China tells UN it is capable of curbing exploding HIV/AIDS epidemic

Wednesday June 22, 2:30 PM

Chinese campaign launched to fight discrimination against AIDS orphans

With a pop tune sung by celebrity Vicky Zhao, a Chinese charity and a U.N. agency launched a publicity campaign Wednesday aimed at stamping out discrimination against Chinese AIDS orphans.

"I want this song to tell everyone that we need to understand and help these kids and let them know that there can be a brighter tomorrow," said Zhao, wearing a white T-shirt with the project logo _ a tree with heart-shaped branches.

The campaign is the first of its kind in China, where the communist government has begun to take action against AIDS after denying for years that it was a problem.

At a press conference held in the briefing room of the Chinese Cabinet, organizers also unveiled a short cartoon about a lonely child whose life is changed by making new friends.

"Despite the achievements made in China to address HIV/AIDS, the associated stigma and discrimination remains a challenge that is yet to be adequately addressed," said Dr. Christian Voumard, a UNICEF representative based in China.

Voumard praised Chinese leaders for publicly shaking the hands of AIDS patients and eating meals with them in front of news cameras _ moves he said had done a lot to change the disease's public image.

A new Chinese law adopted last year outlawing discrimination against carriers of infectious diseases, including AIDS and hepatitis B, was also a "strong indication" of the government's concern for AIDS patients, he added.

Voumard said he hoped the campaign would make life easier for children who had the AIDS virus or whose parents had died of the disease.

Many are frequently mistreated by classmates and even teachers because of the lack of basic knowledge about the disease, he said.

There are at least 1 million AIDS orphans in China, said Sun Zhigang, deputy director of the China Youth Concern Committee.

China says 840,000 people in the country are HIV-positive and 80,000 have developed AIDS. The U.N. has warned that 10 million people could be infected in China by 2010 without better prevention.

China and WHO to provide AIDS intervention for homosexuals

AIDS discrimination in China rife -vice minister

Sun Jun 12,11:51 PM ET

SHANGHAI (Reuters) - China has drafted a new law to protect people infected with the AIDS virus in a country where discrimination against those suffering from the condition is rife, a senior Chinese health official said on Monday.

China, for years criticized as being slow to recognize to the spread of AIDS in the country, has stepped up its public fight against the disease in the past two years, with senior leaders holding publicized meetings with victims.

"Stigma and discrimination are still prevalent," Wang Longde, vice health minister, told a forum in Shanghai. "It is one of the main stumbling blocks to preventing the spread of AIDS."

Last year, Chinese President Hu Jintao shook hands with AIDS patients at a hospital in Beijing, and Premier Wen Jiabao this year spent Lunar New Year with impoverished sufferers of the disease.

Nearly 60 percent of urban residents would be "nervously afraid" to have contact with HIV positive people in public, the Ministry of Health found in a survey last year, underlining the fear and ignorance surrounding the disease.

The Ministry of Health now expects the new law, specifically to protect the rights of those infected and their families, to come into effect by the end of this year, Wang said.

"There is a widespread recognition of AIDS, but an almost complete lack of knowledge about it," he added.

Last year, China passed its first law to try and ensure victims of infectious disease such as AIDS or SARS were not discriminated against.

Although China's official estimate of 840,000 HIV/AIDS cases is regarded as too low by international health experts, the country has begun acknowledging its spread after ignoring it for years.

Experts say at least one million poor farmers were infected in the central province of Henan alone as a result of botched blood-selling schemes in the 1990s.

A Chinese expect warned last week that China faces a tragic surge in AIDS/HIV cases unless it curbs the spread of the disease among the vast country's transient rural workforce, estimated at about 100 million people.

Health experts also fear a rise of the virus among migrant women laborers, many of whom often resort to becoming sex workers when they cannot find other work.

 

China Asked Not to Harass AIDS Activists

By STEPHANIE HOO, Associated Press WriterWed Jun 15, 8:45 AM ET

China should stop harassing AIDS activists, a U.S.-based human rights group said Wednesday as it warned that Beijing's heavy-handed methods of controlling information about the disease could hinder efforts to stop its spread.

