Gabon: The number of people living with HIV/AIDS and treatment available to them; the attitude of Gabonese society toward people with HIV/AIDS; the circumstances in which HIV/AIDS testing is mandatory in Gabon and the confidentiality of the results of such a test (2003-2006)
| Publisher | Canada: Immigration and Refugee Board of Canada |
| Author | Research Directorate, Immigration and Refugee Board of Canada, Ottawa |
| Publication Date | 6 February 2006 |
| Citation / Document Symbol | GAB100947.FE |
| Reference | 1 |
| Cite as | Canada: Immigration and Refugee Board of Canada, Gabon: The number of people living with HIV/AIDS and treatment available to them; the attitude of Gabonese society toward people with HIV/AIDS; the circumstances in which HIV/AIDS testing is mandatory in Gabon and the confidentiality of the results of such a test (2003-2006), 6 February 2006, GAB100947.FE, available at: https://www.refworld.org/docid/45f147332.html [accessed 19 May 2023] |
| Disclaimer | This is not a UNHCR publication. UNHCR is not responsible for, nor does it necessarily endorse, its content. Any views expressed are solely those of the author or publisher and do not necessarily reflect those of UNHCR, the United Nations or its Member States. |
Statistics
The total population of Gabon was estimated at 1.3 million in 2001 (Canada 10 Nov. 2005). According to a joint study conducted by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in 2003 and during the first three months of 2004, approximately 8.1 per cent of adults in Gabon were living with HIV/AIDS (UN 2004). The same study estimated that at the end of 2003, 45,000 adults (between the ages of 15 and 49) and 2,500 children (under the age of 15) were infected with HIV/AIDS (ibid.). The number of deaths (adults and children) due to AIDS was estimated at 3,000 in 2003, while the number of children (under the age of 17) who had lost one or both parents to AIDS was approximately 14,000 (ibid.). Statistics from the study showed that "HIV prevalence rates among women attending ... two antenatal care clinics in Libreville [capital of Gabon] increased from 3.8% in 1995 to 9.0% in 2002" (ibid.).
Actions taken by the government, international organizations and non-governmental organizations (NGOs)
In the report from the 32nd session of the Committee on the Elimination of Discrimination Against Women, the representative from Gabon indicated that [CEDAW English version] "an intensive drive against HIV/AIDS had been launched [in Gabon] by the Government, various associations and non-governmental organizations" (UN 15 Feb. 2005, 1-2).
The Gabonese government and the United Nations Development Programme (UNDP), in cooperation with other UN organizations and NGOs working for the development of Gabon, created the United Nations Development Assistance Framework for 2002 - 2006 (UN n.d.a), which includes a strategy to stop the spread of HIV/AIDS (UN n.d.b).
A 3 January 2006 article posted on the AllAfrica.com Website indicated that, in his New Year's address to the nation, the president of the Republic of Gabon promised to [translation] "intensify the prevention of the [AIDS] pandemic because ... prevention is the most effective weapon against HIV/AIDS" (Gabonews 31 Dec. 2005). The same source also indicated that the Gabonese head of state [translation] "had out-patient treatment centres (centres de traitement ambulatoire, CTAs) set up in the provincial capitals, which offer free care to indigents, and had an antiretroviral (ARV) production laboratory built in Libreville" (ibid.). Created by the French Red Cross [translation] "based on knowledge of the sanitary and social realities of the host country, the CTA is a mobile unit, usually located in a hospital, integrated into the country's health system and associated with the national AIDS program" (Croix-Rouge française n.d.a). For more information on CTAs, consult the attached document, "Le centre de traitement ambulatoire, un concept modélisé," taken from the Website of the French Red Cross (ibid.).
In a PanAfrican News Agency (Agence panafricaine de presse, PANAPRESS) article, the director of Gabon's National AIDS Program (Programme national de lutte contre le SIDA, PNLS) stated that the [translation] "CTAs in Libreville, Franceville, Port-Gentil, Lambaréné and Koula-Moutou were operational. Others were being built and would probably open in April 2006" (16 Sept. 2005). The Website of the French Red Cross reported that the CTA in Port-Gentil
[translation]
had opened its doors at the beginning of July 2004 and had 15 employees. After two months, the centre had already done 95 HIV/AIDS tests and was preparing to develop educational programs on therapeutic treatment and follow-up, and on nutritional welfare. In September, the centre was working on public communication and HIV/AIDS awareness campaigns.
