Togo

1.  General and Epidemiological Data

1.1.    General Data

Togo is a small country of West Africa bounded to the East by Benin, to the North by Burkina-Faso, to the West by Ghana and to the South by the Atlantic Ocean. The area of Togo is 56,758 km2 with a population estimated at 4 million inhabitants. Lome is the political, administrative and economic capital of Togo. The main religions are Christianity, Islam and animism. The economy of Togo is mainly based on the exploitation of coffee, cocoa and phosphates.

The health situation of Togo is characterised by high rates of infant and juvenile mortality attributable to infections and parasitic diseases. Maternal mortality also remains high.

1.2     Epidemiological Data

Just like other African countries, Togo is highly affected by the AIDS epidemics. The prevalence rate is 3.8% in the general population and 6.8% in the sexually active population of 13 to 24 years which represents ¾ of the total population. This situation makes Togo the country with the second highest number of HIV positives in the sub-region after the Ivory Coast.

From January 1987 to June 2000, 12,047 cases of AIDS were reported in the health facilities and the number of PLWAs is reported to be between 150,000 to 200,000. During the past five years, AIDS has spread in an exponential manner in the country. The Togolese youth and the female population pay a high price for it. In fact, youth who are between 15 to 45 years, represent roughly 80% of the infected persons and more than half are women. Furthermore, the rural areas, which for a long time were spared, are heavily affected with approximately 30% of the cases recorded in Togo.

2.  National HIV/AIDS Infection Control Policy

2.1.    Background to the AIDS Control Policy in Togo

The fight against AIDS began in Togo in 1984 with the organisation of awareness-raising and information activities and the creation of the National AIDS Control Committee (NACC) in 1987 and the setting up of Elisa network for diagnosis and screening. Short, medium and intermediate plans of action were drawn up. Today in Lomé, there is a counselling and documentation centre (CCD - Centre de conseils et de documentation) for anonymous and free voluntary screening.

In order to involve all the Churches in the fight, the NACP organised, awareness-raising and training workshops in 1999 for traditional chiefs and religious officials.

2.2.    Strategy Thrusts of the HIV/AIDS Infection Control Policy

The HIV/AIDS Control Policy is based on the objectives and strategies set by the government. There are a total of ten (10) objectives namely:

1. Information, Education and Communication (IEC) in order to reduce HIV transmission;

2. Preventing transmission through sexual means;

3. Preventing transmission through blood transfusion;

4. Preventing transmission from mother to child;

5. Improving the care of HIV positive persons and AIDS patients;

6. Improving knowledge about the epidemiological situation and appreciating the spread of the epidemic;

7. Developing and co-ordinating prevention activities and the fight against STDs;

8. Proposing solutions to ethical and legal problems concerning HIV/AIDS/STD confronted with PLWAs;

9. Mitigating the socio-economic impact of HIV/AIDS/STD on development;

10. Co-ordinating and promoting research on HIV/AIDS/STD.

Pursuant to these objectives, the NACP defined strategic axes which focus on the following fundamental points:

· Decentralisation: empowerment of the regional and district levels for the carrying out of activities;

· Deconcentration: delegation of activities to all partners (governmental, private, non-profit-making associations) for an intersectoral and multidisciplinary fight;

· Integration of synergical programmes: HIV/AIDS/STD, tuberculosis, reproductive health.

2.3.    Stakeholders involved in AIDS Control

The fight against AIDS is not the exclusive affair of the government. Other partners are involved and associated by the NACP in the struggle.

There are four types of partners namely local NGOs, the private sector, international NGOs and bilateral and multilateral co-operation agencies.

2.3.1    Local national Non-Governmental Organisations (NGOs)

Their main field of intervention is prevention. The strategy most often used is Information, Education and Communication (IEC). The main activities are training, counselling and the sale of condoms. Some NGOs/associations are also interested in the care of the sick and HIV positive. The main target groups are the youth, women, school children, prostitutes and child-school dropouts.

2.3.2.   The private sector

AIDS is causing havoc in Togolese enterprises. For this reason, a number of enterprises, with the technical support of the NACP, designed, financed and launched AIDS programmes for their employees.

