Burkina-Faso

1.  General and Epidemiological Data

1.1. General Data

Burkina-Faso, formerly called Upper Volta, is a landlocked country of West Africa which shares borders with Mali to the north-west, the Ivory Coast to the south-west, Ghana, Togo and Benin to the South and Nigeria to the East. The country has an area of 274,000 km². Burkina-Faso is a sahelian country whose relief is low; the average altitude does not exceed 400 metres. The tropical type of climate is characterised by the alternation of a long dry season with a short rainy season which starts from May to September with very strong variations in the rainfall pattern.

Demographic data

The population is estimated at 11,633,000 inhabitants (UNAIDS). The general rate of population expansion is 2.37%. The population density is 38.9 inh./km². Life expectancy which was 52 years, fell to 49 years with the HIV/AIDS epidemics. In 1991, 48.9% of the resident population was said to be male as against 51% female. The age structure shows that the population is very young of which 49% are under the age of 15; the 65 year age group and above aCCount for only 3.6% of the total population. Migration movements between the provinces and abroad, in search of better conditions of life, affect 10% of the population.

There has been a remarkable increase in the number of people practising different religions. The animists who currently represent roughly 25.9% are decreasing steadily compared to the Christians and Muslims who are increasing in their numbers.

Socio-sanitary data

The literacy rate is low: 26% in 1957 with high disparities between men and women, the urban and rural areas. The gross rate of education is 39.7%. In order to ensure health coverage as extensive as possible, health delivery is organised in such a manner that the communities can resolve their health problem as easily as possible. Thus major programmes for combating the disease have been implemented by the government. Despite this the health situation remains alarming. The major endemo-epidemic diseases persist, whereas the medical, para-medical staff and health facilities remain inadequate and poorly distributed. The infant mortality rate remains high (128°/°°), the general mortality rate is 16.6%, the maternal mortality rate is 566 for 100,000 live births. The health personnel-to-population ratio is below WHO standards. The country has one doctor for 29,000 inhabitants, one midwife for 28,000 inhabitants.

1.2. Epidemiological Data

The HIV/AIDS epidemics infection has come to increase the number of deaths in all segments of the population. The first AIDS cases in Burkina-Faso were reported in 1986 and ever since, there has been a significant increase in the number of cases. From 10 cases declared in 1986, AIDS cases shot up to 9,136 in 1996, 13,518 in 1998 then 16,823 in the year 2000 (UNAIDS: number of cumulative cases).

The mode of contamination is mainly sexual and estimated at 85%. The data on the infection's prevalence in high-risk groups is as follows:

• Prostitutes in Ouagadougou: 59.2%; in Bobo Dioulasso 57.7% in 1994
• Persons consulting for STIs: 42% in 1992
• Truck drivers in Ouagadougou: 13% in 1993, Bobo Dioulasso 18.1% in 1994
• Tuberculosis patients in Ouagadougou: 34% in 1994

The overall HIV infection was estimated at 7.17% in 1997 (UNAIDS)

2.  National HIV/AIDS Infection Control Policy

2.1.    Background to the AIDS Control Programme

Since the first AIDS case was reported in 1986, the disease spread very rapidly in the country. Thus, a national HIV/AIDS and Sexually Transmitted Infections Control Committee was established in 1987 to coordinate with the Ministry of Health, a control of the epidemic as well as a monitoring programme.

2.2.    Strategy Thrusts of the HIV/AIDS Infection Policy

The HIV/AIDS and STIs control plans and programmes as designed by the committee with WHO support envisaged actions and interventions spread over a period extending from 1987 to 2000 to be carried out in three phases; a short-term plan from 1987 to 1989, a medium-term plan extending from 1990 to 1995; an extension plan spreading from 1996 to 2000.

Policy components

The policy document which is in the process of finalisation comprises the following main areas:

• Prevention of transmission;
• Comprehensive care of cases (the sick, orphans, widows and widowers, PLWAs);
• Awareness-raising;
• Screening and treatment of opportunistic infections;
• Epidemiological surveillance;
• The development of a national partnership involving civil society, economic operators, ministries, NGOs, traditional healers, Churches and religious communities;
• The development of an international partnership with bilateral and multilateral cooperation agencies.

