N'Djamena — Although treatment for Aids patients in Chad has been expanding, health officials worry that there is a risk that the disease might spread faster than it once did because of conflict. This strife is equally threatening programs that were already in place.
Displaced populations, increasing poverty and deteriorating infrastructure have all complicated the country's battle against AIDS.
For now, the once rapidly growing National Fight Against Aids Program is effectively on hold because of a recent rebel attack on the capital, N'Djamena. During that attack, looters ransacked the program's offices and those of some of its international partners, taking drugs, equipment and office supplies.
Doctors in N'Djamena's hospitals quietly worry that the momentum they need to fight HIV/Aids might not resume after the recent attacks.
"It was the money of the petrol state paying [for these programs]," says Dr. Alioune Blondin-Diop, an advisor on Aids to the director of the General Reference Hospital in N'Djamena. "But right now it [the money] is going to the war."
The Face of an Epidemic
Chad's nearly 10 million people are spread across an arid territory of 500,000 square miles and there are only 22 health facilities that can test for HIV. There is one doctor for every 27,680 people, according to the World Health Organization.
The government says just over three percent of Chad's population, or about 201,000 people, are infected with HIV, although health officials caution that this is an estimate.
Urban residents are three times more likely to be HIV positive than those living in rural areas, according to Chad's Health Ministry. Infections peak among those aged 25 to 29 years. Women are also more likely to be infected. They have a prevalence rate of four percent, compared to 2.6 percent for men.
There are nearly half a million displaced people – Chadian, Sudanese and Central Africans – camped inside Chad's borders. Health professionals worry that the displaced might be at greater risk for contracting HIV/Aids.
"All of the conditions [for infection] are united [in the camps]," the Ministry of Health writes in its 2008 progress report. Sexual violence and the introduction of new populations make contraction more likely; meanwhile, poverty and the plethora or other needs make treatment and prevention a particular challenge.
Increased military movement is also worrisome; members of the armed forces are thought to have a prevalence rate almost twice that of the rest of the population.
A Strong Fight
Medical professionals say that despite the challenges facing Chad as it fights HIV/Aids, progress can be—and was being—made. Before the recent conflict in N'Djamena, the number of patients being treated for HIV/Aids had been growing by 10 percent a month since the government began offering free treatment for Aids patients in April 2007.
With assistance from the World Bank and the African Development Bank, about 7,500 patients are now receiving treatment. If the program recovers from its recent setback, that number is set to rise. A grant from the Clinton Foundation in September 2007 enabled the program to begin providing second-line treatment for patients who are resistant to mainstream drugs.
"Before, there was no possibility for drug-resistant patients," said Dr. Ali Mahamat Noussa, a director for the country's National Fight Against Aids Program. "Now, there are more chances."
The treatment regime costs some US$600 per month for each patient—far more than Dr. Noussa's budget could otherwise provide.
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The Road Ahead
Cartoon signs and billboards across N'Djamena implore residents be prudent about safe sex and to be tested. But outside the capital, Aids awareness and testing have only just begun.
Dr. Blondin-Diop worries about the limited reach of the campaign. Campaigners rarely get to isolated rural communities and insecurity makes other areas off-limits.
In such places, sick patients only occasionally seek treatment, even if it is available. "Where people are sick, they are not always well informed. They don't necessarily know they have AIDS," he said.
This puts them at risk of other opportunistic infections. There are 6,000 tuberculosis cases a year in N'Djamena alone, for example, and more than 60 percent are associated with HIV/Aids.
