Family Health > Programs

WORLD AIDS DAY 2001

Even though AIDS is the subject of many meetings at USAID/Benin, this year the Family Health Team realized that many USAID staff members either had misconceptions about HIV/AIDS, or didn't understand the efforts being made by Beninese themselves to control AIDS. In order to educate its staff and encourage them to get more involved, USAID/Benin planned several site visits for its own personnel to organizations involved in AIDS control in Benin.

The visits, held during the last couple of weeks of November 2001, included stops at the National AIDS Control Program, the Counseling and Information Center and Arc-en-Ciel. USAID staff members who participated in the various visits said that they were surprised about AIDS prevention and control efforts in Benin, and were particularly impressed by the commitment of the individuals they met. Several staff members said that, as a result of these visits, they will try to get more personally involved in fighting AIDS and supporting people living with HIV/AIDS.

A visit to the National AIDS Control Program gave the opportunity for 10 USAID staff members to learn about the government of Benin's efforts. They learned about the national strategy and the priorities for the government.

The Centre d'Information et de Conseil (Counseling and Information Center), located in downtown Cotonou, offers free and anonymous HIV tests and counseling. The director of the center, Séraphine Akovi, gave USAID staff members a tour of the center and talked about the importance of testing as a strategy to prevent HIV transmission. As she explained, only by knowing your HIV status, be it negative or positive, can you make positive life-enhancing decisions. The director also explained to staff the importance of having a second test done about three months after an initial test to confirm the results. At the end of the visit, two USAID staff members were so motivated that they decided to get tested before leaving the center.

Arc-en-ciel (the French word for rainbow) is a Beninese NGO created in 1996 to assure case management for people living with HIV/AIDS. The president of the group, Isidore Zohoun, welcomed about 10 USAID visitors and explained the history of this pioneer NGO. Arc-en-ciel is a membership organization that has worked with nearly 800 people living with HIV/AIDS over the past five years, offering home-based medical care, moral and spiritual guidance and support for income generation. The president explained that the biggest challenges faced by the people they work with include financial difficulties, rejection by family members, and the general stigma in Benin surrounding HIV/AIDS.

One of the major modes of transportation in Cotonou is the motorcycle taxi, or 'zemidjan' (which means "take me quickly" in the local language Fon). It has been estimated that about 40,000 of these two-wheeled taxis circulate in the city, and you can't step foot outside without seeing a zemidjan driver in his yellow shirt uniform. In preparation for World AIDS Day, Population Services International's AIDSMark activity, in coordination with the National AIDS Control Program (or PNLS), trained selected zemidjan drivers in HIV/AIDS education messages and techniques.

Two hundred drivers were trained over the course of two days and each training session ended with a viewing and discussion of the film "Amah Djah-foule" produced by PSI. The film addresses topics such as the increased risk of HIV/AIDS transmission associated with commercial sex and multiple partners, as well as the importance of voluntary testing and counseling for HIV screening. Fifty of the trained motorcycle taxi drivers were then selected to work with PSI educators on World AIDS Day to conduct interpersonal communication sessions on HIV/AIDS prevention and condom use throughout Cotonou, reaching approximately 5,000 fellow zemidjan drivers. The new zemidjan trainers/communicators wore special yellow shirts and caps with the message, "Roulez Protegé avec Prudence"-Drive protected with Prudence (Prudence is the brand of the socially marketed condom in Benin).

To end the educational campaign, PSI and the PNLS organized a caravan of the 200 trained motorcycle taxi drivers, all wearing their new "Roulez Protégé with Prudence" shirts and caps, that made its way through the city. In a morning-long parade, the taxis started at the National AIDS Control Program offices, passed by the Ministry of the Family, Social Welfare and Solidarity, and went on to the port where a new AIDS awareness billboard targeting truck drivers along the Abidjan - Lagos corridor was unveiled. USAID's multi-country regional initiative that targets this high-risk group is the Family Health and AIDS project based in Abidjan. The project has developed a variety of materials targeting truck drivers, including billboards.

The Minister of the Family, Social Welfare and Solidarity, Claire Houngan Ayemona, was joined by USAID/Benin Director Harry M. Lightfoot and PSI Country Director John Justino in addressing the motorcycle taxi drivers and the public gathered for the caravan and unveiling of the new billboard. The Minister officially thanked the taxi drivers for their participation in educating each other about AIDS, calling them 'educators on wheels.'

The day's events concluded with a celebration at a popular Cotonou beach presided over by one of Cotonou's most well known radio DJs. The "beach party" included music and dancing, as well as sketches and skits addressing HIV/AIDS-related topics performed by more than 40 local artists and comedians.

At 4.1%, Benin's national HIV prevalence rate is relatively low compared to other countries in the sub-region. In some parts of Benin, however, HIV rates may be three to four times higher than the national average. The Cuoffo, one of 12 administrative regions in Benin, is probably one of those areas. The region is home to a highly mobile population, with crossroad towns full of truck drivers and migrants, and sentinel sites have shown HIV rates up to nearly 15%.

