Combating AIDS in Guinea

World Bank: What is your assessment of the HIV/AIDS situation in the Republic of Guinea?
 

Dr Mariama Diello Barry, Executive Secretary, National AIDS Council (CNLS) © Banque mondiale

The second challenge is the need to ensure that the supply of ARVs and reagents is not interrupted. We need an adequate and regular supply of reagents and ARVs, as well as drugs to treat opportune infections.

We have also experienced difficulty obtaining real data on new infections. This poses two problems: the difficulty faced in obtaining reliable data as well as the challenge of providing effective and appropriate care for all who are in need of treatment. Decentralization of care services has also begun but has been very limited. We would like to provide care services across the entire country.

We also need to marshal additional resources at both the national and international levels. African States in general and Guinea in particular must be less dependent on foreign assistance. For example, the African Union would like the share of public health department budgets to be increased to 15 percent of the national budget. Only 10 countries have complied with this wish. In Guinea, the public health budget accounts for less than three percent.

Let’s now look at the positive aspects. One of the advantages that we have had with the multi-sectoral approach is the involvement of all the actors and residents in the Republic of Guinea in HIV/AIDS prevention efforts. Curricula have been prepared for educators at primary and lower and upper secondary schools, as well as at universities. And when I say university, I am not referring solely to the Faculty of Medicine, but to the other faculties as well, which also have their curricula, and training for all educators is already underway.

The Chamber of Mines works in close collaboration with the Executive Secretariat of the CNLS to include miners in the care services provided to People Living With HIV/AIDS (PLWHA) and in prevention efforts. Voluntary testing centers have been set up at mining sites and medical and paramedical personnel have been trained in the provision of care to PLWHA and anti-retroviral treatments.

The Guinean army has adopted an HIV/AIDS policy. Voluntary Testing Centers (VTCs) at the barracks in four regions facilitate care for HIV-positive soldiers. The army has trained peer educators so that they can assume responsibility for education, information, and awareness-building. Today, HIV-positive soldiers know exactly whom they should address at their barracks.

Using the modern technical support system, that is, the fluorescent microscope and CD4 counter, we have been able to provide better biological monitoring of PLWHA in a decentralized manner.
Our partners on the ground participate in the decentralization of HIV/AIDS prevention activities and in psychosocial support.

World Bank: Are you satisfied with the CNLS strategy?

MDB: Yes and No. Yes, because people realize that AIDS is a major problem at the national level as well as a development issue. People realize that AIDS is not the concern of just the health sector, that it has a negative impact on the gross domestic product, and that it is important to promote the education of children. People understand that the farmer, the fisherman, the miner and so on, each and every one of us is affected by HIV/AIDS, as we all have the potential to become infected. In this regard, the strategy has been beneficial and extraordinary.

It has also shown the people that they all can play a role in combating HIV/AIDS, that each of them should be concerned about it, and that there can be leadership within the family, at the workplace, in associations, and so on. The multi-sectoral approach and the support that the World Bank has provided to this policy have been beneficial. 

World Bank: Do you think that the concepts of abstinence, fidelity, and condoms are now firmly rooted in the minds of the Guinean people?

MDB: Yes and No. Yes, because the concepts were established, and no because behavioral change does not necessarily follow. One can have all the necessary information and still not change one’s behavior. This is what we observed during the 2005 national seroprevalence survey. For example, when we went to Nzérékoré toward the border with Côte d’Ivoire to meet with road transportation professionals, we realized that their notion of fidelity meant having the same partner for one trip, and that on the return trip, they saw nothing wrong with having another partner. A long training period was required to get them to admit that they were not practicing true fidelity.

Abstinence is not always possible. Take the example of a soldier who goes into action and decides to practice abstinence. Far removed from his family life coupled with a stressful situation, if he does not have any condoms, it is quite possible that he will commit an irresponsible act. That is why we had condoms included in the soldiers’ belongings to be used wherever they go.

World Bank: What are the prospects for the sustainability of the achievements? Are you hopeful that you will receive additional financing?

MDB: We have completed the evaluation of the multi-sectoral project or MAP for 2003-2007. We are now going to develop the 2008-2012 strategic framework with the hope that there will be a MAP II. We believe that the Government and partners must support HIV/AIDS prevention efforts and we hope to receive additional financing. We are now talking about mobilizing additional resources. UNITED AID, for example, is an initiative designed to include taxes on airline tickets in order to establish a fund to combat the epidemic. Guinea is drafting a law to participate in this effort to mobilize additional resources. UNITED AID works with foundations like Bill Clinton’s. I will close by thanking the World Bank for having launched and supported the HIV/AIDS multi-sectoral project, along with its partners, and of course the Guinean Government, which has accepted the policy proposed by the United Nations system.

Contributed by Tabara Barry, World Bank, Guinea