Integrated Regional Information Networks - September 4, 2009

Diffa's official HIV prevalence rate is 1.7 percent, based on a 2006 government study.

But the real prevalence is likely to be much higher, according to Boukar Ousmane Moktar, director of a health centre in Bosso, Niger's last border post before crossing into Chad. During the first half of 2009, he told IRIN 73 of 169 HIV tests given in his centre came back positive. "Of them are tuberculosis patients in whom we suspected co-infections," said Moktar. He said nine out of 10 tuberculosis patients on average tested positive for the virus.

Nana Youssey, head of the local non-profit National Association for the Promotion of Public Health and a trainer of NGOs under the World Bank-funded Multi-Country HIV/AIDS Program, told IRIN government surveys have largely overlooked Diffa until recent years. "In the country's national health survey of 2002, Diffa was not even included. It was not until 2006 Diffa was included. We are so far out here and the terrain is really difficult that access even just to study HIV risk is itself a huge problem."

Youssey told IRIN she trained local NGOs to raise awareness of HIV from 2004 until December 2008 and is in the process of evaluating this project's impacts.

Sex workers

In Bataoungour, a village 10km from the border town of Bosso, a group of women told IRIN they stopped working as sex workers when they received microcredit from a World Bank-funded project. Altogether, seven groups of 20 sex workers each received microcredit.

Bawa Ari, a 33-year-old mother of four told IRIN she started prostitution in 2005 after leaving her husband to whom she was married at age 12. "He never took care of me and did not feed or clothe us." She and other sex workers received small credits in exchange for promising to leave prostitution and helping to educate other sex workers about HIV risks.

Ari told IRIN she never used condoms and did not see one until 2008 as part of the microcredit and HIV training she received.

But when IRIN asked her and the other women in her credit group how many had been tested for HIV, all replied no. The head of the NGO that worked with the women, Madou Abbakoura, told IRIN the NGO's goal was to get the women out of sex work.

The coordinator of Niger's HIV-AIDS coordination group, Moussa Ide, told IRIN that a 1990s influx of sex workers fleeing a religious Islamic law crackdown on prostitution in neighbouring Nigeria has now tapered off and there are as many local sex workers as foreign ones.

Ide said the government is preparing to launch a nationwide survey in September with sex workers as well as men having sex with men in order to "improve targeting and cut disease prevalence."

In Niger's east, there is a year-round steady demand for sex workers he told IRIN. "Socio-economic activities - agriculture, fishing, timber - bring together people from 12 different nationalities who co-exist in permanence," he said. "All these people, far from their respective homes, live on average half the year near lake [Chad] and go home only when they have made enough money." One-hundred kilometres west of Bosso in the region's capital city, also called Diffa, Mohamane Issa, told IRIN he found out in his fifth year of marriage to his ex-wife - a prostitute - that he was infected by her. He said he lost one child to AIDS. "There are so many prostitutes here in town," he told IRIN. "There is no push to get them tested."

There are eight HIV testing centres for less than half a million population spread out over 450 villages, according to the national HIV-AIDS coordination group.

Mother-to-child transmission

Preliminary results from a 2009 government study of HIV infection among pregnant women in Diffa is 2.2 percent, but Diffa region's health centre deputy director Kiari Fougou L. Aissa - who oversees two programmes for the prevention of mother-to-child HIV transmission in the region - said not all mothers are getting tested. "There is widespread stigma of being tested and some women are not able to get their husband's approval," said A ssa. "We cannot break up family harmony and can only advise them to inform their spouses."

Of the centre's 3,593 women who came to the clinic for pre-natal visits, 672 were tested and 19 were HIV-positive, the doctor told IRIN.

The national HIV coordination group's Ide said the group's goals for Diffa is to increase the rate of HIV testing, boost condom sales in remote places, work more closely with traditional and religious leaders and increase HIV awareness outreach near Lake Chad.

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