In a 57-page report, Human Rights Watch called on China to remove restrictions on private groups that work with AIDS patients and at-risk groups.

"Grass-roots organizations have direct experience that could greatly strengthen the country's fight against AIDS," said Sara Davis, the group's China researcher, in a statement.

"But in a number of regions, they face harassment, censorship and even beatings because the Chinese government is suspicious of any activity outside its direct control," she said.

Separately, the United Nations' top HIV/AIDS official, Peter Piot, also called on Beijing to work more with patients at the grass-roots level.

"If China is going to be successful in the fight against AIDS it needs not only the strong leadership ... but also involving people living with HIV in these activities at a community level, and there we still have a way to go," he said.

Piot met this week with China's Premier Wen Jiabao and toured treatment centers in the country's south.

Human Rights Watch said that despite the central government's vows to fight AIDS, many local officials fear public discussion of the disease will embarrass them or discourage investment.

In Henan province, where thousands of people were infected with HIV in the 1990s by an unsanitary blood-buying scheme, activists have complained of inadequate services for patients and of corruption in administering programs, it said.

"Instead of addressing these criticisms, Henan officials have detained those activists who complained too loudly or who took matters into their own hands," the group said.

"Dozens of activists have been jailed, and some have even been beaten by thugs hired by local officials."

The group said China's Internet restrictions are interfering with the flow of AIDS information to high-risk groups like gay men.

"China's laws on pornography say that any Web site with homosexual content is automatically considered to be obscene," Davis said. "That's not only discriminatory; in the context of the AIDS epidemic, it is self-destructive."

China says 840,000 people in the country are HIV-positive and 80,000 have developed AIDS. The U.N. has warned that 10 million people could be infected in China by 2010 without better prevention.

Right now, AIDS in China is limited mostly to certain groups — sex workers, intravenous drug users, and victims of the blood-buying scheme — and the U.N. has warned repeatedly that it risks being spread quickly to the general population.

"Time is running out," Piot said. "Now is the time for initiating large-scale programs. The time of pilots is over."

Wen told U.N. officials that China is up to the task of controlling the disease, citing plans to expand free medical service to AIDS patients and increase public education about how the disease is spread, state media reported.

 

Mandela urges rich world to act against AIDS

Sat Jun 11, 2005 11:45 PM ET

By Gordon Bell

TROMSOE, Norway (Reuters) - Nelson Mandela joined some of the world's top musicians Saturday in pressing the rich world to act against AIDS in sub-Saharan Africa.

"We live in a world where the AIDS pandemic threatens the very fabric of our lives," the Nobel Peace prize winner said at a star-studded pop concert in Tromsoe, northern Norway.

"Yet we spend more money on weapons than on ensuring treatment and support for the millions infected by HIV."

More than 15,000 people watched stars including Annie Lennox, former Led Zeppelin front man Robert Plant and Peter Gabriel perform inside the Arctic Circle under a clear sky and midnight sun.

The 86-year-old former South African president hosted the concert, which was sponsored by the Norwegian parliament, as part of his "46664" anti-AIDS campaign -- named after his prison number during his 27 years in jail under apartheid.

Mandela, who has appeared frail in recent public engagements, smiled broadly and waved to thunderous applause on a giant stage flanked by the sea and snow-capped mountains.

He appealed to the G8 group of industrialized nations to take the lead in helping to end disease and poverty in Africa at their summit in July.

"They have an historical opportunity to open the door to hope and the possibility of a better life for all," he said.

He made no direct reference to an agreement reached earlier in the day by the G8 finance ministers to write off $40 billion in debt owed by the poorest nations.

Mandela retired from public life last year but remains one of the leading international voices on AIDS.

This year he has also addressed the stigma surrounding the disease in his homeland by disclosing that his only surviving son, Makgatho, had died of an AIDS-related illness.

AIDS has devastated communities in sub-Saharan Africa. About 25 million people are infected with the HIV virus, and millions more contract it each year.

