CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
by Alain Agboton, Senegal, December 1998
THEME = AIDS
"You can't taste a sweet if you
don't take the wrapping paper off."
Applying this to the use of condoms, a young man wants to
emphasize
that condoms are there to be used. The presence of AIDS
is both
a problem and a dilemma for Senegalese society
In Africa, Senegal is among the countries less stricken by AIDS. According to Dr. Ibra Ndoye, Director of the National Programme against AIDS, around 1% of the population is reckoned to have AIDS - in Botswana, the infection rate is 30%. (Statistics from the 1998 UNAIDS Conference, Geneva, 1998).
In 1986, six cases were reported. Today, Senegal has 2,500 notified cases. A more accurate estimate would be around 80,000 AIDS- infected people out of a total population of 8 million. The discrepancy comes from the fact that in Senegal's hospitals, consultations are neither commonplace nor regular, so the detection rate is bound to be unreliable. Nevertheless, successes have been achieved because a rapid advance of AIDS (seen within the African Continent as a whole) has been checked. These efforts were acknowledged by the international scientific community on 14 December, when Senegal was awarded a certificate of excellence to this effect. With state assistance, 50 infected patients are presently being given anti-retroviral treatment - a treatment which is still in its early stages.
Even though available means to check the disease are insufficient, a milestone has been reached. Dr. Ndoye is also president of the African Union against Sexually Transmitted Diseases and is convinced that the results achieved by Senegal are due to two major decisions taken by the country's political authorities. Priority has been given to preventing AIDS (by pinpointing the fact that the disease is passed as follows: Through sexual intercourse; from mothers to children; by using contaminated blood in blood transfusions) and by providing care for those ill with the disease. The Senegalese authorities are fully aware that even a 3% contamination rate must sound a warning against potential catastrophe.
In sharp contrast to many African countries with such catastrophic rates as 10% and even 30%, why does Senegal have such a low incidence of AIDS?
Professor Souleymane Mboup, an eminent scientist, puts forward a number of reasons and factors. He's well-placed to speak about it, as he chairs the African Network for Research on AIDS, and coordinates the University Convention for Research on AIDS (involving, among others, the Universities of Dakar, Harvard in the USA and Limoges in France). He was one of the very first men of science in Africa to look into the pandemic - his research is known world-wide and his work has attracted UNAIDS' attention. He made a considerable contribution for a better knowledge about the viruses, more particularly that of HIV-2.
According to Professor Souleymane, the low prevalence and the slow advance of AIDS in Senegal are due to the fact that already in the 1970s, Senegal had implemented the following: A definite programme to fight STDs - an active and efficient programme which is still lacking in many African countries; a safe system for effecting blood transfusions; a way of integrating the programme for fighting against STDs with that of fighting AIDS; using Senegal's tradition of "working together" especially with already existing associations; building on the fact that Senegalese women have control over the sexual aspect of their lives, and their behaviour has a positive influence on society; making use of people's knowledge about AIDS; continuing to encourage the use of condoms (already in general use). This list is a summary of details drawn from a number of surveys.
On the other hand, the surveys do not always take into account the following: Religion - 90% of the population are Muslim; polygamy - 49% of households are polygamous; questions relating to wife- inheritance (levirate and sororate - two ancestral customs by which the brother of a deceased marries his widow; and a sister of a deceased woman becomes the wife of her brother-in-law); excision (which is still practised among certain ethnic groups); immigration. No detailed studies are available dealing with these questions.
We have already mentioned that vis à vis Africa taken as a whole, Senegal has been spared the ravages of AIDS. But this does not mean to say AIDS does not exist in Senegal. In fact, a great number of women in Senegal are now infected with AIDS. A major international conference convened by one of the thirty national sections of the PanAfrican Association of Women against AIDS (SWAA)-Senegal) is due to meet in Dakar, 14-17 December 1998. This 7th African meeting, following previous meetings held at Harare, Lagos, Yaounde, Arusha, Lusaka and Gaborone, is intended to assess the situation of "Women and AIDS" from the angle of "How to improve the response to HIV infection".
The SWAA was established in 1998 when the rapid advance of HIV among women was diagnosed. It aims to work out suitable strategies for countering HIV infection and to help women face the threat. Truth to say, the rapidity of the disease's advance among Senegalese women is alarming. According to one conference delegate, women now form half the number of those infected (figures confirmed by Dr.Ngoye). That's why women are carefully scrutinised. "78% of women in Senegal are illiterate, an obvious handicap, but they are extremely "receptive" to the Information, Education, Communication (IEC) Programme", says the SWAA.
Where does religion enter into all this? What responsibility does it have for such HIV prevalence? What is religion's impact on the present pandemic? In October 1997, an international conference on "AIDS and Religion", was held in Dakar. Participants came from Asia, Africa, the Middle East, Europe and the Americas. They emphasised the importance of religious leaders working with the authorities to fight AIDS, arguing that the pandemic was not "God's punishment", as many imagined.
Religions "of the Book" unanimously convey the message that abstinence and faithfulness remain the best means of preventing AIDS and thus the best way to fight against its advance. They attach great importance to moral behaviour, self- discipline, responsibility and faith. A working party was set up at the end of the Conference to follow up its recommendations, and during the first quarter of 1999, an assessment of the Conference will be made either in Dakar or Abidjan.