2.3.    Stakeholders Involved IN AIDS CONTROL

The HIV epidemic was seen from the beginning as a national multi-dimensional problem requiring a multisectoral and multidisciplinary approach. Several stakeholders have thus associated their efforts with those already engaged by the National HIV/AIDS and STIs Infection Control Committee. These stakeholders can be grouped into several categories namely: NGOs and national secular and religious associations, external partners; Churches, ecumenical organisations, civil society and the private sector.

NGOs and National Associations

These are very numerous in the country. They are either secular or denominational established mainly in Ouagadougou, the political capital or Bobo-Dioulasso, the economic capital. They are very active and play an important role in awareness-raising and sometimes in the care of PLWAs, orphans, widows and widowers.

External partners

The external partners are also very numerous in the country and intervene at several levels in the struggle against AIDS through the provision of expertise and financing. These are mainly UNDP, UNAIDS, WHO, UNFPA, the French Cooperation, Plan International, HIV/AIDS International Alliance, Christians and AIDS, the Red Cross, GTZ, ORSTOM, UNICEF, the World Bank etc...

Churches and ecumenical organisations

In Burkina-Faso, the commitment of the Churches in combating the HIV/AIDS infection epidemics is remarkable be it at the level of the Federation of Evangelical Churches and Missions or that of the Catholic Church or the Assemblies of God. In addition to the Churches, ecumenical organisation such as the Biblical Alliance have not remained silent.

3.  Position and Involvement of the Churches

Since Burkina-Faso's first contact with Christian religion, several Churches and ecumenical organisations have settled in the country. Within the framework of our study, we met with a number of them namely: the Catholic Church, FEME, the Assemblies of the Church of God, the Adventist Church through its aid and development agency and the Biblical Alliance.

3.1     Perception of the Churches

The perception of the illness by Church leaders is identical and unanimous. The AIDS epidemic is acknowledged by all as a reality and a dimensional challenge with multiple components such as medical, social, economic, religious and ethical. The disease does not make any discrimination and everybody is concerned either directly as an infected person or affected by its consequences. Everywhere, AIDS leaves in its trail grief, misery, orphans and widows. The family and social fibre is destroyed and the positive impact of African family solidarity has been erased. AIDS reduces life expectancy and destroys development efforts since it is the youth who pay a heavy price for it.

Viral aetiology is acknowledged by all Churches as the sole cause. However, one cannot rule out rumours among the faithful attributing AIDS to supernatural forces. Sexual promiscuity, uncontrolled sexuality and poverty leading to prostitution and polygamy, have been acknowledged as the main factors responsible for the propagation of the disease. Other factors such as migratory movements, rural-urban drift and pornographic publicity by the media are also mentioned.

However, under no circumstances do the churches consider AIDS as a divine punishment, because “God is a God of love who gives life and not death” . They consider AIDS as “a pastoral challenge which compels us to explain the profound sense of human sexuality and highlight the moral values which are intimately related to it”.

3.2.    Involvement of the Churches in AIDS Control

The commitment of the churches to AIDS control is very remarkable. All Christian Churches which we met have been sensitised on the seriousness of the problem. There is a general awareness on their part of their role as special stakeholders in combating the disease. Thus, virtually, all of them have initiated preventive activities and management activities in order to assist the infected and affected persons by providing them with a minimum of human dignity.

3.3.    Involvement of the Churches in AIDS Prevention

It is in the prevention of AIDS that almost all Churches are involved. In fact many men and women run the risk of being infected due to a lack of information on the mode of HIV transmission. For this lectures and discussions have been organised by all Churches in all parishes.

Points of convergence in the prevention measures

All the Churches above mentioned organised reflection sessions on AIDS within the internal decision-making structures. The two messages delivered were abstinence before marriage and mutual and permanent fidelity during marriage.

The Churches also established committees in the struggle against AIDS in the parishes or dioceses to promote discussions, debates and conferences within organised groups and choristers.

