Integrated Regional Information Networks - November 10, 2006

GANTA, 10 November (PLUSNEWS) - The bustling commercial town of Ganta, a five-hour drive from the Liberian capital, Monrovia, is emblematic of the AIDS challenge facing the country as it rebuilds after 14 years of civil war.

Ganta is the hub of trade and travel with eastern neighbours Guinea and Cote d'Ivoire, sucking in investment and people looking to make quick money. But the factors driving its recovery threaten to undermine its long-term stability. "Everything passes through here; there are visitors every day and the popuation is growing - we do expect an increase in AIDS infection," said Dr Albert Willicor at the United Methodist Hospital, the main health facility in town.

Newly elected President Ellen Johnson Sirleaf is committed to Liberia's recovery and reconstruction, but the challenges are enormous in a country of three million people and an annual budget of just US$129 million.

"The new government is very promising and well-liked here and overseas," said Susan Thomas, field coordinator for Medecins Sans Frontieres (MSF)-Switzerland in Saclepea, 40km from Ganta. "But when you think how much was destroyed during the war ... if you scratch the surface you see you cannot even post a letter."

The war not only stopped effective HIV/AIDS awareness campaigning, but the trauma of the conflict and the aftermath of poverty and joblessness has had a "deep psychological impact", according Rev John Togba, a genial and energetic HIV/AIDS counsellor at the Methodist Hospital.

"Girls are out of school, maybe the only sponsor they had was killed, and they often have no other option but to end up in prostitution," said Togba. "Sometimes it's the parents who push the child out on the streets: 'your friends are bringing home bags of rice, why aren't you?'."

Ganta's Nimba County is one of the main destinations for refugees, still returning three years after Liberia's warlords made peace. "Ninety percent of them are poor; most of them are single women," said Berkone Nagga, protection officer for the UN refugee agency, UNHCR, at Saclepea. "The women lost their men during the war or were divorced. Many of them have nothing except what we give them - it makes them very vulnerable."

It is not that people are unaware of AIDS; everybody IRIN/PlusNews spoke to in Ganta's main market had heard that condoms can prevent HIV infection, and several people mentioned unsterilised medical equipment and mother-to-child transmission as other likely routes for the virus.

The laidback owner of the motel next to Planet 44 - a popular new music bar on the main street, insisted that he handed out condoms to all guests who asked for them. Susan Habbah, who turned heads as she strolled by, said: "I just want to advise my friends on the street, 'stay at home, God will provide.'"

Despite assurances of their personal commitment to safe sex, there was much less conviction on how widespread condom use was among others. "Liberians like skin-to-skin, flesh-to-flesh," was a clich that cropped up in most conversations on the issue. Apart from an antipathy to latex, there was the more practical problem of availability - neither of the two pharmacies visited had any on the shelves.

Sempti Menown, a young and opinionated motorbike taxi-driver, underlined clearly that awareness was not synonymous with acceptance. Describing HIV/AIDS as a "false religion", he added: "I need to be convinced that AIDS exists; people need to show me somebody with it."

The problem is that he is far from alone in his denial. For community radio journalist Pauline Biddle, AIDS was something that happened elsewhere, not in Ganta. It was only when she heard an HIV treatment programme was about to start at the Methodist Hospital under Dr Willicor's supervision that it dawned on her that "AIDS is here".

At the moment Liberia has no national HIV prevalence figure. Among health workers the estimates for HIV infection vary between 5 percent and 10 percent, but all agree that the stigma attached to AIDS will stoke the epidemic unless addressed.

"There's a lot of fear and a lack of knowledge," said MSF's Thomas. "We're at the very early stages of HIV intervention, we're starting from the very bottom."

Togba said 25 of his patients had been diagnosed as HIV positive since March - roughly four a month - most of them having lived at some stage in Cote d'Ivoire or Guinea. They did not come for testing voluntarily, but were identified through blood screening or clinical signs. "There is a problem of confidentiality, that is what people are really concerned about - confidentiality and stigma."

For close to a year Dr Willicor has been preparing for the launch of a treatment programme at the Methodist Hospital. In October he took delivery of the first consignment of antiretroviral drugs from the National AIDS Control Programme, but the initiative was delayed when the first patient selected for therapy pulled out.

"She was so enthusiastic - I had told her it was free; it would be confidential," he said, shaking his head.

"What's needed is more education, done with patience, and it has to be persistent," said Togba, who started counselling only in 2005. "The schools have to be involved and the churches too, and we also need visual AIDS: talking is effective, but seeing is more effective."

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