2.3.3.   International NGOs

The international NGOs play a crucial role in the fight against AIDS in Togo. Not only do they execute directly the programmes in the field, but they also financially and technically support a number of local NGOs. Their field of action remains mainly the prevention of STD/AIDS and the institution of support to local NGOs.

2.3.4.   The international organisations

Today, the main international organisations intervening in the struggle against AIDS in Togo are the United Nations agencies such as UNAIDS, UNDP, WHO. To these, should be added the bilateral co-operation agencies such as the European Union, the French Co-operation, the German Co-operation (GTZ). They support the government and the international and local NGOs technically and financially.

2.3.5.   The role of the Churches

ACCording to the director of the NACP, the Churches are not yet actively involved in the fight against AIDS whereas in his view they have a key role to play in view of their moral, social and spiritual status. The collaboration between the Churches and the NACP is very low and should be redynamised.

3.  Position and Involvement of the Churches Confronted with the Problem of AIDS

We met several Church officials in connection with our study in Togo. The Churches include the evangelical Presbyterian Church, the Assemblies of God, the Methodist Church of Togo, the Catholic Church, the Saints of God Church and the Biblical Alliance of Togo.

3.1.    Perception of the Churches and Religious Communities

All the Church officials whom we met have satisfactory elementary knowledge on AIDS. They know that it is caused by a virus (HIV) which is transmitted in three ways namely, sexual means, blood transfusion and from mother to child.

Furthermore, and in a unanimous manner, they perceive AIDS as a major social and health problem and a source of concern for the Churches for several reasons.

AIDS has been spreading in an exponential manner in the country. It kills a lot of people including the faithful of the Church and especially innocent children. One pastor said that

“Today AIDS kills children in the same way as the Pharaoh killed the children of Israel”

At the social level, the consequences are equally severe. In the country there are currently many orphan children whose parents died of AIDS. A vicious circle is created because these children are abandoned to their fate and without any moral, financial and emotional support they resort to delinquency (stealing, drug abuse) and prostitution only to suffer the same fate as their parents.

AIDS destroys the family unit and also puts African solidarity under severe strain. In fact, in Africa, sick persons (even mad men) were all the time surrounded by their family members and treated with dignity. However this is not the case with the PLWAs who, for the most part, are rejected and abandoned to their sad fate.

Today, AIDS is increasingly affecting the youth and women who disappear in their “prime of life”. The productive force is thus reduced because this age group is the most active economically and socially. This situation engenders confusion within families, leads to social dislocations and seriously mortgages the future of the nation. The Churches which form one body with the society are concerned with this social drama.

In the opinion of religious officials, the propagation of the disease is due to several risk and vulnerability factors which include, inter alia, poverty, rural urban drift, immigration of Togolese youth to the neighbouring countries and vice-versa, ignorance of the population and the suicidal silence of political authorities who have for a long time denied the existence of the disease in order to protect the tourism sector. This was in addition to the socio-political troubles which the country had experienced and which constrained thousands of Togolese to go into exile before returning.

For as much as poverty is acknowledged as a major cause of the spread of the disease, the Churches point out that Christians must transcend this poverty and remain dignified: a Catholic priest said that “poverty is neither a vice nor a sin, it can however drive men to sin, but the true Christian who believes in Jesus Christ his saviour must live and aCCept with dignity his poverty and avoid contravening the laws of God”.

As far as the Churches are concerned, the true immediate causes of the spread of AIDS are the debauchery of the youth, fornication, infidelity of couples, sexual promiscuity. Briefly, all the human sexual comportment which defy moral rules and which are inconsistent with the divine commandments.

In other words, AIDS appears to some extent as a ransom of sin but it is not a punishment from God because the God of the Bible is a good magnanimous God who likes his children and who never seeks the death of the sinner. Furthermore, God created man free of his thoughts and actions. At this moment, man is the only person responsible and aCCountable for the consequences resulting from immoral conduct.

It is therefore obvious that no Church considers AIDS as a punishment from God. It is rather a sickness like all others which can either avoid or contract as a free man responsible for his acts.

3.2.    Involvement of the Churches

3.2.1. The Catholic Church

It is numerically the most important and extensively involved in the education, vocational training, trade, agriculture and health sectors. In all probability, it is more advanced than other Churches with regard to reflections and actions. In 1994 the OCDI (Organisation for Charity for Integral Development) in collaboration with the Catholic Relief France and CAFOD Great Britain (Catholic Fund for Development in Overseas countries), organised a national seminar on the theme: “the Church of Togo confronted with the HIV/AIDS epidemics”.

