DISEASE IN THE DESERT: FIGHTING HIV/AIDS IN

C O N F I D E N T I A L SECTION 01 OF 02 ALGIERS 000465 SIPDIS E.O. 12958: DECL: 05/11/2019 TAGS: KHIV PGOV PREF AG SUBJECT: DISEASE IN THE DESERT: FIGHTING HIV/AIDS IN ALGERIA'S DEEP SOUTH Classified By: DCM Thomas F. Daughton; reasons 1.4 (b),(d). ¶1. (C) SUMMARY: A gradual rise in legal and illegal African migration to southern Algeria over the past 15 years has brought an increase in cases of infectious diseases, particularly HIV/AIDS. The Saharan crossroads of Tamanrasset, which with 130,000 inhabitants is the only city in an area larger than France, has become the regional cosmopolitan hub for the movement of people, contraband and disease through the desert. While the numbers have not yet outstripped the capacity of local public HEALTH officials, the trend is clearly rising, fueled also by a demand for prostitution from truckers and the nearby Algerian 6th Military Region headquarters. On March 24-25 in Tamanrasset, we met with local HEALTH officials and toured the hospital's infectious disease ward as well as an AIDS testing center located in a neighborhood known for prostitution. We found a progressive public awareness campaign led by the local government, a proactive and discreet philosophy for treating patients, and an effective Belgian program of support for local AIDS testing that now catches more HIV cases earlier, offering better hope to reduce the spread of the virus. END SUMMARY. CROSSROADS OF MIGRANTS AND PATHOGENS -------------- ¶2. (C) Abderrahmane Boubekeur, the wali (governor) of Tamanrasset, told us on March 24 that the region's public health issues were a top priority whose urgency had increased within the past few years. He said that AIDS was the primary focus of a large public awareness campaign, but that the increase of diseases also included meningitis and hepatitis. Dr. Ahmed Zenati, Tamanrasset's Director of Health, told us about a 2008 car accident at the southern border town of In Guezzam (400 km from Tamanrasset) involving ten sub-Saharan African migrants. Out of ten, he said, the first five they brought to Tamanrasset for treatment all had either hepatitis or AIDS. Zenati added that meningitis had become a concern along Algeria's southern border as well. In 2008, Zenati said that some 800 foreigners were hospitalized in Tamanrasset for infectious diseases, but that the problem was now also an Algerian one. From 1994-2000, Zenati said that the overwhelming majority of those treated for HIV and AIDS in Algeria as a whole were sub-Saharan Africans, but that since 2000, the number of infected Algerians had outpaced the Africans. ¶3. (C) Tamanrasset straddles the main north-south road in the central Sahara; virtually all traffic between sub-Saharan Africa and northern Algeria passes through the town. The next town with a population of more than 100,000 lies a thousand kilometers to the north. Tamanrasset offers two facilities for HIV/AIDS testing and treatment: the main hospital's infectious diseases ward and a small satellite testing center in a rougher neighborhood known for prostitution. Dr. Lakhdar Nair is the head of the infectious diseases ward at Tamanrasset's hospital, which he said has grown busier in recent years. The ward has beds for 240 patients; as of March 24, there were 101 HIV/AIDS patients in the hospital, up from 20 in 2003. Nair said that there were some 220 known HIV-positive cases in Tamanrasset, and that the first case of HIV/AIDS in the region had been identified in 1993. The hospital began treating opportunistic infections in 1998. Nair said that in Tamanrasset the majority of HIV/AIDS patients are still sub-Saharan Africans, a reflection of migration patterns. He noted that Tamanrasset's population is currently 45 percent African, 55 percent Algerian and 55 percent women, spread across 16 main nationalities. ¶4. (C) Many of Nair's patients are illegal migrants without papers. He introduced us to a Nigerien woman, eight months pregnant and HIV-positive, who had come in the previous week in the hopes of preventing her baby from contracting the virus. She told us she had no papers and had been living in Tamanrasset since 2007. Nair said there was still hope of saving the baby in her case, but that in order to seek medical attention earlier, patients needed reassurance to overcome the stigma of AIDS as well as the fear of deportation. He explained that, at the hospital, he and his colleagues accept anyone and everyone based on an ethical responsibility, and do not face any pressure from local police authorities to divulge names and legal status of ALGIERS 00000465 002.3 OF 002 patients. Often, Nair told us, "all we have is a first name anyway," and the transient nature of much of Tamanrasset's population made statistics and epidemiology an inexact science. AWARENESS THROUGH IMAMS AND CONDOMS -------------- ¶5. (C) Nair stressed that Tamanrasset's ongoing public HEALTH awareness campaign is critical to avoiding more work down the line. He told us that in addition to posters, text messages and radio and television messages, he personally reaches out to local imams with government support to promote the right message. Nair said that the imams are cooperative and understand the importance of public health, encouraging mosque attendees to be proactive in seeking testing and treatment for HIV/AIDS. Nair added that, in addition to the imams' help in de-stigmatizing HIV/AIDS, the local branch of the Ministry of Youth and Sports also pitches in with messages at youth sports functions and formal support for testing. ¶6. (C) At Tamanrasset's satellite AIDS testing center, the results of the awareness campaign were evident. Dr. Amor Ait Said, who runs the center, told us that in 2008 the center tested approximately 2000 people and distributed 100,800 free condoms. Ait Said said that the center is now seeing cases much earlier, whereas before 2008, "we got only the catastrophes." He said that the center found 32 positives in 2008, but many more chose to go to the hospital for testing and treatment. For those who feel uncomfortable, Ait Said explained, the testing center has no sign on the door and offers a discreet side entrance. The location of the center is no accident, he explained, situated in a neighborhood known for prostitution and crime. Through a bilateral agreement with Belgium, the center has benefited from donated equipment and an exchange of doctors, and now has everything it needs, he said, although he estimated it will only be a few years before demand for HIV/AIDS testing and treatment overtakes the capacity of his center and the hospital. The standard HIV test Ait Said and his colleagues use is the ACON quick test made in San Diego, which he said is especially useful for testing in rural areas. COMMENT -------------- ¶7. (C) The public HEALTH campaign to promote HIV/AIDS awareness in Tamanrasset is, by all accounts, progressive and effective. As the rise in infectious diseases appears to correlate directly to the movement of people through the region, the cosmopolitan nature of migrant and pathogen alike will continue to reflect trends on the rest of the continent. While the absolute numbers of patients still remain within the ability of local HEALTH officials to treat, the figures are only moving in ONE direction. As Dr. Nair pointed out, "anytime we see a 500-percent increase in infection within a five-year period, we consider it an urgent public HEALTH issue." PEARCE