To support AIDS education in this highly vulnerable part of the country, for one week in November, in preparation for World AIDS Day, PSI, through the USAID-funded AIDSMark program, conducted a variety of social mobilization activities in the Cuoffo. Activities included song and theater contests, with local artists vying for a variety of prizes. Political authorities were involved in social mobilization activities throughout the week, and more than 20,000 people participated in the opening and closing ceremonies.

According to Benin's 1996 Demographic and Health Survey (DHS), basic knowledge about AIDS is high; 82% of women and 95% of men already know that AIDS exists. Over 88% of men surveyed knew that AIDS is transmitted sexually, and 69% knew how to prevent sexual transmission. Among women, 62% knew that AIDS is transmitted sexually, and 54% knew of a means of avoiding sexual transmission. (Results from the 2001 DHS are currently being analyzed and should be available in early 2002.)

Despite widespread knowledge of HIV and modes of transmission and prevention, however, it is difficult to establish whether or not there has been any reduction in risky practices. According to the DHS, more than 82% of men and 73% of women reported that they thought they were at no risk or minimal risk of contracting AIDS. A national survey conducted by Population Services International in 1999 reported that 42.7% of men and 50.4% of women have a negative perception of condoms. Only 53.6% of people reported using a condom during their last sexual encounter with an "occasional" partner. Of those who reported not using a condom, 34.2% said it was because their partner refused.

Apparently, communication efforts have thus far not been fully successful in helping people make the link between risky behaviors in general and their own personal risk for being infected with HIV.

Furthermore, most of Benin's education and communication campaigns have missed the mark by not adequately targeting specific groups that practice high-risk behaviors and require special communication strategies. Such groups include adolescents, commercial sex workers and their clients, people with sexually transmitted infections, and mobile groups, including seasonal workers and truck drivers.

Certain religious institutions present formidable obstacles to effective AIDS prevention activities in Benin, as they are very powerful and most Beninese do not tend to question the authority of their religious leaders. Catholicism, Islam, and traditional religions all encourage behaviors that are, in effect, risky for HIV transmission. The Catholic Church in Benin has taken a particularly strong position against condoms. In 1999, prior to and following World AIDS Day, the Catholic Church actually spread incorrect information to its members, informing them that condoms are not an effective barrier to the virus that causes AIDS.

A challenge of a different sort is presented by Beninese traditional religions and Islam. Both religions permit polygamy, and extramarital relations outside of monogamous and polygamous arrangements are common. Clearly, the acceptance and, in some cases, encouragement of multiple sex partners is a norm that will be difficult to change.

Benin is one of the few countries in Sub-Saharan Africa in which the current HIV prevalence rate remains relatively low, currently around 4.1%. The rate continues to rise in Benin, however, and neighboring countries have much higher rates. Benin cannot afford to be complacent about AIDS. USAID/Benin considers support to AIDS control efforts in Benin to be a top priority--one that requires immediate attention.

Benin's 1999 HIV prevalence rate of approximately 4.1% was more than 16 times greater than the 1986 rate of 0.25%. It is currently estimated that more than 50 Beninese contract HIV each day--and the great majority of these people fall within the most economically productive segment of the population, aged 20-49.

The first case of AIDS in Benin was identified in 1985, and by the end of 1999, more than 150,000 people were estimated to be infected with HIV. Data for 1999 reflect more than 36,000 recorded cases of AIDS, and over 33,000 reported AIDS-related deaths. The proportion of women and men infected is about equal, but prevalence rates vary widely throughout the country.

Most of the countries bordering Benin have higher HIV prevalence rates. Burkina Faso has an estimated rate of 8%. Togo has already reached a rate of 8.5%. The last-reported official rate in Nigeria is 5.4%, but the region bordering Benin has a rate of 7% and some parts of the country have rates of more than 20%. With a population of more than 100 million, Nigeria has more than 6 million HIV-positive citizens. Given the permeability of the borders separating these countries, the prevalence of HIV and AIDS in Benin is undoubtedly being affected by the evolution of the disease in neighboring states.

Although its economy has shown signs of improvement, Benin remains one of the least developed countries in sub-Saharan Africa. With an average annual per capita income of about US $370 per year, rising unemployment, and a high external debt, Benin ranked 157 out of 174 countries worldwide in the United Nations Development Program's 2000 Human Development Report. As in many African countries, in Benin poverty and AIDS are linked in a vicious cycle. AIDS tends to affect the most productive segment of the population, devastating the work force. AIDS also can have a devastating financial impact on the victim's family, which is forced to use its limited resources for medical care. Poverty also increases the risk of people contracting the virus and can lead people, especially disadvantaged women, to engage in high-risk behavior. Short-term survival strategies for poor women may include exchanging sex for money, food or clothing. According to the UNDP's Human Development Report, many African countries are slipping in the rankings from year to year, mostly due to increasing poverty and decreasing life expectancy as a result of AIDS.

Given its stable political situation compared to other countries in West Africa, Benin has the potential of investing its national resources to organize an effective governmental response to the AIDS epidemic. However, Benin is now poised on the brink between maintaining rates at a manageable level and letting HIV/AIDS grow to epidemic proportions, which would have devastating effects on its fragile economy and young democracy.

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