The objective of this seminar, which brought together some sixty participants from all the dioceses, was to mobilise the participants with a view to a more rational fight and map out a strategy which will ensure the care of HIV positive persons, the sick and AIDS orphans. At the end of this seminar, which was addressed by resource persons from other African and European countries, the participants, sensitised on the existence of AIDS and its seriousness, made important recommendations which underlie the current actions:

1. Information, Education and Communication (IEC) meetings should be organised at the level of all the dioceses of Togo in the area of AIDS and STDs

2. A new behaviour must be adopted with a view to halting the expansion of HIV transmission. The focus is especially on sexual education in the Christian spirit, chastity outside marriage and fidelity during marriage.

3. A schedule should be drawn up at the parish level, for visits to the hospitals and dispensaries and visits to homes for material, moral and spiritual support to the sick.

4. There should be a personal commitment towards family members and their immediate entourage for a discrete charity action for material, moral, psychological and spiritual care.

5. The seminar also recommended a mobilisation of the Church at all levels to combat AIDS:

A. Recommendations to Christian homes: testimony of an authentic Christian life by prayer and dialogue.

B. Recommendations to the parish communities:

1. The reality of the AIDS problem should be integrated into the catechises and into the homily

2. Counselling, reflection and prayer unit should be established in order to support those who are suffering with the collaboration of all the organs of the parishes.

C. Recommendation to the national OCDI:

1. The priests, religious officials, nuns, the entire parish communities of all dioceses should be sensitised

2. Periodic evaluation sessions should be organised for the training of new teams.

D. Recommendations for Catholic schools at all levels
The training of teachers should be organised at all levels

E. Recommendations to the bishops.

F. Listen in order to discern, facilitate and encourage initiatives.

As it can be observed, this is a complete plan of action which each diocese is in the process of implementing aCCording to its realities, its own planning, means and resources.... with the collaboration of the OCDI represented at the level of all parishes. There are difficulties in the implementation of the plan of action but the will to forge ahead is still there.

3.2.2.     Evangelical Presbyterian Church of Togo
(EEPT - Eglise évangélique presbytérienne du Togo)

Since the time of the missionaries and up until today, the leitmotiv of the EEPT - over 100,000 faithful - is “all the Gospel for all people". In other words, the evangelisation must be associated with development and with anything which contributes towards the well-being of the human being. In order to attain this objective, the Church established educational, health and community development structures. Several primary and secondary schools who trained many executives of the country, several health facilities of various sizes, several agro-pastoral projects bear the label of EEPT throughout the country. A department called “co-ordination of works and projects” is responsible for the monitoring of all these structures.

With regard to the struggle against AIDS, the policy of the EEPT is more visible through the Protestant Association of socio-medical works (APROMESTO - l'association protestante des oeuvres médico-sociales), which will be discussed in more detail, without the Church having felt the need to discuss this problem at the level of the higher authorities which is the synod. It should be emphasised that practical problems arise with regard to the Holy Communion. The EEPT is still in favour of the use of the common cup whereas reservations are being expressed against it.

Prevention

It is centred on awareness-raising. With the support of APROMESTRO, the care of the Church organised information meetings and seminars for the pastors. The information on AIDS has already been integrated into the programme of one synod, however, there was no follow-up.

Care

All the health facilities of the EEPT deal with AIDS cases by trying to treat the opportunistic infections. Unfortunately, the EEPT does not have specific care structures.

For the co-ordination of works and projects in Lome, leaders indicated to us that they were managing four (4) AIDS cases by financially providing for the purchase of drugs and the coverage of other needs as much as possible. Through its department of the chaplaincy, the Church also intervenes for the sick who are hospitalised.

The leaders of the works and projects co-ordination expressed the wish to see leaders of the WCC and the WAYMCA assist them in establishing a data bank aCCessible to all Churches and religious communities. The need for training in the field of pastoral support is also felt.

3.3.3.   The Methodist Church of Togo (EMT - l'église méthodiste du Togo)

Attached for many years to the Methodist Church of England, the EMT gained its autonomy since the proclamation of its conference on 26 March, 2000. Its principal mission is “to preach the Gospel to the whole person in as far as soul, spirit and body, and render service to the poor, the marginalised and the oppressed of society.”

