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Cablegate: World Aids Day: Where Is Sierra Leone?

DE RUEHFN #0709/01 3321644
R 281644Z NOV 07





E.O. 12958: N/A

1. SUMMARY: As World AIDS Day approaches (Dec. 1), it appears that
Sierra Leone's HIV/AIDS prevalence rate is reportedly low,
officially at 1.53%, although some sources believe it to be higher. Th
military's prevalence is higher. Efforts to combat HIV/AIDS are
coordinated by the National HIV/AIDS Secretariat, which currently
receives funding from the World Bank and the Global Fund, though
World Bank funding ends soon. USG support comes directly from USAID an
DOD, and indirectly through major inputs via the Global Fund. Sierra
Leone is neither a PEPFAR country nor a nation included in the
President's Malaria Initiative. Thus, it faces major resources
challenges in battling now-chronic illnesses. END SUMMARY.

2. CIVILIAN STATUS: As of 2005, Sierra Leonean HIV prevalence is
1.53% according to the National HIV/AIDS Secretariat (NAS) sero-
prevalence survey, and 1.6% according to UNAIDS estimates. Some
authorities believe the current figures to be low, though, and the
ante-natal clinic positive testing rate of 2.9% suggests that may be
true. According to UNAIDS, out of the total of 43,000 people living
with HIV/AIDS, 26,000 are women and 5,200 are children. HIV/AIDS
related efforts are coordinated by the NAS, an independent
governmental agency, and implemented by a wide variety of partners,
including the
Ministry of Health and Sanitation. In the past few years, the
greatest areas of progress have been in health care, treatment, and
preservation of legal and human rights for people living with HIV/AIDS.
Monitoring and Evaluation has been the area of least progress. Of note
is the abundance of free anti-retroviral (ARV) drugs, but delivery of
testing kits to the provinces is sometimes delayed. The top priority
for the NAS is prevention, which has proven difficult as it requires
changing people's behavior. Malaria is by far the greatest health
challenge facing Sierra Leone. However, HIV/AIDS is of growing concern
in 2002, a Centers for Disease Control and Prevention (CDC) sero-
prevalence study showed an HIV/AIDS rate of only 0.9%, but did not
account for the likely large number of young ex-combatants. There
are currently two major sources of funding for anti-HIV/AIDS efforts:
the World Bank and the Global Fund to Fight AIDS, Tuberculosis and
Malaria. The Global Fund approved a new grant of $26,482,115, the first
tranche of which is $9,627,778 and went into effect in July 2007. NAS
works with 44 partners in multiple sectors to implement programs with
the Global Fund money. Among other things, the Global Fund provides
funding for ARV drugs. Conversely, Sierra Leone HIV/AIDS Response
Project (SHARP), the four-year World Bank project, is due to end in
December, leaving NAS without funding for salaries, building rent,
and several initiatives throughout the country. Despite Parliament
action in budgeting money, no funds have actually been provided to the
NAS by the GOSL.

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3. MILITARY STATUS: The most recent prevalence survey in Sierra
Leone is the May 2007 Republic of Sierra Leone Armed Forces (RSLAF) HIV
sero- preva1ence survey. Though the study's sample size is smaller than
the statistical ideal, the surveyed military HIV rate is 3.29%, more
than twice the national rate. The 40-59 year old age group had a highe
prevalence rate (4.9%) than the 20-39 group (2.97%). Married
subjects were more than twice as likely to test positive. Knowledge of
HIV transmission was mostly good except regarding mother to child
transmission during pregnancy. However, only 23% of respondents had
used a condom during their last sexual contact. According to
military physicians, challenges include insufficient drugs for
non-HIV/AIDS sexually transmitted infections, condom supplies in some
units (largely due to distribution problems), and insufficient HIV test
kits. Also, at least half of military physicians seeing HIV/AIDS
patients need training in understanding and usage of HIV/AIDS drugs.
There is no infectious disease doctor on staff, nor are updated HIV/AID
reading materials and other resources available to military doctors.
There is also little to no home-based or hospice care when ARV drugs
fail. One of the major challenges for military medical facilities is
that they are required to provide free care to civilians, who make up
70%-80% of the case load. Luckily, anti-retroviral drugs are readily
available from the NAS, as they are within the civilian population.

4. USG ACTIVITY: At this time, direct USG HIV/AIDS efforts in
Sierra Leone come primarily from two agencies, USAID and DOD. USAID ha
three related projects in Sierra Leone: the USAID/Washington-managed
Sport Health Project on HIV/AIDS, the USAID/West Africa-managed Action
for West Africa Region (AWARE Reproductive Health and AWARE-HIV), and
the West Africa Ambassador's AIDS Fund (WAAF). WAAF is a component of
AWARE-HIV/AIDS supporting local NGOs in non-presence countries.
USAID/WA supports the NAS for Prevention of Mother-To-Child
Transmission (PMTCT), cross-border activities for HIV prevention
with neighboring countries, and a Blood Safety Program in a referral
hospital. The Defense Attache Office works with the Republic of
Sierra Leone Armed Forces (RSLAF) through the DOD HIV/AIDS Prevention
Program in Sierra Leone (DHAPP SL). In September 2007, DHAPP opened a
Voluntary Confidential Counseling and Testing Center (VCCT), which
is also open to civilians, at the RSLAF 5th Brigade headquarters in Bo,
Sierra Leone's second-largest city. Pending funding, DHAPP hopes to
open two more VCCTs in the other provincial capitals, Kenema and
Makeni. DHAPP also provides RSLAF with condoms and funds and trains

peer educators. The Centers for Disease Control and Prevention

FREETOWN 00000709 002 OF 002

(CDC) also conducted the 2002 sero-prevalence survey and funded NAS's
testing lab. In terms of indirect aid, the USG is by far the largest
donor to the Global Fund, providing nearly 30% of worldwide funding.
Sierra Leone is neither a PEPFAR country nor a nation included in the
President's Malaria Initiative. The Ambassador will speak at the
World AIDS Day Commemoration on December 1, at which the Defense Attach
will also donate t-shirts to HIV/AIDS peer educators and counselors.

5. COMMENT: With an unemployment rate of 80%, it is possible that
the percentage of sero-positive Sierra Leoneans is truly significantly
higher than reported. Add to that the 11 years of war; the number of
young soldiers infected yet uncounted is unknown. In addition to
official USG support, there are already signs of private sector
institutions as exemplified by Baylor College of Medicine's two
assessment missions in Sierra Leone. Baylor has established
HIV/AIDS centers of excellence elsewhere on the continent. Such a
health facility in Sierra Leone would be an apt extension of our and
others' international involvement. Such public-private partnerships
would make a significant difference as this resource-poor nation must
fight not only for democracy but also for a healthy population to move
the country forward.


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