Guinea

1.  General and Epidemiological Data

1.1. General Data

Located in the South-West of West Africa, Guinea covers an area of 245,860km² distributed into four natural regions: lower Guinea, middle belt Guinea, upper Guinea and forestry Guinea. Guinea shares its borders with Senegal, Guinea Bissau, Sierra Leone, Liberia, Mali, the Ivory Coast and the Atlantic Ocean.

Conakry is the capital of Guinea and the country's population is estimated at over seven million inhabitants including roughly 70% rural dwellers.

Guinea was a French colony up to 1958. The country is currently in its third republic. The first (1958-1984) which was marked by a socialist dictatorial regime inflicted considerable suffering on Christians: all those who were not socialists were rejected and persecuted. Sunday was a working day just like other days. With the advent of the second republic (1984-1994), the military regime introduced the freedom of worship and expression: several missions were thus able to enter the country. However the spread of the Gospel still remains very insignificant, and the Islamic tradition, which is several centuries old, still maintains its full impact: over 80% of the population is Muslim.

At the economic level, the country, which is still fragile despite the numerous resources (bauxite, gold, diamond and iron), depends mainly on bauxite and agriculture. Worst of all, Guinea, has moved from the status of an exporting to an importing country over the past twenty years. Today Guinea is one of the poorest countries in the sub-region and has the peculiarity of sharing its borders with countries which have had years of internal wars. It has thus been forced by circumstances to play host to Liberian and Sierra Leonean refugees.

1.2. Epidemiological Data

Up to 1984, Guinea has been relatively protected on aCCount of the "protectionism”instituted by the ruling government and which made, as much as possible, relatively impermeable borders. Today, various health officials point out that it is difficult to know with precision the current status of the HIV epidemics in the country, because reliable epidemiological data are lacking.

The situation currently is as follows:

· From 1987 to the first half of 2000  7,898 cases  of HIV/AIDS

· For the first half of 2000                 1,067 cases  of HIV/AIDS

§ Men                                       552 cases

§ Women                  515 cases

· Percentage of persons infected by HIV/AIDS

§ Men                         54%

§ Women                    43%

§ Children                      3%

§ Blood donors ( +)    2.2%       (7.322 tested including 161 positive cases)

· Average age of AIDS patients        26 years   ( against 39 years in 1989)

· Most affected age group:

§ Men                       35-39 years

§ Women                  25-29 years

· Types of virus

§ HIV 1                     94%

§ HIV 2                     4%

§ HIV 1 + HIV 2         2%

ACCording to the study on the socio-economic impact of AIDS conducted in 1996, the statistical data (estimates) are as follows:

§ HIV prevalence among adults    2.2% – 4.1%

§ Persons infected by HIV 100,000 – 130,000

§ Annual cases of AIDS 6,000 – 12,000

§ Annual deaths from AIDS 3,000 – 7,000

§ Number of AIDS-related orphans        7,000 – 14,000

§ HIV prevalence among prostitutes     32%

It should be pointed out that these figures provided by the STD/AIDS Coordination Committee Office reflect only the tip of the iceberg. In fact, on 31 December 1997, “UNAIDS estimated HIV prevalence among Guinean adults (aged between 15 and 49 years) at 2.1%”. ACCording to health officials, these data are based on an extrapolation of the result of a survey of sero-prevalence conducted in 1989. It is thought that the national rate of sero-prevalence is currently higher, but its precise level is not known. One thing is certain, the situation tends to deteriorate rapidly.

Besides, there is no clear idea regarding the prevalence rate in regions such as forestry Guinea which plays host to most of the Liberian and Sierra Leonean refugees. Nor is the epidemiological status of the migrant population within Guinea known. However to date, all the prefectures of Guinea reported AIDS cases and for each AIDS case reported, it is estimated that between 5 and 14 cases are unreported. Today all the socio-professional categories are affected by HIV/AIDS and the health officials pointed out that all the risk factors are currently present in Guinea and can, within a short period, trigger an explosion of the HIV/AIDS epidemics: those vulnerable groups who are highly infected (motorists, sexual workers, security agents....) and the high prevalence of STIs.