In South Africa, some 12 percent of the population are infected. In Botswana and Swaziland, it is up to 40 percent.

The disease is spreading fast elsewhere. More than a million people are infected in Russia and other former Soviet states, and an estimated 5 million people in India are HIV-positive.

"There is a genocide happening ... and we need to get very upset about it," former Eurythmics lead singer Lennox said.

 

Japan's AIDS stigma hampers treatment, activists say 22 Jun 2005 10:00:49 GMT Source: Reuters

By Elaine Lies

TOKYO, June 22 (Reuters) - A strong stigma against AIDS in Japan is hampering access to treatment in the world's second-largest economy, activists said on Wednesday, even as experts warn an explosion of the deadly disease may be looming.

AIDS is spreading fast in Asia, home to 60 percent of the world's population, and experts warn that the fight must be intensified or the region risks having the epidemic spin out of control, much as it did in Africa.

The issue will be taken up at an Asia-Pacific AIDS Conference in the western city of Kobe from July 1 to 5.

Affluent, well-educated Japan may be one of the world's most advanced nations, yet it is also the only such nation where AIDS cases have not dropped dramatically, a situation that AIDS activist Hiroshi Hasegawa blames at least partly on prejudice against both the disease and its sufferers.

"In Asia, many people cannot gain access to AIDS treatment due to poverty, but in Japan many people cannot access treatment because of the strong stigma," Hasegawa told a news conference.

Hasegawa, who is in his early 50s, is openly gay, rare itself in conservative Japan, and in 1996 became one of the first Japanese to announce publicly that he was HIV positive.

"The way the problem presents itself in different countries varies due to social and political factors, but the situation is the same," he added.

In 2004, there were 1,165 new HIV/AIDS cases reported in Japan, the highest annual figure yet and more than a tenth of all reported cases since 1985.

Some experts warn that cumulative numbers could jump to 50,000 by 2010 due to such factors as less condom use and increased sexual activity among teenagers.

Nearly half of all 17-year-old girls have had sex, up from around 17 percent in 1990. For boys, the figure is 40 percent, nearly double the 1990 figure, Health Ministry data shows.

Official indifference is also seen as a factor.

"In Japan, AIDS policy is handled by one bureau in the Health Ministry," Hasegawa said. "But in many other places, it becomes a national campaign, taken up by the nation's top leaders."

STRONG STIGMA

Hasegawa is among a handful of Japanese who admit to being HIV positive. Others fear being forced out of their jobs or losing friends should their infection become known.

These fears prevent many from even going to be tested, much less treated. Hospitals require people to give their names, and while public health centres offer anonymous testing, their hours are extremely limited and results can take a week.

As a result, experts say, there may be thousands who do not realise they carry HIV until they actually fall ill. Hasegawa said the stigma against AIDS in Japan is partly due to squeamishness about frankly discussing sex in either homes or schools -- a reluctance many see as ironic in a nation where pornography abounds.

Minimal coordination between government ministries has hampered AIDS teaching in schools, where sex education itself is the focus of debate between those who want more detailed education and others who say schools are already too explicit.

There is also a widespread view that the only people in danger are special groups such as homosexuals or haemophiliacs, some 2,000 of whom became infected due to tainted blood products.

The majority of new cases are homosexuals.

Hasegawa said it was imperative that Japan's AIDS policies become much more realistic.

"When we teach children about the danger of car accidents, we don't do it without actually showing them cars," he said. "With AIDS, we also have to think of policies that are quite concrete."

 

Zambian army wins praise for battle against AIDS

Blacks hardest hit by HIV in US - report

Mon Jun 13, 2005 03:56 PM ET

By Paul Simao

ATLANTA (Reuters) - Blacks account for nearly half of the more than 1 million Americans with HIV, according to federal data released on Monday that suggests the battlelines of the nation's AIDS epidemic are marked as much by race as by sexual preference.

An estimated 1,039,000 to 1,185,000 Americans were living with HIV at the end of 2003, the Centers for Disease Control and Prevention said at the 2005 National HIV Prevention Conference in Atlanta.

