LAKE CHAD, 9 June 2010 (IRIN) - Health authorities in Chad are considering how to re-launch HIV testing on the islands of Lake Chad after they were forced to cut short their first attempt in April. The testing was offered without counselling or health education – and ended with rumours and confusion.

"We need to find out how to gain the confidence of local populations to resume testing. There was not [enough] health education done before the campaign," Raoul Ngarhounoum, the Health Ministry regional director overseeing the islands, told IRIN.

Health workers on the island of Kinaserom in Lake Chad advertised the tests as general health evaluations to encourage higher turnout, said nurse and clinic director, Mahamat Boukar Moussa.

"It was then painful for us to give results because people were shocked when they learned they were HIV-positive. They did not even know what test they received. People stopped coming for the results and started telling others that the test was making people sick," Moussa told IRIN.

Of the 200 tested in Kinaserom, 30 who received their results learned they were seropositive. Gradually, the number of people coming for their results has dropped. "People get scared and flee into the city," said Moussa.

Ngarhounoum said more work had to be done to prepare and educate the island population about HIV testing.

HIV NGOs from the islands, representatives from national HIV organizations and health workers have been invited to a regional forum on 15 June in Bol, the regional capital near Lake Chad, to discuss ways to improve HIV testing in the islands, after which testing will resume, said Ngarhounoum.

Access

Hundreds of islets dot Lake Chad, which has shrunk by more than 90 percent in recent decades. Overgrazing near the lake, dying vegetation and encroaching sand are contributors, according to the government. While there has long been HIV testing "on land" as people refer to the towns bordering the water, testing has not been offered on the islands.

The national HIV prevalence rate is 3.3 percent, based on the most recent national survey in 2005. This rate was 26 percent in Lake Chad's islands, based on a 2001 survey conducted by the Lake Chad Basin Commission, which includes representatives from the countries bordering the lake – Chad, Cameroon, Niger, Nigeria and Central African Republic.

The HIV risk is higher around the lake, according to the commission. "Herders, fisherman, prostitutes and business people converge on the lake," said Deoudje Noé, its regional coordinator for HIV programmes. "You have vendors in search of money from all over."

Almost 10 percent of pregnant women in Bol tested positive for HIV in 2009, double the rate from 2002, according to the government. Most of those testing positive are from the islands, said Ngarhounoum.

"It is very hard to reach the islands," he added. "When the water level drops, it takes an enormous amount of time and money – and is at times impossible – for regional health authorities to carry out any vaccination or testing campaigns."

Stigma

Moussa told IRIN he suspected the rate of HIV infection was higher than reported. "I have received patients who were tested [in the past] in Mada [Cameroon] but when they were given their result, they simply threw it away because they did not want anyone at home to know."

He added that the clinic's strategy was to tell islanders who test positive that they can go to Bol, the closest hospital at least five hours by motorboat, for a second exam to "get better", but Ngarhounoum disagreed.

"We have had all-night discussions with these health directors to get them to give proper health messages. We need to tell people directly about the disease, their options and course of treatment," Ngarhounoum told IRIN.

He said the 15 June forum will instruct health workers to send HIV-positive patients to the hospital in Bol for lab analyses to decide if the patient needs to begin treatment.

With only one doctor in Bol, equipment problems in the regional hospital's lab and a fire in the capital in early May, which destroyed a part of the national stock of ARVs and testing equipment, none of the patients from the islands has been able to start treatment.

Chad's HIV focal point for the Lake Chad Basin Commission, Mahamat Taher Adoum, told IRIN a technician, new laboratory equipment, more testing agents and HIV medication had arrived at the hospital as of 7 June.