The CTA in Franceville has been in operation since 3 April 2004 ... and has a team of 16 people (doctors, a nurse, laboratory technician, receptionist and manager, orderlies and caregivers).
Located in the Libreville Hospital Centre, the Libreville CTA opened in April 2001. It was the first of a new generation of CTAs, the result of cooperation between various partners: its construction was almost entirely financed with Gabonese funds and its equipment with funds from Gabon, the OPALS/Croix-Rouge française and the Coopération française. At the end of 2003, the CTA was treating more than 2,500 patients. More than 600 of them were receiving antiretroviral treatment (Croix-Rouge française n.d.b).
The chief medical officer of the Libreville CTA explained that
[translation]
it is important that all services be made available to patients under one roof. The CTA is the only structure that meets that need for people with HIV. After consultation or hospitalization, these people are never left to their own care. Thanks to its partnership with the Gabonese Red Cross, the CTA provides residential follow-up care (ibid.).
In September 2005, the PNLS director also stated that [translation] "the National Solidarity Fund, created in 2000 and totalling 1 billion CFA francs, made it possible for more than 4,000 people to receive a three-drug regimen, at a rate of nearly 200 people per month" (PANAPRESS 16 Sept. 2005).
A 29 April 2005 article appearing on the Website of the United Nations Integrated Regional Information Networks (IRIN) announced that the Gabonese government was offering free HIV/AIDS testing and ARV treatment to the [translation] "most vulnerable" people.
Clarifying what constitutes vulnerable, the same article reported that
[translation]
seropositive pregnant women, nursing infants and children under the age of 12, victims of rape or people who have been exposed to contaminated blood through transfusions, students, people who are unemployed or retired, indigents, and public service employees with a monthly salary equal to or less than $200 can be tested or treated free of charge in certified health centres (UN 29 April 2005).
In February 2005, a factory for producing malaria and AIDS medications was established in Gabon (ibid. 14 Feb. 2005; AFP 6 Mar. 2005). The factory was built by the Belgian group Propharex, was funded by the Gabonese government to the amount of $647,000, and has been placed under the management of Gabon's state-owned pharmaceutical company, OGAFRAM (UN 14 Feb. 2005). OGAFRAM will market its products in the six countries of the Central African Economic and Monetary Community (ibid.).
In December 2004, [translation] "300 taxi drivers in the Gabonese capital participated in an HIV/AIDS awareness campaign by distributing free condoms and flyers about the virus and prevention methods to their passengers" (ibid. 16 Dec. 2004; IPS 22 Dec. 2004). Some residents and women's groups were of the opinion that the campaign focused too exclusively on the use of male condoms, failing to promote female condoms (ibid.; UN 16 Dec. 2004).
In September 2004, Gabon saw the launch of its first HIV/AIDS information hotline (ibid. 20 Sept. 2004, Journal l'Union Plus 17 Sept. 2004), a free, anonymous, 24-hour telephone hotline offering
[translation]
technical information (epistemology, etc.) and general information (access to treatment, testing, what to do following an accident involving contact with a tainted object in the case of medical staff or of a ripped condom during sexual intercourse, the risks following a rape, etc.) (ibid.).
On 2 July 2004, the Public Health minister, the UNDP representative in Gabon, and the president of the Gabonese Network of NGOs Against AIDS signed a funding agreement with the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria in the amount of $3,154,500 (UN n.d.c). The program that grew out of those funds had the following objectives:
[translation]
– to increase preventive measures nationally;
– to promote public access to counselling and testing through the training of health care personnel and the increase of health centre capacities (including preventing mother-to-child transmission (MTCT) of HIV);
– to improve care available to people living with HIV/AIDS (PLWHA), particularly regarding access to ARV treatments;
– to increase NGO involvement in preventive programs and in-home care for PLWHA;
– to strengthen care, both educational and nutritional, available to orphans who lost their parents to AIDS (ibid.).
On 17 February 2004, the minister of the Fight Against Poverty and the UNDP representative signed an agreement in the amount of $1,217,831 to fund a development program to reduce the impact of HIV/AIDS on the [translation] "poor and/or vulnerable populations, particularly women and AIDS orphans" (ibid.).
