Office for the Coordination of Humanitarian Affairs (OCHA)

Integrated Regional Information Network (IRIN)

ASMARA, 10 July (IRIN) - It's mid-morning at the HIV voluntary counselling and testing centre (VCT) in Asmara. About 20 men and women are waiting to be seen by a counsellor.

The centre, which opened last month, is Eritrea's first "free-standing" HIV testing facility. Offering rapid, on-the-spot HIV tests, as well as pre- and post-test counselling, it represents part of a nationwide campaign by the government to improve AIDS awareness as well as care and treatment for people living with HIV/AIDS (PLHAs).

The HIV/AIDS epidemic is considered to be in its early stages in Eritrea. Compared to other African countries, it has a relatively low HIV prevalence rate of less than 3 percent among adults.

However the forthcoming demobilisation of around 200,000 soldiers and the gradual opening of borders following the war with neighbouring Ethiopia - which has the third-highest HIV-infected population in the world - could result in a rapid spread of the HIV infection, according to health experts.

NIPPING THE DISEASE IN THE BUD

The government is aware that the present situation could quickly change.

"We currently have one of the lowest levels of HIV/AIDS in Africa, but that is nothing to be proud of, tomorrow we could be the highest," Saleh Meky, Eritrea's Minister of Health, told IRIN. "The most important thing is to keep working on the problem. We cannot be complacent."

Saleh said that raising awareness of HIV/AIDS and increasing knowledge about how to prevent its spread is a priority. "One of the most difficult challenges we face in Eritrea is to overcome the stigma and ignorance that is still associated with the disease," he said. "The whole community has to become involved if we are to make a difference."

He added that cultural taboos often prevented open discussion about HIV/AIDS and its dangers. "In our traditional society, people don't talk about sexuality or HIV/AIDS. Unless we can get them to talk about it, nothing will ever change," he said.

EDUCATING THE PEOPLE

Last year, the minister presided over the establishment of the HIV/AIDS, Malaria, Sexually Transmitted Infections (STIs) and Tuberculosis Control Project (HAMSET). HAMSET was set up to coordinate and improve the treatment and management of these four communicable, and often interlinked, diseases.

Financed by the government and the World Bank, the HAMSET project has already overseen the building of a new national blood bank in Asmara. All blood donations in Eritrea are screened for HIV and other infections.

As well as Asmara's new VCT, at least 20 other such centres have been set up in hospitals around the country and more than 100 counsellors trained.

HAMSET, USAID, the Italian Cooperation and UN agencies are among those who are helping to provide education and information about HIV/AIDS - through schools, the workplace and community groups.

Working with the ministry of education, HAMSET is developing a life skills curriculum for schools, which will encompass AIDS education. Radio and television, as well as posters and leaflets, have also been used extensively around the country.

Recent research indicates that the message is getting through. Last month, the health ministry released the results of a nationwide survey - the first of its kind in Eritrea - into attitudes and preconceptions about HIV/AIDS as well as the prevalence of HIV.

The study found that awareness is very high, with 99 percent of those surveyed saying they had heard of HIV/AIDS and STIs.

The HIV/AIDS Risk Groups and Risk Behaviours Identification Survey studied a nationally representative sample of 4,753 people aged between 15 and 49 years. It focused on five specific social groups - the army, mothers-to-be, female bar workers, secondary school students and the general population.

The study, which was conducted in 2001, found an approximately 3 percent HIV prevalence within the general adult population. The rate increased to 4.6 percent in the army and 22.8 percent among female bar workers.

It also showed that most people (72 percent), although aware of HIV/AIDS/STIs, thought they were not at risk of contracting the virus. A number of those believed they were low risk because they had changed their behaviour since learning about the disease, but researchers say that some respondents were ignorant about how the HIV infection is passed on.

For example, more women thought they had "no risk", compared to men because they had only one sexual partner, although over 56 percent of women surveyed reported that their husbands or partners had more than one wife.

A high number bar workers (60 percent) and soldiers (62 percent) also thought they had no risk of being HIV infected. "If people don't realise they are vulnerable, they are unlikely to change their behaviour," one researcher involved in the survey concluded.

Since the first case was reported in Eritrea in 1988, at least 12,000 people in the country have been diagnosed with AIDS and an estimated 60,000 - 70,000 people are currently living with the HIV infection, although many of these may not know their condition.

SUPPORT GROUP ESTABLISHED

An organisation has recently been set up to support these people. Bidho - which means "challenge" - was formed by men and women living with HIV/AIDS earlier this year. Because of the stigma still associated with the epidemic, members of Bidho asked not to be identified, but one young man in his early thirties told IRIN his story.

After working as a government teacher for 10 years, he was called for national service in 1998, and sent to the front line during the two-year border war with Ethiopia. Two years later, during a visit home to his wife in Asmara, he saw his doctor as he was permanently tired and listless.

After a series of tests, he was finally told he had tested positive for HIV. "I was totally unprepared and refused to believe it," he said.

"I ran out of the doctor's office and would not listen to him. For three months I refused to do anything, I did not return to the army, I stayed in my home thinking my life was over," he said.

A conversation with an uncle, visiting from America at that time, changed his attitude. "He told me that being HIV positive did not mean the end of my life, he told me that there is treatment, and gave me some hope."

"After that I decided to do something, so I went to see the minister for health and was given a job with the government's National AIDS Control Programme (NACP). Now I want to do something to help people who are in the same position as me. I want to be able to tell people that it is not so bad."

Bidho, which is run out of a small office in Asmara, currently conducts workshops and courses to educate people about HIV/AIDS. It also plans to set up an advice hotline and to act as an advocate for PLHAs, lobbying to improve health care and treatment.

Antiretroviral drugs, which can prolong the lives of sufferers, are unavailable in Eritrea. People are forced to buy them from overseas and cost more per month than most people earn in three months.

The health ministry, together with UNAIDS, is currently working to improve medical treatment for PLHAs and has recently started a pilot programme in antenatal clinics to provide antiretroviral drugs to prevent mother-to-child transmission of the HIV infection.

As the morning session at Asmara's new VCT comes to an end, Abeda, the counsellor on duty, said that attendance at the centre has been high.

"People who come to see us are very relieved to have somewhere they can seek help, even if they simply want somebody to talk to. We are already making a difference," she said.

Saleh Meky, the health minister, is realistic about the challenges faced by Eritrea in its fight against the AIDS pandemic.

"The country is committed to a long, long, sometimes tedious fight," he said. "But our history indicates that we can cope, and we can win this war."