Forty-seven percent were black, a disproportionate figure considering that blacks make up about 13 percent of the U.S. population. Whites accounted for 34 percent of the HIV-positive population and Hispanics 17 percent.

Gay and bisexual men made up 45 percent of the total.

"The HIV epidemic, initially most prominent among white gay men, has expanded to affect a wide range of populations, with African-Americans now most severely impacted," Dr. Ron Valdiserri, deputy director of the CDC's HIV, STD and TB prevention programs, told reporters in a conference call.

In a separate analysis of 1,767 men who have sex with men, CDC researchers found that 46 percent of blacks were infected. That compared to 21 percent of whites in the group and 17 percent of the Hispanics, according to the study, which was carried out in five U.S. cities and presented at the conference.

MOST UNAWARE

The researchers also discovered that 67 percent of the black men in the group did not know they were infected before participating in the study, more than three times the percentage of whites who were unaware.

Valdiserri said providing gay and bisexual black men and other high-risk subgroups with testing and prevention services was a key step to halting the spread of HIV.

AIDS, which destroys the immune system and leaves victims vulnerable to opportunistic infections and cancers, has killed about a half million Americans and at least 22 million people worldwide since 1981.

Health experts have been warning of a possible resurgence of the epidemic, which eased in the early 1990s following the development of antiretroviral drugs targeting the disease.

Since the late 1990s, when U.S. deaths from AIDS stabilized at 16,000 per year and new HIV infections stabilized at 40,000 per year, the disease has shown signs of a comeback among gay and bisexual men and intravenous drug users.

The CDC, however, said it was possible that the make-up of the HIV positive population would shift in coming years to reflect a higher proportion of infections among blacks, women and individuals infected by high-risk heterosexual contact.

To combat the changing scope of HIV, the U.S. government is emphasizing programs that focus on testing and counseling people who are already infected.

AIDS activists, however, attack the approach, which was introduced two years ago, because they believe it leads to reduced funding for programs that emphasize condom use and other safe-sex practices for uninfected people.

The government recommends that pregnant women, intravenous-drug users and anyone who engages in unsafe sex receive routine HIV testing.

HIV positive African clergy fight AIDS stigma

Wed Jun 22, 2005 03:50 PM ET

NAIROBI (Reuters) - A group of African clergy infected with HIV is urging the faithful to test for the virus and admit their status to help fight stigma hampering efforts to stem AIDS in the worst-affected continent.

Africa is home to 25 million of the world's 38 million people with HIV/AIDS despite accounting for only 10 percent of the global population.

"HIV is a virus, it's not a moral condition," said Anglican vicar Father Jape Heath, who tested HIV positive in May 2000.

"What we're encouraging people to do is to know their HIV status and to know there's no concept of sin attached to HIV," said the 41-year-old South African, a senior figure in the African Network for Religious Leaders Living With And Personally Affected by HIV/AIDS (ANERELA).

The charity was set up in 2002 to encourage greater openness about the virus.

Heath is one of the few Christian priests to openly declare his status since Gideon Byamugisha, an Anglican clergyman from Uganda, became the first more than five years ago.

He was speaking on the sidelines of an ANERELA conference in Nairobi, where clergymen swapped their experiences of being infected with HIV and the discrimination they faced.

"DAMNATION AND PERSECUTION"

Religious leaders are hugely influential across Africa, where millions flock to churches, mosques and temples.

But they have long been guilty of fueling stigma rather than fighting it, U.S. government development arm USAID's senior regional HIV/AIDS adviser Warren Buckingham said.

"Where vision has been articulated by religious leaders, too much of it and for too long has been a vision of judgment and damnation, of punishment and persecution," he was quoted as saying by Kenya's Daily Nation newspaper.

Advised by his bishop, Heath did not inform his congregation until 2002.

"It was one of the most lonely things to be living with a condition like HIV and not to be allowed to speak to anyone about it," he told Reuters.

"It binds you into a place of silence as if there's something so terrible about yourself."