For all Churches, the importance of pre-marital serology is acknowledged and aCCepted but this is not demanded. It is only advised in a number of special cases by pastors.

Points of divergence in the prevention measures

Many controversies exist regarding the utilisation of condoms. There are two opposing view points. In the view of Father Fran&CCedil;ois Sedgo, coordinator of activities for the struggle against AIDS in the Catholic Church and the Assemblies of the Church of God, the utilisation of condoms should be proscribed. None of the leaflets disseminated by these two Churches mentioned the use of the condom as a method of prevention.

The second position is that of other Churches, in their view, believe that the prevention message should give abstinence and marital fidelity all their intrinsic value. However, the use of the condom is tolerated within a couple where there is an acknowledged risk of contamination of one spouse.

It should be pointed out that if the sexual mode is acknowledged by all Churches as the principal mode of transmission, sexuality must be at the centre of prevention measures. However, Church leaders are not prepared to tackle the problem. Thus, neither catechism nor training programmes for pastors seem to have taken into aCCount the sexuality dimension.

3.4.    Churches' Stance Towards the Care for the AIDS Infected and Orphans

In Burkina-Faso, AIDS is known to all segments of the population due to the numerous cases of death in families and due to the high rate of prevalence. The slogan “AIDS kills” pervades the Burkinabe society. Contrary to its objective of prevention, this message plunges the sick into moral, emotional and spiritual distress. The information concerning the infection is still kept intimately in the family or reported only to leaders of Churches who keep it confidentially. Besides pastoral support, none of the churches visited have established care structures. This is not due to a lack of commitment or perception of the problems but due to a lack of experience and resources. It should however be noted that there are a few oCCasions on which food, drugs, clothes or financial assistance are provided.

In any case there are denominational health facilities which organise remarkably well the care of PLWAs as well as orphans. Examples of these health facilities are the Saint-Camille medical centre of the Catholic Church “Vigilance”, “Bergerie, Foi, Univers, Compassion” of the Assemblies of the Church of God and Christian Medical Union. The Adventist agency ADRA includes the various aspects of care in its assistance and development mission while “Home KISITO” of the Catholic Church is specialised in the care of orphans.

4.  Poverty and Human Rights

Burkina-Faso, just as most countries in the sub-region, is faced with daunting developmental problems. The urbanisation of the country, however modest, creates social, economic and health problems which especially affect the youth. Faced with difficulties, the young girls tend to indulge in prostitution. The government's efforts to improve the situation were negated by the HIV/AIDS epidemics which has increased the number of neglected people. Confronted with this situation, NGOs, national and international organisations, Churches.... have been striving to rise to the challenge.

In support of the social pastoral work of the Church, the faithful of the Catholic Church are urged to be involved in socio-sanitary activities in order to alleviate the misery, suffering and promote the development of the individual.

FEME, for its part, has an extensive assistance and development structure namely the Evangelical Churches Development Office (ODE). Its sector of intervention in favour of the communities are agro-ecology, agro-pastoral water supply, socio-sanitary construction and emergency aid. The Assemblies of the Church of God intervenes through three denominational organisations: AIDS Action Mission of the Assemblies of God (MASAD), "Vigilance”, "Bergerie, Foi, Univers, Compassion".

The Adventist agency initiated community development projects, income-generating activities, establishment of food collection centres and promotion programmes for women and child survival.

5.  Ecumenical Movements and Health Facilities

5.1.    Biblical Alliance of Burkina-Faso

In the view of Biblical Alliance of Burkina, the HIV/AIDS infection is a major problem which threatens mainly the youth. The project initiated by the Alliance has the following objectives:

• indicating to the youth the spiritual path which will safeguard them against infection because our body is the “temple of God”
• sensitising adults on marital fidelity of the couple based on excerpts of biblical verses.
• supporting infected or affected subjects through pastoral support, because the sickness is not a conviction.

Theologically, the infected person must aCCept with faith his suffering without resignation. Caring should not be considered as an act of pity but as a demonstration of love in faith to provide relief. The methodology approach inspired by the theological understanding of the problem will take the spiritual dimension into aCCount. The causes and modes of transmission will be tackled briefly.