In order to attain this objective, the EMT whose faithful are roughly 40,000, established specialised organs including the Methodist Development Programme of Togo (PMDCT)

Prevention

Sensitised on the AIDS problem, the EMT, through the PMDCT, has just initiated an AIDS awareness-raising campaign project in the south-maritime region where the EMT is strongly implemented. This project aims at reducing the spread of AIDS and the improvement in the living conditions of the populations, which will be a benefit to the youth and women in the region.

The PMDCT will train 20 motivators who will be the stakeholders of awareness-raising in 30 Christian communities. Ten branches will be created in this region

Church officials insist on the need for Churches to “revisit”the African culture in order to derive all its values and update them.

For the time being, the project is at the stage of the search for financing. Church officials would like the WCC and the WAYMCA to draw up a schedule for visits with the Churches in order to discuss this problem with them because they pointed out that they did not have all the information to be able to talk about it.

3.3.4.   The Assemblies of the Church of God

The number of its faithful is more than 100,000 and it is one of the charismatic Churches which are currently the wind in its sails. It was with surprise that its leaders realised that AIDS also affected the Church. Preventive measures therefore needed to be taken. The Church sponsored a young person for training in this field in Nairobi, Kenya and plans to detach him to take care of health problems.

Prevention

Apart from abstinence before marriage and fidelity among couples, the Assemblies of the Church of God now demands the serological test for prospective couples for marriage. In the event where the result is positive, the marriage is not celebrated. The admission of candidates to the biblical school also depends on this test. The Church also instituted AIDS day which has been observed for six years every 10 December. On that day, the preaching is focused on the consequences of sin including AIDS. The Assemblies of the Church of God does not only abide to this sensitisation but also tries to train the youth who are victims of poverty: a school of apprenticeship was established for young women who are unoCCupied. However, the officials acknowledge that their means are very limited.

Care

A psychological, material and spiritual support is provided to persons infected and affected by AIDS. However, the Assemblies of the Church of God, which manages a number of health centres, does not have adequate structures for therapeutic care.

The officials indicated the strong desire to see the AIDS problem discussed at the level of the Christian Council of which their Churches are members.

3.3.5.   The Church of the Saints of God

It forms part of the so-called independent Churches and is said to have up to 13,000 faithful with branches in Benin, Burkina-Faso, Niger and Gabon. The novelty of this Church is that it established its own plant-based pharmacy of the sub-region. Concerned with the AIDS problem, the laboratory of the Church tried to develop a drug called “Sidacrom”. Unfortunately, for the time being, Church officials, for whom AIDS is not only a physical disease but also a spiritual one, are not in a position to indicate whether the drug is effective or not.

Besides the therapeutic approach, the officials advocate a life of sanctity, even if they admit that this is not always obvious.

If on the whole all the Churches visited have a common vision of the causes and factors of propagation of AIDS, their positions differ on one point regarding the means of prevention: that is whether to use the condom or not.

In fact all Churches without distinction hold the view that the safest means which conform to the Word of God are chastity, abstinence and mutual fidelity among couples. This is not the same with regard to condoms.

The “adherents”include the evangelical Presbyterian Church and the Methodist Church. They claim they are open and realistic because Church officials acknowledge that all the faithful, particularly the youth, do not necessarily conform to the divine commandments. In this regard, it would be unrealistic to be intransigent on principles. However this does not mean that they undertake the promotion of condoms, but besides abstinence and fidelity, they remain open to all the other methods which make it possible to prevent AIDS.

The opposition comes from the Catholics, the Assemblies of God and the Saints of God. They adhere to the only preventive measures which in their view are consistent with the Bible. As far as they are concerned, recommending the condom to the faithful would open the way to sexual promiscuity. The Assemblies of God seem more moderate because in their view the condom can be used by the couples for family planning purposes but especially when one of the partners is HIV carrier.

The Catholics are more radical. ACCording to them, it is scientifically proved that the condom does not provide full protection against AIDS. They point out also that the campaign for the promotion of condoms responds more to commercial interests and indirectly motivate minors, adolescents, youth and adults to sexual promiscuity. It is also a moral catastrophe which could further aCCelerate the spread of the disease. “Condoms are not being sold in Africa to combat AIDS. Indeed, it is conspiracy by the Western countries to control birth in Africa. We shall not aCCept it”a Catholic priest told us.