Heath criticized the "ABC" strategy -- Abstinence, Be Faithful and use Condoms -- promoted by many African countries, such as Uganda, to reduce infection rates.

"We see it as very stigmatising because it says to us the only mode of transmission in terms of HIV is sex," he said.

"What does ABC say to the woman who has to make a decision as to whether she's going to breastfeed or bottlefeed? Absolutely nothing. What does it say to the doctor who's determining whether to re-use needles or use a clean one? Absolutely nothing."

Not only does lack of information put Africans at risk of contracting HIV/AIDS, but so does many cultural practices, Zambian Muslim cleric Sheikh Ali Banda said.

He cited the custom of wife inheritance, when widows are passed on to the family of her dead husband, as exposing women to the disease.

"As religious leaders we should understand that it's not a curse, not everyone that is HIV positive is promiscuous, not everyone who is HIV positive is sexually immoral," he said.

Africa's HIV pandemic is one of the main issues leaders of the G8 group of rich nations hope to help tackle at next month's summit in Gleneagles, Scotland.

AIDS funding must triple to $22 bln in 2008 - U.N.

Wed Jun 22, 2005 12:52 PM ET

GENEVA (Reuters) - Global funding for AIDS needs to triple to $22 billion in 2008 to reverse the spread of the killer disease in the developing world, the United Nations said Wednesday.

UNAIDS, the U.N. agency, said financing from all sources must rise sharply from next year when $15 billion would be needed, compared with the $6.1 billion spent in 2004 and the some $8 billion expected to be made available this year.

"We have come a long way in mobilising extra funds for AIDS ... but we still fall short of the $22 billion needed in 2008," said UNAIDS executive director Peter Piot.

Around half of the money needed by 2008 would go to prevention campaigns, UNAIDS said in a statement, while some $5 billion would be required for drugs and treatments.

The aim was to ensure that 75 percent of AIDS sufferers, or around 6.6 million people, were receiving antiretroviral treatment in 2008.

According to the World Health Organization (WHO), only some 700,000 people worldwide were receiving antiretrovirals in December last year, the latest date for which figures are available.

About 38 million people, including 25 million in sub-Saharan African, are living with HIV/AIDS.

According to the coalition, which includes French NGO Médecins Sans Frontières (MSF) and representatives of people living with HIV/AIDS, the monthly charge of 1,000 Naira (US $7.50) for the antiretroviral (ARV) medication is more than many Nigerians can afford.

Participants to the programme - run by the government with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US government - also have to find cash for regular laboratory tests, treatment of opportunistic infections and transport to health centres.

"These costs are far beyond what many of the thousands of people living with HIV in Nigeria, who are on antiretroviral drugs, can afford," the group said in a jointly signed petition to President Olusegun Obasanjo, dated 8 April but released to reporters last week.

The 11 member coalition want Obasanjo to scrap the fees.

"If people living with HIV have to pay for their treatment, they will have to sell their property and cut down on education, food and other essential needs to be able to afford it," the petition said.

The coalition said HIV-patients had been forced to interrupt their drug regimes or cut down on the number of laboratory tests needed for treatment because of the costs.

Nigeria had previously set a goal of providing subsidised treatment to 100,000 people by 2005 but later scaled it up to a target of 250,000 by mid-2006, using more than US $300 million of funds provided by the Global Fund, the World Bank and the US President's Emergency Plan for AIDS Relief (PEPFAR) - a US $15 billion programme launched by President George W Bush in 2003 to tackle HIV/AIDS in 12 African countries and the Caribbean region over five years.

By adding a policy of charging what it considered minimal fees, the Nigerian government said it hoped to raise funds to help sustain the schemes when international donor-funding dried up.

However, AIDS activists see this policy as a serious impediment to efforts to curb the spread of the virus and consequent fatalities and are pushing for a completely free treatment programme targeting the very poor.

"A political decision was taken that 1,000 Naira must be charged and the only thing preventing its removal is lack of political will," said Pat Matemilola, president of the Network of People Living with HIV in Nigeria and spokesman of the coalition.