The messages adapted from Bible excerpts will be disseminated in French, in the national languages for printing, audio cassettes and broadcasts on the country's denominational radio stations.

5.2.    Saint-Camille Medical Center

The Saint-Camille medical centre is a health facility of the Catholic Church located in a suburb of Ouagadougou and headed by Father Salvador who is the only permanent doctor of the centre. With regard to the care of HIV/AIDS cases, a therapeutic trial based on molecules extracted from medicinal plants in the sub-region is taking place in this centre. Satisfactory results are said to have been obtained. A well-equipped laboratory makes it possible to undertake HIV screening tests and biological monitoring (dosage of CD4 rates, viral load) of PLWAs a the centre. An inexpensive treatment of opportunistic infections is provided. This makes Saint-Camille medical centre a reference centre in the treatment of PLWAs. The sick persons included in the therapeutic trial protocol will soon be transferred to a thirty two (32) bed annex unit whose construction is in the completion phase. This new unit will conduct research into therapeutic trial protocol on materno-foetal transmission of HIV.

5.3.    Christian Medical and Para-Medical Union (UCMP)

The UCMP is an inter-denominational evangelical association bringing together Christian medical and para-medical personnel of all religious denominations. The goals of this association of Christian medical personnel are:

• to take care of man in his totality: body, soul and spirit;
• to encourage members to demonstrate their faith in their work places;
• to spiritually and materially support the sick without discrimination.

Established since 1992, the UCMP is represented in all the regions, provinces and departments of the country. Its activities are geared towards awareness-raising and training within all the denominations. The target groups are mainly associations, organised groups, leaders, pastors and priests. Lectures-discussions and projection of films are the approach strategies during awareness-raising sessions for the faithful on health problems in general and particularly HIV/AIDS infection.

Since the beginning of the year 2000, UCMP has designed a 2-year plan of action for the care and prevention of HIV/AIDS through a multi-sectoral and integrated action of care, counselling and prevention.

In addition to awareness-raising, UCMP has initiated another management project specifically in Ouagadougou where PLWAs oCCupy 30% to 80 % of hospital beds.

The objectives of this project envisaged are the care of the PLWAs in hospitals in collaboration with the health personnel and at home in collaboration with the community health staff. It is also envisaged that food, drugs......requirements of the needy will be taken care of.

5.4.    Bergerie, Foi, Univers, Compassion Assiociation

It is a denominational association established in 1989 within the Assemblies of the Church of God in Burkina-Faso. The association's goal is to help in improving the health status of the faithful by supporting the Church in its social, humanitarian and health action. The members of the association are Christians with various professional skills: pastors, doctors, nurses, psychologists, biologists etc...

In order to take care of man in his physical and spiritual dimension, Compassion has combined health delivery with evangelisation in the communities. Its concern is to provide replies to exclusion, solitude, despair and restore the social link of patients. In view of the rapid propagation of the infection among the population, Compassion gave priority to the struggle against AIDS from 1994-1995 without neglecting the other activities. Groups of motivators were trained in 96 parishes in all Churches of the two provinces (Oubritenga and Kourwéogo). Each team is composed of one pastor, one leader of a women's group, one deacon, one youth association leader.

The head office of the Association is located in the semi-urban zone, it has a lecture and reunion room, a pharmacy unit, two treatment and day hospitalisation rooms, a consultation and counselling room. With these facilities, care of persons infected or affected by HIV/AIDS has been organised by the Compassion team since 1996. Most of the persons are introduced by the families, the NACE or the hospitals.

Meetings were organised between the PLWAs so that they get to know each other, break out of isolation and share their experiences.

The partners which support Compassion are:

· the Burkinabe State;

· the Assemblies of the Church of God which provides material support;

· Medecins sans Frontière (Doctors without borders) through drug donations;

5.5.    Vigilance Association

T his is an association of Assemblies of the Church of God of Burkina-Faso. ACCording to its President Pastor Nikiema Michel, Vigilance was established in 1996 by the will of God because AIDS is a medical and moral sickness. After one year of awareness-raising activities in Churches, a team was established, composed of persons of good will and various expertise: doctors, psychologists, financial experts and administrators aimed at establishing the basis of the association.