It should be pointed out that the religious figures and lay Catholics whom we met have a more open position, full of nuances.

4.  Poverty and Human

The socio-economic situation of Togo is one of the most dramatic in west Africa. The country has been isolated from the international community because of inadequate democracy. Donors are withdrawing, economic activities are sluggish. Civil servants are no longer paid regularly and purchasing power is dwindling daily. The impoverishment of the population is deepening.

The Togolese Churches give the impression of being overwhelmed by the situation as their resources are limited to cope with the problems. Their most significant contribution remains the setting up of schools, health centres and vocational training centres. In addition, there are the implementation of various development projects in the urban and rural areas.

In the area of the defence of human rights, the results are mixed not by the lack of will but on aCCount of the oppressive nature of the ruling government. It should however be pointed out that during the socio-political crisis, the Churches worked hard to ensure peace and reconciliation.

5.  Ecumenical Organisations and Denominational Health Center

5.1.    Young Men's Christian Association (YMCAs)

Togo YMCA forms part of the most prominent youth associations and the most outstanding and reputed NGO of the country. Several programmes contribute to this image. The most significant are the community development programme which covers some twenty communities, the agro-pastoral training centre and the Adolescent Reproductive Health (ARH) programme.

The ARH was initiated to sensitise the youth on the risks inherent in the area of reproductive health and suggest to them the behaviour to adopt. The purpose of the project is to improve the skills, reproductive health attitudes and practices of adolescents between 12 and 19 years and exceptionally up to 23 years through basic education. YMCA runs, inter alia, a youth orientation centre and through the provision of contraception services.

The main target groups are both the youth and adults with priority given to adolescents students and apprentices.

The project is being implemented in Lome, in the Bè district, a popular area of the capital.

The main activities cover:

Training of peers on all subjects of the ARH

• Education and awareness-raising sessions at training centres and in schools.
• Socio-cultural and sports programmes
• Discussion workshops
• Lectures/discussions
• Projection of films
• Distribution of condoms and contraceptives

The centre for youth counselling and orientation (CCOJ - Centre de Conseils et d'Orientation de Jeunes) is run within a friendly framework based on confidential counselling and orientation/transfer of the sick to the treatment centres for STD cases.

The project's strategy is based on recourse to peer educators: students and apprentices are trained in IEC applied to ARH and who educate their colleagues and friends within the study groups.

This awareness-raising of peers is supported by the action of “opinion leaders”, teachers, workshop leaders or youth workers in the neighbourhoods. The project does not have a component for the care of sick or infected persons.

5.2.    The Biblical Alliance of Togo
(ABT - L'Alliance Biblique du Togo)

The ABT began its activities in the 1960s and has been involved in the translation of the Bible into the various national languages as well as its dissemination. In order to reach as many people as possible, the ABT uses radio cassettes for the illiterate and the Braille for the blind. Portions of the writing are also adapted for children and the youth. The ABT collaborates with all Churches in Togo and mainly with those of the Christian Council (the evangelical Presbyterian Church, the Methodist Church, the Assemblies of the Church of God, the Baptist Church, the Pentecostal Church, the Lutheran Church, the 7 th day Adventist Church) and the Catholics. In addition to the Holy Scriptures properly so called, the ABT also puts at the disposal of the faithful books and cassettes which deal with the problems of daily life.

Faced with the rapid spread of HIV/AIDS and in the light of its devastating consequences within the population and especially the faithful, ABT has just designed a project centred on prevention and care for which it is seeking financing. “... the fight against AIDS and the care of those who are either infected or affected by it in Togo is a challenge for the Church which not only must serve as the therapeutic community for the PLWAs but also assist by prevention...”

The ABT project should, when completed suCCessfully, cover about 45% of the Christian population or a little over 2 million inhabitants. The ABT plans to organise a consultation workshop with Church leaders in order to enlist their support. A plan of action will then be prepared with their assistance. Based on the data gathered from Churches, the ABT will subsequently organise training sessions on STI/AIDS. With regard to IEC, the ABT plans to put leaflets in each Bible sold. Posters will also be produced for education and training centres.

