Identifier
Created
Classification
Origin
09ALGIERS465
2009-05-11 13:29:00
CONFIDENTIAL
Embassy Algiers
Cable title:  

DISEASE IN THE DESERT: FIGHTING HIV/AIDS IN

Tags:  KHIV PGOV PREF AG 
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ZNY CCCCC ZZH
P 111329Z MAY 09
FM AMEMBASSY ALGIERS
TO RUEHC/SECSTATE WASHDC PRIORITY 7457
INFO RUEHEE/ARAB LEAGUE COLLECTIVE
RUEHNK/AMEMBASSY NOUAKCHOTT 6755
RUEHBP/AMEMBASSY BAMAKO 0971
RUEHNM/AMEMBASSY NIAMEY 1932
RUEHOU/AMEMBASSY OUAGADOUGOU 0287
RUEHNJ/AMEMBASSY NDJAMENA 0101
RUEHGV/USMISSION GENEVA 0434
RHMFISS/HQ USEUCOM VAIHINGEN GE
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).

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