"Poverty and HIV can't be separated. If poverty accentuates the spread of the virus, it is very clear what the situation of poor people living with HIV will be," he added.

Matemilola expressed disappointment that neither Obasanjo nor Education Minister Eyitayo Lambo had responded to their petition asking for free treatment.

Government officials, contacted by IRIN, were unavailable for comment.

Tobias Luppe of MSF said his group set up a free treatment centre in Lagos, where more than 800 people are currently enrolled to demonstrate that it is possible to provide such access without charging money.

MSF-Netherlands launched this HIV/AIDS care and support project at Lagos General Hospital last August to offer a comprehensive programme of treatment to people with HIV/AIDS.

Of the 800, Luppe said 330 people living with AIDS were receiving ARVs. The others have not reached the stage where treatment is deemed to be beneficial.

"Treatment is not necessarily a financial problem in Nigeria, it is a political problem," Luppe said. "The Nigerian government is not necessarily poor, it's only its people that are poor."

More than 70 percent of Nigerians live on less than one dollar a day, according to government figures. Nigeria, the Africa's most populous country, has the largest number of people living with HIV/AIDS in the world after South Africa and India. The authorities estimate that five percent of the country's more than 126 million people are HIV-positive.

MSF said roughly 500,000 are in desperate need of ARV treatment to prolong their life, but less than 15,000 were currently receiving the therapy.

AIDS is rampant in this epicentre of the sex trade in Niger, where heavy trucks jostle for road space with camels, donkeys and motor-cycle taxis.

But the town's medical facilities are limited and efforts to control the disease here are still in their infancy.

A study of 114 local prostitutes conducted in 2003 showed that 60 percent of them were HIV-positive. But local doctors told IRIN there was no point in telling the sex workers of Birnin-Konni they had AIDS since there was little they could do to treat them.

"We don't encourage them to find out whether or not they are HIV positive, our approach is only based on a quarterly health check which allows us to detect syphilis and urinary infections, said Yahaya Issoufou, the head doctor at Birnin-Konni's government hospital.

"It is no good telling you that you have tested HIV-positive, because we can't help you if you have," Issoufou continued. "It is like telling you that you are in the terminal phase already. We would simply hasten the decline."

As a result, many sex workers in this cross-roads town on the Nigerian border whave stopped going to the local hospital for treatment and the number of people asking for AIDS tests there has plummeted.

At "Le Campement" one of a dozen busy brothels in Birnin-Konni, Imostate, a 24-year-old prostitute on the run from the imposition of Islamic Shari'ah law in her home state in northern Nigeria, explained why.

"They don't tell us what is wrong with us"

"When we go to the hospital, they don't tell us what is wrong with us, they just give us a list of medicines to buy," she told IRIN, as she sat in the shade of a tree, waiting for the night shift to begin.

"Why don't they tell us what our illness really is?" piped up her friend Soyaba, a pretty 22-year-old girl from Niger with beauty scars on her temples and forehead. "Even if it is AIDS, we want to know!"

At night, punters pack into the brothel's large courtyard striking deals with the girls before disappearing with their chosen partner into one of the surrounding rooms, illuminated by garish green, yellow and pink neon lights.

But during the daytime, the sex workers of "Le Campement" lounge around and relax.

Sitting with her friends in the shade of the tree, Fatima, a plump 24-year-old woman from Niger, said she had stopped going to the hospital altogether.

"We noticed that they always gave us the same stuff…cotrimedazole, methonidazole and jantamycine," Fatima said, reeling off a list of treatments for venereal disease.

"But now, whenever we get skin infections or abcesses in the vagina, we don't bother going to the doctor," she added. "We just buy Nifluril or other medicines that we find in the stalls of street vendors."

The sandy streets of Birnin-Konni are full of petty traders selling packets of assorted medicines smuggled in from Nigeria alongside packets of cigarettes and cheap Chinese torches.

Landlocked Niger, which is one of the poorest countries in the world, launched a campaign last year to distribute life-prolonging anti-retroviral (ARV) drugs to people living with AIDS.