For the time being, ABT is awaiting to secure financing for this project.

5.3.    Christians Against AIDS

This is an independent association of some twenty youth, students, medical and social welfare assistants aged between 18 and 42. It is handled by a young pastor of an independent Church.

Prevention

Established in 1996, Christians against AIDS has been involved in sensitisation and training. The sensitisation is done from the projection of films in denominational schools and training sessions are organised for religious officials. Pastor Yves Gaba, the leader of the association, acknowledged that the task is not easy for the members of the association: all religious officials do not always identify themselves with their initiatives.

In the future, Christians against AIDS plans to open a free counselling and assistance centre. The association also wishes to extend awareness-raising through the print media.

Care

Christians against AIDS, registered by NACP and which survives mainly on contributions from its members, takes care of some twelve PLWAs by bearing as much as possible, the costs on medical care and food as the case may be. The association is also in contact with the WCC which provides it with documents for pastoral support.

For Togo, the association has expressed the wish that a network should be established bringing together all associations in the struggle against AIDS. It expressed the wish that the WCC and the WAYMCA make available to these associations posters designed from biblical principles which can enlist support at all level of all Christians.

5.4.    The Protestant Association Medico-Social Works of Togo (APROMESTO)

APROMESTO is an association bringing together seven Churches of the Christian Council of Togo. It was established in 1994 and aimed at co-ordinating the action of the health centres and hospitals belonging to these Churches, sensitising the faithful in the struggle against AIDS, train the nursing personnel and resolving the health problem through concerted actions. Generally, APROMESTO encourages the team of health facilities to establish a psychosocial care unit and draw up AIDS projects in order to address the epidemics more effectively.

On the other hand, based on the projection of video films, the association educates the faithful of Church members (women and youth associations, choristers...) on the HIV/AIDS and STIs.

In the future, APROMESTO would wish to centralise its activities for increased effectiveness. A project called the struggle against “HIV/AIDS in the community of Protestant Churches of Togo”was designed in this connection. It should make it possible to involve the population in a participatory approach, in order to ensure that they are involved in the search for solutions to the problem of HIV/AIDS. Specifically, this is aimed at:

· organising training workshops in the peer groups

· equipping each Church member to have a specific information programme on HIV/AIDS and STDs and encourage voluntary testing

· Organising choristers' singing competition on the theme of AIDS

This project, which will spread over a two-year period, could commence as soon as its financing is secured.

Even though the relations are still timid, APROMESTO has been trying to collaborate with OCDI (organisation for charity and complete development), which is a Catholic project.

5.5.    The Saint-Jean-de-Dieu Hospital of Afagnan

This hospital which belongs to the Catholic Church receives patients from all over Togo and the neighbouring countries such as the Benin and Burkina-Faso. It is a reference hospital in the area of epidemiological surveillance which receives a lot of PLWAs and HIV positives.

In the year 2000, it had recorded over 500 AIDS cases. At the time of the interview, at least 30 out of 250 beds (capacity of the welcome centre) were oCCupied by them. There is an AIDS care unit composed of doctors who are priests, nuns and the laity.

But what is peculiar about the centre is the introduction of an original treatment of the sick based on auto-vaCCination. Unfortunately the officials did not want to give further information on this experience which would be effective, because since 1984, 80 patients who underwent this treatment are doing well. The advantage of this treatment is that it costs the patients only 30,000 (FF 300) per annum.

The hospital has also recorded numerous HIV positives including about hundred who are under surveillance and benefit from the psychological support of the care unit.

The Afagnan hospital is also involved in awareness-raising activities of populations. Thus, besides periodic educational discussions for the visitors to the centre, the Church trained community health staff who organise awareness-raising activities in the rural communities of the prefecture where the hospital is located.

It should be pointed out that the Afagnan hospital encourages people to undergo voluntary tests, however the requests are few. Candidates for the voluntary test are taken care of by the team of counsellors before and after the test.

Even though it is a Catholic institution, the team of the Afagnan hospital has not taken any position for or against the condom, giving the impression of having an ambiguous attitude.