2.  National AIDS Control Policy

2.1.    Background Information

The first cases of HIV/AIDS were diagnosed in 1987 among people who had lived abroad, particularly in Sub-Saharan Africa. Shortly afterwards, subjects who had never travelled were also diagnosed positive. The National AIDS Control and STD Committees, which were established in the same year, created from 1988 to 1990, as Prefectoral Committees and identified the risk sites, in order to conduct studies and surveys on seroprevalence.

2.2.    Strategy Thrusts of HIV/AIDS Infection Control

Intervention strategies

The National STI/AIDS infection Control Programme (NACP) which is the execution body of the governmental policy designed the following strategies:

Prevention

In this area, the emphasis is placed on:

§ the prevention of the sexual transmission of HIV and other STIs.

§ the prevention of the blood transmission of HIV

§ the prevention of the transmission from mother to child

§ the training of the stakeholders involved in combating STI/AIDS in research methodology (survey on knowledge aptitude/practice, study on germs resistance/sensitivity, survey on HIV/STI sero surveillance...)

Furthermore, a multi-sectoral programme is under implementation. There is a focal point of the National AIDS Control Programme in all the Ministries and concrete actions are being developed by a number of them: for example the Ministry of Agriculture has created agricultural popularizers, elected premises..., the Ministry of Education has created ten AIDS control clubs in the 5 communes of the capital Conakry. The Ministry of Defence/Security trained 53 pairs of animators within the army and security forces.

Care

The following are noted:

§ care of PLWAs

§ involvement of communities in the care of these persons

§ effective care of STIs

§ establishment of care facilities for the medical care of persons living with HIV

§ reinforcement of the national essential drugs policy by taking into aCCount the opportunistic infections during the course of AIDS and other STIs

It should be emphasised that there is not yet in Guinea an anonymous screening centre.

2.3.    Stakeholders Involved in AIDS Control

Guinea , just as all African countries, benefits from the financial, technical, and logistic support of international organisations, international NGOs and bilateral co-operation agencies.

The NACP works in collaboration with the following partners:

§ UNAIDS

§ WHO

§ The population generic health project of the World Bank

§ GTZ

§ AIDS control support project (Canada)

§ Project for the reinforcement of interventions on STI/AIDS (USAID).

Numerous national NGOs are working in the field alongside the government, A more or less active involvement of Churches and religious communities has been noted.

3. Position and Involvement of Churches

We were able to contact the Church leaders or those responsible for the Health Departments of the Anglican, Catholic, Evangelical Protestant, Assemblies of God, Adventist Church...Officials of the Muslim community were also contacted.

3.1.    Perception of the Disease by Churches and Other Religious Communities

In Guinea, studies have shown that up to 94% of the mode of HIV transmission is sexual; perinatal and blood transmission represent only an insignificant proportion. This observation strengthens Churches, missions and religious communities in their conviction that the epidemics is associated with moral degradation (infidelity of couples, promiscuity, sex trade, sexual profligacy...) closely related to the economic crisis facing the country, poverty and growing misery: despite the natural wealth of the country, unemployment is very high and half the inhabitants of the capital are said to be living below the poverty line. At the same time, the epidemics is contributing to reducing very significantly the productivity of the labour forces thereby creating a vicious cycle. The spread of the virus is also attributable to the ignorance of people: the reality of AIDS is not evident to everybody. The churches which are located in the forestry region, where there is a strong refugee presence, observe that the propagation of the virus is also encouraged by the chronic lack of hygiene.

Churches are aware of the need to put faith into action in the light of the epidemics. However, they do not approve the use of condoms as a means of prevention. The Muslim community in Guinea has a clearer position on the issue: AIDS epidemics, aCCording to leaders, has a close link with the failure to observe the divine commandments: “God gave the commandments to Man, but the latter, thinking that he is more intelligent than God, chose to ignore them thus incurring His wrath".

On the whole, Churches were sensitised on the AIDS problem and a relatively clear vision of its causes: man is largely responsible for its spread, however, under no circumstances, is HIV/AIDS considered as a punishment from God

Faced with the epidemics, Churches, missions and religious communities are conscious that they have a role to play. On the one hand, Churches and missions feel they are called upon to be providers of a cure and the Koran recommends to the Muslim to provide assistance to all the needy.