The objectives pursued by the association are:

· Serving the Christian Church by providing it with ministers specialised in the field of sexuality

· Supporting the Church in its evangelisation through information to the population on the dangers of STIs particularly HIV infection as well as through training for a life of chastity for bachelors, fidelity of couples and sanity for all;

· Preparing future couples for marriage

· Teaching for an effective care of the human potential

· Organising the care of affected persons (sick, widows, widowers and orphans)

6.  Resources Structure

6.1.    Private and Community Initiative in HIV/AIDS Infection Control
in Burkina-Faso (PCI)

PCI is a Non-Governmental liaison Organisation (NGO) established by the international HIV/AIDS Alliance whose headquarters is in London and by Plan International of Burkina-Faso.

It is a novel initiative which seeks to mobilise Non-Governmental Organisations (NGOs) and Community-Based Organisations (CBOs) in order to consolidate and increase their efforts in the prevention of HIV/AIDS infection, care to infected persons and support to communities.

Pursuant to this goal, the PCI:

· Encourages project design by the Associations

· Provides financial and technical support to projects under implementation in the field

· Seeks alternatives for local resource mobilisation from potential donors for the financing of field activities

· Contributes to national advocacy for the development of a congenial environment for the struggle against HIV/AIDS infection.

6.2.    LAAFI LA VIIM Association (ALAVI)

The Laafi la Viim Association was established on 7th July 1995. It brings together PLWAs. The mission of the Association has several components as follows:

· Promoting the dignity and self sufficiency of persons infected by HIV/AIDS

· Psychological and medical care of PLWAs

· Promoting early screening for HIV/AIDS

· Material support (food and clothes)

· Educating women and youth in the prevention of the HIV infection

· Promoting income-generating activities to improve economic aCCess to health care

The association gives priority to the following target groups: underprivileged men, women and children infected or affected by HIV/AIDS. It limits its action to three localities with a view to maximising the quality of the free services which it provides. The localities include Ouagadougou, Bobo-Dioulasso and Tanghin Dassouri.

The main results obtained by the association in these three localities in 1999 are as follows:

• Support by way of drug supply to 113 persons living with HIV/AIDS (PLWAs) including 63 women, 23 men and 22 children;
• 352 visits to homes and the hospital (an average of 25 beneficiaries per month)
• pre and post-HIV screening counselling in favour of 95 persons in Ouagadougou for 40 men and 55 women
• One hundred and forty six (146) medical consultations carried out on 113 PLWAs including 68 women, 23 men and 22 children
• Food supplies to 50 PLWAs including 19 women, 3 men and 28 children
• Organising group discussions once a fortnight for an average of 15 persons a session
• Training of 23 members in the psychosocial care of HIV/AIDS
• Production of a broadcast on early and voluntary screening of HIV/AIDS on radio Palsar on 1 December 1999
• Production of 44 discussions for 1399 persons including 1108 women and 291 men
• Production of 267 personalised discussions for 176 beneficiaries including 113 PLWAs

7.  Networks

At the national level, there is a network called “Coordination of Associations in support of PLWAs”(CAS/HIV) which was established in 1998. Today, it brings together nineteen organisations including nine in Ouagadougou and seven in other cities and provinces of the country. Its objective is to harness the efforts of the various parties involved for increased efficiency. The network edits the liaison bulletin “ Le CORDON ” for the information of association members.

With regard to the Churches, there is no network bringing together all Churches in the area of the struggle against AIDS. However, FEME is already a framework to be explored for the establishment of a network including all Churches. It brings together the Assemblies of the Church of God, the Alliance of Christian Church, the Association of Evangelical Churches of Burkina-Faso, the Evangelical Protestant Church, the Association of Evangelical Churches of Pentecost, the Apostolic Church, the Baptist Convention and the Mennonite Mission and Church. Its development organ ODE has made the struggle against AIDS its main concern by integrating it into its “training” component. Several discussions and lectures were already organised for the faith of the general public.