Until recently, these were only distributed free-of-charge to 300 people living in the capital Niamey, 417 km to the west of Birnin-Konni.

But this cross-roads town, which sees trucks heading north across the Sahara desert to Algeria and Libya and south to the Atlantic ports of Lagos and Abidjan, recently came within closer reach of effective AIDS treatment.

Not much enthusiasm for AIDS testing

Doctor Abdoulaye Bagnou, the government top advisor on AIDS and sexually transmitted diseases, said the people of Birnin-Konni could now pick up ARV drugs from a recently established AIDS treatment centre at Galmi, a small town 50 km to the east.

The facility was opened in the town's Christian missionary hospital earlier this year as part of a drive to decentralise AIDS treatment in Niger and Bagnou said 35 people there were already receiving ARV treatment.

Doctor Issoufou at the government hospital in Birnin-Konni, said he had been referring patients to it for the past month.

A national study carried out in 2002 show an overall HIV prevalence rate of 0.87 percent in Niger - equivalent to 80,000 people in this mainly desert country of 12 million.

But the same survey showed a much higher infection rate of 25 percent among prostitutes. And health workers estimate there are at least 500 of them in Birnin-Konni.

The United Nations Children's Fund (UNICEF) set up a voluntary AIDS testing centre in the town two years ago as part of an initiative to reduce mother-to-child transmission of the disease.

Doctor Thalcienne Ddihokubway, a UNICEF official connected with this programme, said it had enabled some people living with AIDS in Birnin-Konni to receive treatment for opportunist infections connected with the decline of their immune system, even though they could not get ARV drugs.

But Doctor Issoufou said local people who feared they might have AIDS, appeared to be losing faith in his hospital's ability to help them.

He noted that about 20 women per day came to the hospital's HIV testing centre when it first opened in 2003, but the number of people turning up there had since dwindled to between five and 10 per day.

"If the number of women agreeing to be tested is going down, it is simply because we can't provide them with the necessary treatment," he said. "Any woman who tests HIV positive is left to her own devices."

Although treatment for AIDS remains woefully inadequate at Birnin-Konni, some progress has been made on the prevention side in conjuction with Niger's national union of truck drivers.

Use a condom or forget it

The European Union has financed an AIDS awareness and condom distribution campaign, "Aids on the move", implemented by the US non-governmental organisation CARE, that has succeeded in making both truck drivers and sex workers more aware of the need for protected sex.

The truck drivers have been briefed to pass the message on to thousands of seasonal migrant workers who flock into Birnin-Konni's lorry park looking for transport south towards Cote d'Ivoire.

And the sex workers have become so condom-conscious that they sometimes gang up to expose and harass a punter who refuses to wear a sheath.

At "Le Campement," Mariama, a 35-year-old sex worker, proudly flourished a packet of 72 condoms.

She said she had bought it from a nearby kiosk run by the Niger Association of Truck Drivers for the subsidised price of 1,250 CFA francs (US $2.50).

"Say a client comes into the room, and he pays 1,000 CFA ($2) for the ride," Mariama said.

"I give him the condom and will even put it on him if I need to. If he refuses, he only gets half his money back. And if he won't agree to that, I keep the lot. If he wants to make a fuss about things, we argue. But in the end he is the one losing out."

Rakia, a young colleague who looked half her age, agreed.

"Sometimes we get together and beat up a customer who refuses to wear a sheath," she said as a group of other girls listening in on the conversation nodded in agreement.

"Since I received awareness training, it is a sheath or nothing," Rakia said. "That also has the advantage of protecting us against other sexually transmitted diseases."

It sounds good in the clear light of day.

But later that night Mariama, with several drinks inside her, could be seen chatting up a client at a nearby bar.

She held a cigarette in one hand and a bottle of Conjoncture - a local brand of beer - in the other. Soon the couple headed off, arm in arm towards the brothel, with tipsy Mariama unsteady on her feet.

"It is difficult to believe right now that she is going to remember to use a condom before they get down to business," remarked Ibrahim Adama, an outreach worker of the local CARE programme, as he looked on.

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