At the beginning of 2004, the first voluntary and anonymous HIV testing centre in Gabon opened its doors (Journal l'Union Plus 16 Mar. 2004, UN 20 Apr. 2005). According to the centre's manager, psychologist Mabik-ma-Kombil, [translation] "confidentiality and the low cost of consultations" explain the centre's success (ibid.). An article appearing on the IRIN Website indicated that
[translation]
the cost of testing and ARV treatments has dropped significantly in Gabon, where ARV treatments cost between $4 and $10 per month. The cost had ranged from $800 to $1,000 per month prior to April 2003, when the government implemented a therapeutic solidarity fund of approximately $3 million to care for the country's 38,000 seropositive citizens. More than 3,000 people, 1,700 of whom are women, have been tested at the PNLS pilot centre – the first in Gabon to offer voluntary and anonymous testing, and psychological support. According to authorities, the centre receives an average of 30 clients per day, a visitation rate three times too high given the time that medical staff must dedicate to each patient (ibid.).
Attitude of society and government toward people with HIV/AIDS
Whereas Gabon's national AIDS policy is primarily related to access to care, so legislation preventing discrimination against PLWHA has yet to be developed (UN Mar. 2005).
No specific information on the attitude of Gabonese society toward PLWHA in 2003, 2004 or 2005 could be found among the sources consulted by the Research Directorate within the time constraints for this Response. Nevertheless, the results of a 2001 UNAIDS study of six African countries, including Gabon, may be useful. The study showed that
[UNAIDS English version]
– there are widespread cases of systematic violations of fundamental human rights of people living with HIV, including, among others, violation of medical secrecy, non-respect of private life, violation of the right to employment, violation of the right to health care, violation of the right to accommodation, violation of the right to property, violation of the right to free movement, violation of regulations governing research and therapeutic experiments, violation in the area of insurance and credit, etc.;
– systematic testing is widely practised;
– the magnitude of stigmatization and discrimination against PLWHA constitutes the most important factor hampering the involvement of PLWHA in prevention, care and treatment actions in the area of HIV/AIDS control;
– HIV aggravates the woman's social status;
– medical personnel lack information and adequate training in the area of HIV/AIDS;
– PLWHA are often powerless in the face of discrimination and stigmatization, because of fear and shame. In fact, without taking into account the other modes of transmission, the society considers PLWHA as being sexually immoral. They cannot even claim their rights in court for fear of being recognized as infected with HIV;
– AIDS heaps opprobrium on the entire family, and, in most cases, the latter rejects the victim;
– rejection, moral judgement, physical and psychological suffering and attack on their dignity sometimes compel PLWHA, including even those who militate in support of associations, to isolate themselves and go into hiding, which seriously hampers the fight against HIV (UN June 2002).
The following information, posted on the World Council of Churches (WCC) Website may also be useful. According to a WCC report, "in Gabon, many people, particularly women, who have HIV ... do not receive proper care," mainly because "discrimination against people living with HIV/AIDS is rampant in the communities" (WCC n.d., 8). The same source reported that "fear of negative consequences for themselves or their family have contributed to the fact that very few people living with HIV/AIDS are willing to identify themselves in any forum, let alone in public" (ibid., 23). One seropositive person is reported as saying, "in my family, nobody knows my new serological status. Very often, my parents kept saying that I should pay attention to HIV/AIDS, whilst I am already living with the virus" (ibid., 23).
According to the same WCC report,
many people affected and infected by HIV/AIDS are not treated with respect, love and dignity. Instead, they are ostracised, rejected, stigmatised and discriminated [against]. Another problem is that many people with HIV/AIDS cannot afford treatment at local hospitals, and some complain that they are not welcome (ibid., 12).
Another person living with HIV/AIDS stated that
Dr. Chantal Zamba is well known [in Gabon] as the medical doctor that deals with the HIV/AIDS epidemic. ... She sent me to the laboratory for an ordinary medical check up. The lab technician was not pleased [to have] to take [a] blood [sample] for examination because of Dr. Chantal's signature. I wasted 3 hours without being tested since the lab technician knew that I was HIV positive (ibid., 26).
At the same time, in certain cases, the medical referral could have a positive effect:
I went to my insurance company with a letter written by Dr. Chantal Zamba in which she asked my insurance company to provide me with financial resources for medical reasons. Since the cashier knew [of] Dr. Chantal's good [work] in the field of HIV/AIDS, he gave me the money without delay (ibid., 26).
The WCC report also indicated that stigmatization of and discrimination against PLWHA is still common in Gabon (ibid., 26). Many Gabonese are not properly cared for because they cannot afford the necessary treatments (ibid., 26). Moreover, various legal provisions are not respected once someone is found to be HIV-positive (ibid., 27).
