the end of 1999

Adults and children : 68000 of which:

Adults (15-49)       65000 (Adult rate (%) 2.99)

Women (15-49)     36000

Children (0-15)     3300

Estimated number of adults and children who died of AIDS during 1999:  8200

Estimated number of orphans:

(1)                 Estimated number of children who have lost their mother or both parents to AIDS (while they were under the age of 15) since the beginning of the epidemic: Cumulative orphans 56000

(2)                 Estimated number of children who have lost their mother or both parents to AIDS and who were alive and under age 15 at the end of 1999:  Current living orphans 36456

has been available for anyone concerned enough, but we are not sure if our government ever used it to mount a campaign of awareness among the population.

There are reasons why public reticence about HIV/AIDS is so sharply pronounced in our communities. One is the fear of being stigmatised. Obviously, in addition to the ignorance that exists about the disease, there is also the fear of the social stigma that will attach to a victim, their family and immediate circle of friends and associates. Such is the pervasive nature of the impact of AIDS/HIV. In societies like our own, which are based on extended kinship with very wide family circles, the effect of this can be devastating and disconcerting for those affected. The issue thus becomes one of protecting family honour and, when extended at the national level, protecting State pride and honour. The South African President's current ambivalence and resulting discomfiture over his country's affliction is a case in point.

We are concerned that Sierra Leone, too, is in a state of denial about the incidence of AIDS/HIV among the population. It is the same state of denial that once encouraged the belief, which accounted for the disgraceful complacency of previous governments and the entire population, that the civil war was just a minor skirmish by a motley group of bandits and did not merit the concern that others were calling for; that it was merely country people squabbling among themselves …until it finally arrived to hit them in the City; and the arrogant assumption that, unlike other nationalities, Sierra Leoneans were not capable of committing horrific violence on themselves and so blamed other nationalities for their war. Only to discover now that some of the key people involved came from well established household names in Sierra Leone.

Now the chicken has finally come home to roost. People need to be informed about AIDS. The ravages of the disease are very well documented and there is no reason for national complacency. But if Sierra Leoneans still want to treat this subject lightly as they have tended to deal with other national emergencies before, then we advise that they should again look at some of the harrowing statistics emerging from Southern Africa. There, most of their governments have at least accepted that that there is impending catastrophe and are trying to do something about it. As has been starkly put in a recent article, “One third of the population of Kenya is expected to die in the first few years of this century. In Zimbabwe, it is thought that at least one quarter of all working age adults are affected with AIDS. The United Nations has called it the worst health catastrophe of the century. And life expectancies have dropped drastically in many countries because of the epidemic - from 61 years to 39 years in Zimbabwe, and from 66 to 48 in Botswana.”


We have been moved to go public with our comments in the wake of the publication of the Guardian article because we have been told by one usually reliable source that the unofficial reaction, last week, from government sources in Freetown was that the claims about and HIV/AIDS epidemic in Sierra Leone were exaggerations, and that the matter is not as serious as claimed.

If it is true that this thinking is prevalent among members of the present government, then we say categorically to them that that they are wrong and that it is criminally negligent for them to think so.

Focus on Sierra Leone will hold fire for now until a UN report, which we understand contains a more detailed account and data, is released. We must press for its immediate release to the public so that it is not sanitised by officialdom as often happens with this type of report.

In the meantime, we challenge the Government of Sierra Leone to come up with an official statement in reaction to the report in the Guardian (UK) article (See above)  and, generally, on the country’s state of health vis a vis a threatening Aids pandemic. The fact that an article like this about Sierra Leone appeared in a serious international newspaper and a government statement has not been made to acknowledge, rebut or confirm its substance, is clear evidence of the lack of concern which have become the hallmarks of this administration. They must answer some questions:

*  Were they aware of the situation described in the Guardian? If so, how much more do they know, and what have they done to inform and prepare Sierra Leoneans?

*  What, if anything, have they done to alert those who know more about this disease, to help and advise us on the ways of dealing with it?

One person who comes out of this first round of catastrophic news emanating from our beleaguered country, with flying colours, is Major Dr James Samba of the Sierra Leone Army, whose frank and outspoken statements were quoted in the above article. More pips on your shoulders, Major! That's the least we expect from our public officials.

 

© FSL