UN Integrated Regional Information Networks - December 5, 2008

"There is a clear lack of monitoring and evaluation mechanisms for STIs [sexually transmitted infections] and HIV and, more generally, there are gaps in the health information system in Guinea," Marcos Sahlu, UNAIDS country coordinator, told IRIN/PlusNews.

The Global Fund to fight AIDS, Tuberculosis and Malaria, one of the main donors to AIDS programmes in Guinea, suspended its funding to the country for four months in 2008, while waiting for clarification on how its grants were being used. During that time, no new patients could start taking ARVs. These transparency problems are partly due to poor information management and systems for monitoring drug supplies.

Officially there are now around 8,000 people on ARVs, out of 87,000 people estimated by UNAIDS to be living with the virus. However, there is no system for compiling data from the different treatment centres, so it is possible that some patients have been counted more than once, said Dr Mouctar Diallo, coordinator of the national STI and HIV/AIDS Health Care and Prevention Programme (PNPCSP).

Franck Bossant, head of mission at the international medical humanitarian organisation, Medecins sans Frontieres, which provides ARVs to around 3,000 people, noted that interruptions in ARV supplies in 2008 may also have caused some people to be counted twice when they re-registered at treatment centres.

Existing data incomplete

HIV data for Guinea exists, but is out-of-date and incomplete. Most of the figures come from the limited sample in the last Demographic and Health Survey (DHS), carried out in 2005.

Dr Hadja Mariama Djelo Barry, executive secretary of the National Committee to Combat AIDS (CNLS), says there is no data on HIV transmissions from traditional practices such as circumcision, which is widely practiced.

Neither is there any information on groups generally considered to be especially vulnerable to infection, such as men who have sex with men (MSM), said Djelo Barry, or figures on how many HIV-positive people are co-infected with tuberculosis, a common opportunistic infection linked to HIV.

Organisations working in the HIV/AIDS sector need the data to tailor their interventions, and often have no choice but to go into the field and attempt to gather the information themselves - a long and costly process.

The only data available relate to indicators required by donors for monitoring and evaluating the projects they fund, said Nathalie Daries, the head of mission at Solidarite therapeutique et initiatives contre le sida (SOLTHIS), an international medical non-governmental organisation (NGO) that provides ARVs and monitoring. One of its objectives in Guinea is to help build capacity to collect better HIV-related statistics.

New initiatives

SOLTHIS has helped set up software for collecting data on people receiving treatment at Donka hospital, one of two main hospitals in Conakry, Guinea's capital. A lack of qualified medical and administrative staff is another major obstacle to data collection, but the NGO is training staff to use the new system and there are plans to equip other treatment centres with the same software.

UNAIDS, in conjunction with various partners, is preparing to launch a survey that will map HIV risk and vulnerability, service provision and HIV/AIDS interventions, and provide a more accurate picture of Guinea's AIDS epidemic.

Sahlu of UNAIDS said the findings would help identify and respond to the needs of risk groups, and should improve the effectiveness of interventions generally.

Djelo Barry pointed out that data collection was useless if the findings were not applied. The 2005 DHS survey, for example, revealed that HIV prevalence was up to four times higher among better-off and educated women than among less educated women from poorer backgrounds.

Yet HIV interventions have made little headway in targeting such women, said Djelo Barry, partly as a result of the high levels of stigma still attached to HIV and AIDS.

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