AIDS in Bongoland: Better Hope you Live in the City

  
Bongo looks pretty serious about AIDS

Omar Bongo Ondimba has controlled Gabon for more than four decades. Fewer than two million people are scattered across his sprawling jungle-stuffed country and Bongo does not value them equally. A resident of Mbondou in the northeastern portion of Gabon, which was formerly Pygmy territory, referred to this region as the "neglected provinces." A middle-aged man from the same village approached our team as we sat with the chief in the evening and asked, "Is it really possible for AIDS to come to our village?" The high-profile social marketing dominated by Bongo's smiling or stern face does not radiate far from the capital city.

Accordingly, the question of AIDS in Gabon can be approached from at least two very different perspectives. The national administrator of the Projet National Lutte Contre le SIDA (PNLS), Emmanuel-Badho Mengome Abiagha, has a decidedly positive view. He cites flattering numbers that indicate a stabilizing national AIDS rate (somewhere around 10%), an increase in condom sales, and a rising number of people willing to submit to the AIDS test. He is proud to describe the way that all of the resident NGOs are coordinated by the central government, provided with homogenous resources, and harmonized with one another. He knows when the president first became committed to the struggle and he can detail all of the first lady's activities—including her whirlwind caravan tour of the provinces, where she talked about AIDS in front of an uninformed section of Gabonese society.

The one hard-hitting poster of the social marketing campaign was withdrawn under pressure; it featured a partially nude skeletal woman suffering from AIDS under the caption, "It is not sorcery that did this. It is AIDS." Now most pictures feature a baby in diapers or Bongo's face.

Despite this, the Gabonese PNLS does not deserve unflinching cynicism. The leadership of REGAP +, the association of people living with AIDS in Libreville, almost take for granted their easy access to anti-retroviral drugs (ARVs).

  
One of many sexual health murals in Libreville

Yves Anguile, the second vice president of REGAP +, nearly brushed the subject aside: "We do not have any difficulty getting our anti-retroviral drugs; we can afford them." The Gabonese government has taken the original step of creating a sliding price scale for ARVs that adjusts their cost according to the profession and financial assets of the patient. The result is an unusually fair arrangement where affluent Gabonese people foot the bill for the more impoverished and everyone near to the capital can procure their life-prolonging drugs with minimal difficulty.

At REGAP +'s weekly meeting the greatest concern is now income generation. Members of the society feel the burden of supporting their less fortunate members and the orphans and vulnerable children within their community. They pool their resources and try to maintain steady jobs. Many of them, though, are unemployed, many of them are women, and most of them find it more taxing to hold steady employment while living with HIV/AIDS.

Once you move away from the capital, the unemployment concerns of a city-dweller do not attract much sympathy. In the villages scattered along the country's slowly developing network of roads, unemployment is an ordinary thing. People cultivate what they can, trap and hunt small animals for food, and receive very little attention from the central government.

  
Rural village in Gabon

In Mbondou, a fairly representative rural town of approximately five hundred inhabitants where there is neither electricity nor running water, our team was surrounded by dozens of people, many of them sexually active young men who didn't know the first thing about AIDS.

As in many places where autopsies are unlikely or taboo, the rural citizens of Gabon tend to blame all death by sickness on malaria, which is indeed a killer. As a result, there are villages where condoms are not visibly available, through which long-haul truckers pass, where the prevailing belief is that AIDS has not yet arrived and may not come.

It is natural for a government to struggle when attempting to bring its messages to far-flung smaller populations, and in most African countries one can almost certainly find villages where awareness is unusually low. Gabon, however, has the resources and the stability to do better than this. Bongo's country is resource-rich and he has had four decades to improve on his models for health education; it is also clear that the country has the right approach and intentions in Libreville. The citizens of Gabon's smaller, more distant towns and villages are disproportionately at risk as long as they are allowed to remain so ill-informed.