At the same time, it has become clear that irrespective of the form which an intervention may take in the field of AIDS control, it is out of the question that the parties concerned should resort to the promotion of condoms.

3.2.    Involvment of the Churches

3.2.1.   Anglican Church

Founded in 1855, in principle it is the oldest church in the country. Unfortunately its development was stalled for several reasons. It became a diocese only in 1985. Its first Bishop was ordained in 1986 and he died one year later. His suCCessor was ordained only in the year 2000.

Forming part of the West Africa province which brings together Ghana, Liberia, Sierra Leone, the Gambia..., the Anglican Church has 4,500 to 5,000 faithful distributed all over the national territory and supervised by ten priests.

The Anglican Church expresses its presence in the society mainly through its nursery and primary schools, its health centres and agricultural activities. It manages 4 schools and 2 dispensaries. Guinea is one of the poorest countries in the sub-region and the structures established by the government are not able to cover the needs of the population in this area.

With regard to AIDS control, the action of the Anglican Church is not yet developed. To date, it consists in a number of awareness-raising activities at the level of women's associations. The Anglican Women's Union of Guinea (UFAG - Union des Femmes Anglicanes de Guinée), with the assistance of the NACP, organised information and awareness-creation meetings not only for women in the Anglican Church but also for those of the Catholic and Protestant Church. These three denominations have a common structure called “The Union of Christian Women of Guinea”(UFCG - Union des Femmes Chrétiennes de la Guinée) which brings together all women from their Churches who meet periodically for common activities. From these meetings, each Association Officer takes over and spreads the message in his church.

In the area of care, there is neither a programme nor a structure. The health centre of the Church are content with dealing, where necessary, with the most serious case by trying to treat the opportunistic infections.

The Anglican Church would like to count on the assistance of the WCC and WAYMCA for the formulation of concrete projects.

3.2.2 The Catholic Church of Guinea

Currently, Catholics of Guinea are said to represent roughly 4% of the population and the Church is divided into three dioceses. Like other religious communities it develops, alongside the preaching of the word of God, the education and health sector. The Catholic Church has created eight centres countrywide.

The Episcopal Conference of Guinea understood quite early on that the HIV/AIDS epidemics is a crucial problem requiring the involvement of the Catholic Church. This conviction was strengthened by the fact that in Guinea, many associations and NGOs have been involved in prevention, even though the caring component of the disease is not adequately provided for. The health centres are often compelled to hand over the PLWAs to their families or leave them to fend for themselves. The Church should therefore be able to remedy this shortcoming. Unfortunately words are not matched with deeds.

Prevention

From the outset, the Catholic Church has worked in collaboration with its partners, particularly CORDAID, MIMESA, CARITAS... With the support of a German expert, it organised working sessions with 3 dioceses to define the main thrusts of its involvement. Unfortunately for reasons of communication, the dialogue was interrupted. However, a relatively advanced work is being done in the field of prevention. The Catholic Church has participated in the awareness-raising procession which crossed the length and breadth of the forestry Guinea and the mining zones of Upper Guinea. Furthermore, the Department of Health has ensured training scouts in the field of awareness to the problem of AIDS. It also organised awareness-raising sessions in schools. In the same vein, the annual diocese meetings have put STI/AIDS awareness-raising sessions on their agenda.

Care

In order to address this need, the Technical Committee of the Health Department designed a project for the creation of a socio-medical centre. Besides all the activities connected with AIDS (screening, care...), it has been envisaged to ensure the anonymity of this centre and its aCCessibility by developing other activities there, particularly family planning and the care of disabled persons. However, for the time being, the project is still at the stage of the search for financing.

3.2.3.   Associations of Evangelical Churches and Missions of Guinea

In a country where Muslims are in a majority by over 80%, the Association of Evangelical Missions and Churches of Guinea (AEMEG) is a structure which strengthens, above all, the presence of the Christian communities. AEMEG brings together 29 Evangelical Churches and Missions which represent roughly 76,000 evangelical Christians (1% of the Guinean population). Their prime objective is the preaching of the Word of God and the translation of the Bible. In the social sector, AEMEG concentrates its efforts on education and health (nursery, primary, secondary schools, literary programmes, health centres...)

