VZCZCXRO8090
RR RUEHMA RUEHPA
DE RUEHFN #0709/01 3321644
ZNR UUUUU ZZH
R 281644Z NOV 07
FM AMEMBASSY FREETOWN
TO RUEHC/SECSTATE WASHDC 1553
INFO RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA 0113

UNCLAS SECTION 01 OF 02 FREETOWN 000709 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR AF/W, S/GAC; USAID FOR GLOBAL HEALTH OFFICE 
 
E.O. 12958: N/A 
TAGS: KHIV SOCI TBIO PREL EAID SL
SUBJECT: WORLD AIDS DAY:  WHERE IS SIERRA LEONE? 
 
¶1.  SUMMARY:  As World AIDS Day approaches (Dec. 1), it appears that 
Sierra Leone's HIV/AIDS prevalence rate is reportedly low, 
officially at 1.53%, although some sources believe it to be higher.  Th 
military's prevalence is higher.  Efforts to combat HIV/AIDS are 
coordinated by the National HIV/AIDS Secretariat, which currently 
receives funding from the World Bank and the Global Fund, though 
World Bank funding ends soon.  USG support comes directly from USAID an 
DOD, and indirectly through major inputs via the Global Fund.  Sierra 
Leone is neither a PEPFAR country nor a nation included in the 
President's Malaria Initiative.  Thus, it faces major resources 
challenges in battling now-chronic illnesses.  END SUMMARY. 
 
¶2.  CIVILIAN STATUS:  As of 2005, Sierra Leonean HIV prevalence is 
1.53% according to the National HIV/AIDS Secretariat (NAS) sero- 
prevalence survey, and 1.6% according to UNAIDS estimates.  Some 
authorities believe the current figures to be low, though, and the 
ante-natal clinic positive testing rate of 2.9% suggests that may be 
true.  According to UNAIDS, out of the total of 43,000 people living 
with HIV/AIDS, 26,000 are women and 5,200 are children.  HIV/AIDS 
related efforts are coordinated by the NAS, an independent 
governmental agency, and implemented by a wide variety of partners, 
including the 
Ministry of Health and Sanitation.  In the past few years, the 
greatest areas of progress have been in health care, treatment, and 
preservation of legal and human rights for people living with HIV/AIDS. 
Monitoring and Evaluation has been the area of least progress.  Of note 
is the abundance of free anti-retroviral (ARV) drugs, but delivery of 
testing kits to the provinces is sometimes delayed.  The top priority 
for the NAS is prevention, which has proven difficult as it requires 
changing people's behavior.  Malaria is by far the greatest health 
challenge facing Sierra Leone.  However, HIV/AIDS is of growing concern 
in 2002, a Centers for Disease Control and Prevention (CDC) sero- 
prevalence study showed an HIV/AIDS rate of only 0.9%, but did not 
account for the likely large number of young ex-combatants.  There 
are currently two major sources of funding for anti-HIV/AIDS efforts: 
the World Bank and the Global Fund to Fight AIDS, Tuberculosis and 
Malaria. The Global Fund approved a new grant of $26,482,115, the first 
tranche of which is $9,627,778 and went into effect in July 2007.  NAS 
works with 44 partners in multiple sectors to implement programs with 
the Global Fund money.  Among other things, the Global Fund provides 
funding for ARV drugs.  Conversely, Sierra Leone HIV/AIDS Response 
Project (SHARP), the four-year World Bank project, is due to end in 
December, leaving NAS without funding for salaries, building rent, 
and several initiatives throughout the country.  Despite Parliament 
action in budgeting money, no funds have actually been provided to the 
NAS by the GOSL. 
 