On 30 January 2004, as a result of a workshop organized by the PNLS that brought together some 30 Gabonese journalists, [translation] "a national media network against HIV/AIDS (Réseau national des médias contre le HIV/AIDS, Renames)" was created in Gabon (AFP 30 Jan. 2004). The PNLS workshop [translation] "also enabled journalists to better understand PLWHA by taking into account, for example, the words used when referring to them because 'language reinforces the stigmatization'" (ibid.).
No information on the circumstances in which HIV/AIDS testing is mandatory in Gabon, or on the confidentiality of the results of such a test could be found among the sources consulted by the Research Directorate within the time constraints for this Response.
This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of additional sources consulted in researching this Information Request.
References
Agence France-Presse (AFP). 6 March 2005. "La première usine pharmaceutique d'Afrique centrale bientôt en marche." Agence panafricaine de presse (PANAPRESS). 16 September 2005. "Plus de 4 000 malades du sida traités au Gabon." Canada. 10 November 2005. Department of Foreign Affairs and International Trade. "Fiche documentaire: Gabon." Croix-Rouge française. N.d.a. "Le centre de traitement ambulatoire, un concept modélisé." Gabonews [Libreville]. 31 December 2005. "Le prochain septennat sera aussi celui de la lutte contre le sida (Omar Bongo Ondimba)." Inter Press Service (IPS). 22 December 2004. Antoine Lawson. "Les femmes encore oubliées dans la campagne des taxis contre le HIV/AIDS." Journal l'Union Plus. 17 September 2004. "Allo PMLS!" United Nations. 29 April 2005. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon: Dépistage et traitements gratuits pour les plus vulnérables." World Council of Churches (WCC). N.d. Ecumenical HIV/AIDS Initiative in Africa (EHAIA). What Do We Do? "Mapping of Resources: Gabon." Attachment
Croix-Rouge française. N.d.a. "Le centre de traitement ambulatoire, un concept modélisé." Additional Sources Consulted
Oral sources: Attempts made to contact the Association Sida Zéro, the Albert Schweitzer Hospital and the Gabonese Network of NGOs Against AIDS were unsuccessful.
Internet sites, including: Amnesty International (AI), Association gabonaise des assistants de service social (AGASS), Les Cahiers Panafricains, Freedom House, Human Rights Watch, Gabonevasion.com, International Committee of the Red Cross (ICRC), Médecins sans frontières, UNICEF, Réseau national pour la promotion de la santé reproductive des adolescents et des jeunes, United States Department of State.
_____. 30 January 2004. "Création d'un réseau de journalistes au Gabon pour lutter contre le sida."
_____. N.d.b. "Gabon: Les programmes pour ce pays."
_____. 16 March 2004. "Le premier centre de dépistage anonyme opérationnel."
_____. 20 April 2005. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon: De nouveaux centres de prise en charge des personnes vivant avec le VIH."
_____. March 2005. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon – Country Profile."
_____. 15 February 2005. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). Committee on the Elimination of Discrimination Against Women, Thirty-second session, 10 – 28 January 2005. Concluding Comments: Gabon. (CEDAW/C/GAB/CC/2-5)
_____. 14 February 2005. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon: Ouverture d'une première usine de fabrication d'ARV pour l'Afrique centrale."
_____. 16 December 2004. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon – Les taxis: Une nouvelle arme dans la lutte contre le VIH/SIDA."
_____. 20 September 2004. Integrated Regional Information Networks – HIV/AIDS News Service for Africa (IRINPlusNews). "Gabon – 1313: Le premier numéro vert gratuit pour être informé sur le VIH/SIDA."
_____. 2004. Joint United Nations Programme on HIV/AIDS (UNAIDS). "Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections."
_____. June 2002. Joint United Nations Programme on HIV/AIDS (UNAIDS). Situation Analysis of Discrimination and Stigmatisation Against People Living with HIV/AIDS in West and Central Africa: Ethical and Legal Considerations.
_____. N.d.a. United Nations Development Program (UNDP). PNUD au Gabon – Country Programme 2002-2003. "Introduction."
_____. N.d.b. United Nations Development Program (UNDP). PNUD au Gabon – Country Programme 2002-2003. "Objectifs, domaines du programme et résultats escomptés."
_____. N.d.c. United Nations Development Program (UNDP). PNUD au Gabon – VIH/SIDA. "Lutte contre le VIH/SIDA."