During our meeting with the AEMEG, representatives of four Churches and Missions were present to share their experience with us. It should be pointed out that 10 health centres fall within the purview of the association countrywide.

AIDS has been a daily challenge for AEMEG especially since 1990 which marked the beginning of the influx of Liberian then Sierra Leonean refugees. Most AEMEG members were involved in the forestry zone, the region in which refugees camps were located. In addition, AIDS affects all the prefectures of Guinea.

Prevention

There is no common programme to AEMEG members. Each of them tries to deal with the epidemics with the resources at its disposal and one can observe a real commitment which is also manifested through projects.

The Evangelical Protestant Church of Guinea (EPEG)

The Church was able to participate in information, awareness-raising and training sessions organised at the national level and also by MAP international in Abidjan (Ivory Coast). Since 1998, it established the "Evangelical Committee against STD/AIDS”. The Church has just designed a “project for the sensitisation, prevention and training for combating AIDS and STDs”. This project concerns seven prefectures located in forestry Guinea where the EPEG is strongly established (roughly 50,000 members). The project's objectives are to involve local Christian communities in combating HIV/AIDS and strengthening the pastoral care of PLWAs.

It envisages:

§ the strengthening of the national essential drugs policy

§ the training of male and female motivators and health personnel

§ the sensitisation of pastors

§ the development of IEC...

The Assemblies of the Church of God (ACG)

The Vice President of the ACG had the opportunity in March 1999, to participate in the seminar organised by the coordination of the Assemblies of the Church of God in Africa (ACGA) where each religious leader was called upon to establish an AIDS control programme in his country.

Following this meeting, a ACG Guinea initiated a series of activities as follows:

§ an awareness-raising and an AIDS control department was created

§ an awareness-raising session was organised bringing together the faithful of various Churches in which youth volunteered to participate in a public awareness-raising programme

§ Training seminars were organised for volunteers

§ The youth were sensitised in schools on world AIDS day.

§ Information and sensitisation visits were undertaken to Churches in the capital

§ Awareness-raising campaigns were undertaken in markets and prisons

With regard to caring, a relatively elementary work is being done at the level of health centres (ecumenical institutions and denominational health centres). The department has relatively positive contacts with the care of the NACP which facilitates the work by the issuance of mission authorisations and provides it with technical advice.

In addition, it has just designed a project which aims at extending the awareness-raising activities to a wider segment of the population particularly the youth with the setting up of anti-AIDS clubs and a greater commitment in the field of caring (screening, medical assistance, psychological assistance, spiritual assistance...). This project also includes the creation of a welfare centre which will be a place for listening, information, sharing and counselling.

Other members of the AEMEG are also involved in various degrees, in the field of prevention, and there are some also who are only at the reflection stage. However, in the opinion of Churches and missions present at our meeting, there are needs to be taken into aCCount in the short term:

§ training of Christians at all levels of the church (particularly leaders of the Church)

§ welfare and documentation centre

§ reagents for free and confidential screening.

§ Anti-retroviral

§ Improvement of communication systems

§ Financial support

§ Solidarity and mutual assistance from other communities and international agencies

3.2.4.   7 th Day Adventist Church

Established since 1991-1992 in Guinea, the 7 th Day Adventist Church has 500 members countrywide (100 of which are in the capital Conakry) who are supervised by two pastors and four evangelists.

The Church has a development structure called ADRA ( Adventist Development and Relief Agency) which takes care of development throughout the country: agricultural projects, construction of school.

Prevention

The Adventist Church does not have a specific programme in the field of prevention or care. It deals with health problems in a comprehensive manner. Basing itself on the biblical principle which says that “our body is the temple of the Holy Spirit”, the Adventist church puts a special emphasis on the health of the faithful who are taught to consider their bodies as belonging to God and to take special care of it in all areas. The faithful is thus urged not only to eat in a healthy manner but also to shun adultery or fornication, tobaCCo and to quit any behaviour which can damage the integrity of his body.