5.6.    Bethesda Hospital Agou Nyobo

The Agou Nyogbo Bethesda hospital belongs to the evangelical Presbyterian Church of Togo. This health facility enables the Church to express the humanitarian dimension of its mission and make its contribution towards the promotion of a better welfare of the individual in terms of health. Even though it is located in the rural area, this hospital is not spared from the expansion of the AIDS infection epidemics in the country. A recent estimation puts the rate of infection among hospitalised subjects at 2.15% and at 50% the rate of prevalence among the benevolent blood donors to the hospital. These donors are recruited from among the youth of the community where the hospital is located. Even though all doctors and paramedical staff underwent two or three training or awareness-raising sessions in the care of AIDS cases, there is still not yet any PLWA psychosocial care unit. Each doctor is responsible for providing pre and post test counselling for any request for serology. The care and consultative medical commission of the hospital, conscious of the seriousness and urgency of the situation, envisages the establishment of control committee to ensure the safety of blood transfusion to patients and sensitisation of the community.

5.7. St-Paul Cathol Dispensary of Avenou

Located in one of the outskirts of Lome the capital, this dispensary has a high rate of attendance because of its credibility and the low cost of its services. The personnel, made up mainly of nuns, combine curative care with activities relating to the prevention of major endemic including AIDS whose number of cases is estimated at 10 per month among the population who undergoes consultations.

Since one year, the medical staff instituted an awareness-raising programme for consultants and a programme on information for the youth of the community (students, apprentices) on the risk factors of HIV contamination by resorting to the GRAAP method. The difficulty encountered by the team is that the infected persons do not aCCept the result of their serology and often blame their illness on spell-casting and witchcraft. In order to convince them and ensure greater efficiency, a total commitment from the Church at all levels, a sensitisation of priests, nuns, care of PLWAs and orphans are necessary.

6.  Networks

The Christian Council, which brings together the evangelical and Protestant Churches of Togo, is the biggest ecumenical institution of the country. Apparently, the Council functions well, and serves as the consultation framework for Church members. However, for the time being, the problem of AIDS has not yet been put on its agenda, but the Council members express the wish to see that this should be done soon. With regard to the Secretary General of the Council, he expressed the wish that the WCC and WAYMCA convene in the short term a meeting of the heads of Churches of the sub-region to talk about AIDS and take common measures to combat it. He acknowledged that the religious officials and the laity need training in order to be able to be involved effectively in this fight. Besides the Baptist convention, the Lutheran Church (based in the north of the country), and the 7 th day Adventist Church (associate member) whose officials we could not meet, all the officials of the other Churches members of the Christian Council are in favour of a common action against the epidemics.

Furthermore, there are periodic meetings between the Protestants, Catholics and Muslims to defend the common interests of believers and especially to settle a number of political conflicts which have serious consequences for the nation. In the past, at the height of the socio-political crisis, the religious officials served as mediators and conciliators between the ruling party and the opposition. Unfortunately, these Churches have never consulted each other in order to discuss the AIDS problem and create a network which could serve as a framework for collaboration and the sharing of experiences between them. It can however be pointed out that one is witnessing the beginning of the collaboration between the Protestants and Catholics. As a matter of fact, the OCDI and the APROMESTO have began, albeit timidly, to organise together seminars and training and sensitisation activities. This initiative is a sketch which should be strengthened and extended to other Churches. This will be all the more easy as the religious officials who met claim it is necessary and urgent to harness their efforts to combat AIDS together which has become a threat and a challenge for Churches.

At the time of the drafting of this report, we learnt that an international seminar was to be held in Lome in January 2001 on the role of the “Church against AIDS”organised by the “Christians and AIDS”association in conjunction with NACP, OCDI (organisation for charity and full development) and APROMESTO, it brought together delegates from religious confessions of Benin, Burkina-Faso and Togo. Its aim is to review the action taken by Churches against HIV/AIDS.

7.  Conclusion

Togo is experiencing a very difficult and peculiar socio-economic situation because of its political instability and the resulting economic consequences. Unfortunately it is the population which bears the brunt of this crisis. Meanwhile Churches which, for a long time have contributed towards the alleviation of the plight of the families have reached their limits today. Many of them no longer receive the regular subventions from outside as hitherto and the faithful who are supposed to support them also lack the necessary resources. It is therefore very logical that we are witnessing a deterioration in the health system. Many health facilities are not in a position to undertake screening tests and there are numerous families who are living in silent dramatic situations.