¶3.  MILITARY STATUS:  The most recent prevalence survey in Sierra 
Leone is the May 2007 Republic of Sierra Leone Armed Forces (RSLAF) HIV 
sero- preva1ence survey. Though the study's sample size is smaller than 
the statistical ideal, the surveyed military HIV rate is 3.29%, more 
than twice the national rate.  The 40-59 year old age group had a highe 
prevalence rate (4.9%) than the 20-39 group (2.97%).  Married 
subjects were more than twice as likely to test positive.  Knowledge of 
HIV transmission was mostly good except regarding mother to child 
transmission during pregnancy.  However, only 23% of respondents had 
used a condom during their last sexual contact.  According to 
military physicians, challenges include insufficient drugs for 
non-HIV/AIDS sexually transmitted infections, condom supplies in some 
units (largely due to distribution problems), and insufficient HIV test 
kits. Also, at least half of military physicians seeing HIV/AIDS 
patients need training in understanding and usage of HIV/AIDS drugs. 
There is no infectious disease doctor on staff, nor are updated HIV/AID 
reading materials and other resources available to military doctors. 
There is also little to no home-based or hospice care when ARV drugs 
fail. One of the major challenges for military medical facilities is 
that they are required to provide free care to civilians, who make up 
70%-80% of the case load.  Luckily, anti-retroviral drugs are readily 
available from the NAS, as they are within the civilian population. 
 
¶4.  USG ACTIVITY:  At this time, direct USG HIV/AIDS efforts in 
Sierra Leone come primarily from two agencies, USAID and DOD.  USAID ha 
three related projects in Sierra Leone:  the USAID/Washington-managed 
Sport Health Project on HIV/AIDS, the USAID/West Africa-managed Action 
for West Africa Region (AWARE Reproductive Health and AWARE-HIV), and 
the West Africa Ambassador's AIDS Fund (WAAF). WAAF is a component of 
AWARE-HIV/AIDS supporting local NGOs in non-presence countries. 
USAID/WA supports the NAS for Prevention of Mother-To-Child 
Transmission (PMTCT), cross-border activities for HIV prevention 
with neighboring countries, and a Blood Safety Program in a referral 
hospital.  The Defense Attache Office works with the Republic of 
Sierra Leone Armed Forces (RSLAF) through the DOD HIV/AIDS Prevention 
Program in Sierra Leone (DHAPP SL).  In September 2007, DHAPP opened a 
Voluntary Confidential Counseling and Testing Center (VCCT), which 
is also open to civilians, at the RSLAF 5th Brigade headquarters in Bo, 
Sierra Leone's second-largest city.  Pending funding, DHAPP hopes to 
open two more VCCTs in the other provincial capitals, Kenema and 
Makeni.  DHAPP also provides RSLAF with condoms and funds and trains 
 
peer educators.  The Centers for Disease Control and Prevention 
 
FREETOWN 00000709  002 OF 002 
 
 
(CDC) also conducted the 2002 sero-prevalence survey and funded NAS's 
testing lab.  In terms of indirect aid, the USG is by far the largest 
donor to the Global Fund, providing nearly 30% of worldwide funding. 
Sierra Leone is neither a PEPFAR country nor a nation included in the 
President's Malaria Initiative.  The Ambassador will speak at the 
World AIDS Day Commemoration on December 1, at which the Defense Attach 
will also donate t-shirts to HIV/AIDS peer educators and counselors. 
 
¶5.  COMMENT:  With an unemployment rate of 80%, it is possible that 
the percentage of sero-positive Sierra Leoneans is truly significantly 
higher than reported. Add to that the 11 years of war; the number of 
young soldiers infected yet uncounted is unknown.  In addition to 
official USG support, there are already signs of private sector 
institutions as exemplified by Baylor College of Medicine's two 
assessment missions in Sierra Leone.  Baylor has established 
HIV/AIDS centers of excellence elsewhere on the continent.  Such a 
health facility in Sierra Leone would be an apt extension of our and 
others' international involvement.  Such public-private partnerships 
would make a significant difference as this resource-poor nation must 
fight not only for democracy but also for a healthy population to move 
the country forward. 
 
PERRY