3.2.5. Islam and AIDS in Guinea

If AIDS is the consequence of the non observance of divine prescriptions, one of the prevention measures should be to sensitise the faithful in these precepts and to urge them to put them into practice. During the fasting period, competitions in reading and recitation of Coranic verses were organised with the aim of encouraging youth to be interested in the Koran and to know the content because it is by doing so that they will know the commandments of God. This strategy falls within the framework of the recommendations of the first national seminar organised in Conakry on “Islam, population and development”. This seminar has focused on the protection of the family, amongst other issues, which is a basic unit of the family. The respect of marriage as the sole legal institution of the family was strongly recommended. The leaders, after taking part in the meetings organised by governmental institutions, reflect on how to organise prevention and are also in the process of receiving information on the experiences gained by other Islamic leagues in other countries. In the future, it will be necessary to see how to involve the Ulemas in sensitising the faithful through their sermons. The reflection is also on the production of education manuals for the youth just as what has been done in Chad where the Ministry of National Education published brochures in schools within the framework of the fight against AIDS.

With regard to caring, it should be pointed out that the Koran recommends to every Muslim to provide necessary assistance for moral support and even medical support to the sick. No PLWA should, in principle, be abandoned to his fate, even if in the event of death, no prayers are said for him.

4.  Poverty and Human Rights

Churches and Missions in Guinea are committed to respect fundamental Human Rights. This explains why they combine evangelisation and the preaching of the Word of God with socio-educational and medical work, as well as agricultural support. Depending on the case, the national Churches also try to be involved in the socio-political life. In light of the difficult situation facing the country for some months and which is reflected in repeated incursions of rebels groups into forestry Guinea, the Catholic Church made a disapproving declaration “the political manipulation is detrimental to the construction of a nation where solidarity, justice, respect for human life, concord and national unity should prevail”. It did not gloss over the anguish of war, insecurity and famine which have dogged the daily life.

What is lacking in this approach is a sustained advocacy before governmental authorities for a better distribution of wealth with a view to reducing poverty which is one of the factors of the propagation of HIV/AIDS. As we are aware, governments very often have a tendency, within the framework of the structural adjustment constraints, to reduce the educational and health budgets in favour of those from other departments. Meanwhile the cut back in health expenditure negatively impacts the fight against AIDS. However, for the time being, it seems that the Churches and religious communities do not yet establish the link between human rights and AIDS.

5.  Ecumenical Organisations and Denominational Health Facilities

5.1. Ecumenical Institutions

The Biblical Alliance of Guinea

Just as the other African countries, the Biblical Alliance of Guinea works in collaboration with all Churches even if its facilities are not yet extensively developed. In addition to the propagation of the Holy Scriptures and the Christian literature, the Alliance has played an essential role in the life of Churches in Guinea. It suCCeeded in conciliating Churches by enabling them to come closer to one another instead of confronting each other on doctrinal issues and aCCusing one another based on assumptions. This achievement is to the advantage of the Alliance and should be taken into aCCount during the search for structures which can easily provide the link between Churches and the religious communities in order to ensure common work.

With regard to AIDS control, the Biblical Alliance of Guinea is only at the reflection phase. It plans to embark on a prevention campaign by the production and distribution of leaflets and awareness-raising audio cassettes on the causes of AIDS, the ways and means of halting its expansion.

The St Gabriel Catholic dispensary

With regard to caring it has tried as much as possible to deal with the situation through screening and monitoring. However, in the absence of the appropriate structures and drugs, it is constrained to put the PLWAs in contact with the “Hope Foundation”of Guinea which has encouraged the formation of the “Association of PLWAs”. Neither does St Gabriel have the possibility of providing free testing which cost between FF 100 and FF 200, not to mention that, for the time being, aCCess to anti-retroviral is impossible.

The ADA Health Centre

One of the two health centres of the Assemblies of God is trying to immerse itself into the field of caring by facilitating screening; in principle, screening is free but for unknown reasons, it is not free in reality. This is an obstacle for those who are expected to make it. The ADA centre has therefore tried to find a solution. In agreement with the national referral laboratory and the care of the NACP, it is responsible for the first phase of the operation by taking the blood samples which are then transmitted to the laboratory. A modest amount is paid and the results are also withdrawn from the health centre.

With regard to treatment, the centre places at the disposal of the PLWAs relatively complete generic products (there are no antiviral) which are free for those who lack the means to pay for them.

As far as support is concerned, the centre is in the process of initiating a group of Christians who can visit the PLWAs in their homes in order to support or encourage them.