Obviously, religion is of prime importance. Paul Sagna is Executive Director of AIDS-SERVICE, an organisation set up by the Bishops of Senegal to encourage people to take personal responsibility for their own actions, by respecting and controlling their bodies, by strengthening their faith and faithfulness - all fundamental strategies for preventing and fighting infection. "We must educate", he advises, because condoms which are rejected by the Catholic Church "do not provide 100% protection".
AIDS-SERVICE provides "social, moral and spiritual counselling" by means of discussions, conferences, meetings among the grassroots population and among people in special circumstances, including prisoners. Apparently, their ideas are "well received" by the highly Islamised Senegalese society. Paul Sagna is pleased to note that on HIV/AIDS-related issues, principles of the Islamic religion blend with those of the Catholic Church. "Chastity before marriage and faithfulness thereafter find common cause in both Islam and Christianity". He says that "faithfulness" applies in both monogamous and polygamous marriages, and stresses that this is a "message of truth".
Senegal's life structure is one based on people living and working together. The country has all kinds of "associations" for citizens, in every walk of life and for every circumstance. One of the most efficient and effective associations is the National Alliance against AIDS (ANCS), which was established in 1994, with its headquarters in London. In Senegal, the ANCS works on fertile ground as it has no major difficulty in encouraging, supporting and strengthening NGOs and community groups (including AIDS-Service and SWAA) in their work of financing the prevention, support/counselling activities and programmes.
For example, the ANCS was able to provide back-up technical assistance for associations directly involved in the fight against the HIV epidemic. Mrs Magatte Mbodji is in charge of the ANCS' programmes. She points out that this is precisely in line with the ANCS' aim - to offer support and planning services for those associations working in the community.
Since it got off the ground, the ANCS has financed 250 projects costing anything between 2,500 and 50,000 French Francs each. Senegal has areas where AIDS is rampant - places such as Kaolack, Le Fleuve, Thiès and Dakar. Here, ANCS' action within the community was encouraging as the epidemic undeniably includes a social dimension.
Two types of AIDS have been detected in Senegal. Thanks to Professor Mboup's research, it was possible to draw a very instructive epidemiological table. HIV-2 is mainly located in West Africa (but it can be found in other areas of Africa and Asia) and is clearly present in Senegal. HIV- 1 on the other hand, has become "slightly more frequent" in recent years.
A recent analysis conducted over a period of time and monitoring a number of people (both those infected and those free from the virus), revealed that HIV-2 infection has remained "either stable or is even decreasing", whereas "HIV-1 infection has "increased exceptionally", which raises enormous problems as it is much more virulent". The two viruses have different transmission rates. HIV-2 is transmitted more slowly by sexual intercourse and is less pathogenic. Professor Mboup also chairs Africa's Civil and Military Alliance against AIDS (he's a military man himself). He's shown that the annual advance of HIV-2 is lower (0.5%) than that of HIV-1 (3%-5%).
The incubation period for HIV-2 is longer. If, for example, two people are infected at the same time with the HIV virus, the one with HIV-1 will develop AIDS six to ten times quicker than the one with HIV-2. Professor Mboup's research also stresses the transmission from mother to child, which is reaching peaks of 20%- 30% with HIV-1, whereas with HIV-2 it ranges only from 0%-8%.
A Network for People Living With AIDS has been set up and is chaired by Mr Pape Moussé Ndiaye. On 1 December 1998, when commemorating World Day against AIDS, he issued a special call to the youth (this year's target group) "to become aware of their sexual activity and to use condoms. Those who already have AIDS no longer want to hide themselves". He also appealed to the government to increase its care for people with AIDS.
Is an AIDS-infected person a pariah? C.M. is HIV-positive, and he describes his present martyrdom: "My family rejects me because I'm sick and they say I'm a good-for-nothing. Dogs get more respect than I do". "It's sad that people like myself have to remain in conditions of anonymity. If the whole issue is not brought out into the open, AIDS will devastate Senegal, considering the speed with which it is spreading".
What is traditional medicine's part in the fight against AIDS? This aspect of medical treatment has to be taken into account when we know that about 85% of Senegalese consult traditional healers. Dr. Eric Gbodossou is a medical doctor in charge of "Malango", the well-known (both at home and abroad) traditional medical hospital, situated at Patick, about 150 km south of Dakar. Dr. Gbodossou says: "The practice of traditional medicine has been left out of anti-AIDS therapy. It does not deserve this. Traditional medicine can help a lot, as long as it is divorced from its religious and mystical connotations. Traditional medical practice has its part to play especially when it comes to Informing, Educating and Communicating. Traditional practitioners are irreplaceable agents when it comes to healing, for combatting opportunistic diseases, and for participating in research.
Dr. Gbodossou points out: "Any effective health policy must closely examine the role of traditional healing, whilst taking into account, local realities. Traditional healing has achieved "clear" success in the treatment of AIDS-related "opportunistic diseases" and "viral diseases". Traditional healing can make an invaluable contribution and this will be proved at the First International Congress Dr. Gbodossou is planning to convene in March 1999. Healers from about 15 African countries will be joined by traditional American-Indian, Aztec, Maya and Hawaiian therapists, along with eminent scientists and researchers coming not only from Africa, but also from Europe and the United States.
END
CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
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