The Church places a lot of hope on the creation of a welcome centre which will enable it to better organise the care of AIDS cases.

6.  Resource Structures

Besides the NACP, we could not (due time constraint) visit the NGOs or associations which intervene in the field of AIDS in order to identify those which can provide helpful assistance as in the case of an action from WCC and the WAYMCA. The existence of Guinean Association exists for the prevention of STDs including AIDS, the Fondation Espoir, (Hope Foundation), the Guinean Women's Association for combating STD and AIDS (ASFEGMASSI), Sidalerte (Aids Alert...)

7.  Ecumenical Networks

With regard to networks, the existing ones are not extensive. This shortcoming is said to be partly due to the communication difficulties facing the country. The Catholic Church forms part of the sub-regional network of denominational health facilities and participated, within this framework, in the 3 rd meeting of the West and Central African denominational health facilities coordination networks. Generally, during these meetings, the discussions focus on current health-related issues. During the last meeting, the AIDS problem was mentioned and the organisers even appealed to other religious institutions including Muslims. On the other hand, at the national level the Catholic Church of Guinea does not, foster this type of relation in this field with the other Churches or religious communities.

Churches of the AMEG have a number of contacts with MAP international in Abidjan. The ADD of Guinea forms part of the Pan African structure of the Assemblies of God (ADA). The Anglican Church does not belong to any networks on this matter. However, during the meeting in November 2000, which brought together the Anglican Churches of the West African sub-region in Sierra Leone, the problem of AIDS was raised and Churches were exhorted to take this into aCCount. Will the proposals lead to the formation of a network? This is not yet the case.

The wish and the strong recommendation of the Anglican Church of AMEG is to see WCC and WAYMCA facilitate the creation of a network which could assist in resolving the problems which face them in the field of AIDS control (periodic consultations, organisation of training seminars… AEMEG indicated that it was ready to second an officer to work with this network. However the project initiators also have the latitude to work with these AEMEG Churches and missions in an individual manner and vice-versa.

The Catholic Church, for its part, would see this network in a very favourable light.

The Muslim community would be open to any discussions on the issue.

In the Adventist Church, AIDS is considered as a catastrophe and one is prepared to gloss over doctrinal differences in order to collaborate with any action likely to contribute to halting the devastation.

8.  Conclusion

Guinea is one of the countries where the need and urgency for external assistance is felt acutely. The Churches and missions have really appreciated the initiative of WCC and the WAYMCA and are awaiting a completion of the study. Even though, there is a mobilisation of the Churches in the light of the AIDS problem, aCCess to information, expertise and financial resources are lacking.

ACCording to official documents “6,049 cumulative AIDS cases were reported in the health institutions from January 1987 to the first quarter of 1999 including 316 cases for the first quarter of 1999 (men 59%, women 38%, children 3%). It has been observed that the average age of PLWA decreased from 39 years in 1989 to 26 years in 1999”.

As of 31 December 1997, “UNAIDS estimated HIV prevalence at 2.1% among Guinean adults (aged between 15 to 49 years)”. ACCording to health officials, these data are based on the extrapolation of the results of seroprevalence survey conducted in 1989. Indeed, it is thought that the national seroprevalence rate is currently the highest, however its precise level in not known. Worst of all, data for the risk or vulnerable groups give cause for concern. Thus, a specimen of 140 sex professionals in the urban area showed that 32% of this group is infected. Among the consultations for sexually transmissible infections (STIs), 4% are infected by HIV (a specimen of 800 persons in 1996). During the same year, 5% of a specimen of 250 long-distance truck drivers were found to be HIV positive.

Furthermore, it is not yet well known the situation which prevails in the regions such as forestry Guinea which plays host to most Liberian and Sierra Leonean refugees. Nor is the epidemiological status of the migrant population within Guinea. However, to date, all the prefectures of Guinea reported AIDS cases and for each AIDS case reported, it has been estimated that between 5 and 14 cases were not reported.

Today, all socio-professional categories are affected by HIV/AIDS and health officials pointed out that all the risk factors are currently present in Guinea and could soon trigger an explosion of the HIV/AIDS epidemics. These factors include the highly infected vulnerable categories (long-distance truck agencies, sex workers, security agencies…) and the high STI prevalence rate.