Côte d’Ivoire

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TOTAL POPULATION

National responses to HIV/AIDS in most west African countries have historically focused on the general population, with little focus on key populations. Despite the emerging evidence indicating a heavy HIV burden among key populations, the public health response in most west African countries does not call for an urgent scale-up of initiatives focused on key populations. Although most west African governments are unwilling to engage with key populations stakeholders to help expand and sustain programs, men who have sex with men, female sex workers, and people who inject drugs have been recognized as priority populations for HIV prevention and universal treatment for those living with HIV in the Ivorian national strategic plan for HIV.

Although the President’s Emergency Plan for AIDS Relief (PEPFAR) has scaled up comprehensive services for female sex workers and men who have sex with men, these programs remain dependent on external donor funding and have not transitioned to country-owned programs. Inadequate financing for HIV prevention programming for key populations remains a primary reason why low coverage of HIV prevention services for key populations persists in west Africa.

-MIGRANT POPULATIONS

MIGRANT POPULATIONS
AND HIV

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TOTAL MIGRANT POPULATION
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HIV PREVELANCE AMONG PERSONS FROM AFRICA AND THE CARIBBEAN
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HIV INCIDENCE AMONG PERSONS FROM AFRICA AND THE CARIBBEAN
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PROPORTION OF KEY POPULATIONS THAT ARE MIGRANTS

TOP 5 AFRICAN COUNTRIES
OF ORIGIN FOR MIGRANTS IN
COTE D'IVORE

  • 1. Burkina Faso: 1,284,323
  • 2. Mali: 356,019
  • 3. Guinea:    94,980
  • 4. Liberia:   82,428
  • 5. Benin:   54,068

-TOTAL POPULATION

PEOPLE LIVING WITH HIV

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HIV PREVALENCE

NEW INFECTIONS

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HIV INCIDENCE

HIV TREATMENT CASCADE

460,000
hiv prevalence
42%
Percentage of people unaware of HIV-positive status
Unknown
TOTAL NUMBER OF PEOPLE LINKED TO HIV CARE
Unknown
TOTAL NUMBER OF PEOPLE RETAINED IN CARE
41%
Percentage of people on anti-retroviral therapy
32%
Percentage of all people living with HIV who are virally suppressed
78%
Percentage of people living with HIV on treatment who are virally supressed

KEY AND AFFECTED POPULATIONS

11%

11% HIV prevalence among men who have sex with men

It is estimated that there are approximately 59, 040 men who have sex with men in Côte d’Ivoire. Data from Côte d’Ivoire indicates that a substantial number of infections occur among men who have sex with men, many of whom also report having sex with women. It is common for men who have sex with men to be married or in long-term relationships with women. In a study of men who have sex with men in Abidjan, Côte d’Ivoire a majority of respondents identified as bisexual. It is estimated that HIV prevalence among men who have sex with men is 11.2% in Côte d’Ivoire.

Information on migrant men who have sex with men is sparse. No information was found on HIV incidence or prevalence among migrant men who have sex with men.

Côte d’Ivoire is one of the countries most severely affected by the HIV/AIDS epidemic in West Africa, with an estimated HIV prevalence in the adult population of 3.9% and a two-fold to five-fold higher prevalence in female sex workers.

The HIV prevalence among female sex workers is estimated to be 26.6% in Côte d’Ivoire. Although data are scarce for male and transgender sex workers, a study conducted among male sex workers in Côte d’Ivoire identified an estimated HIV prevalence of 50% which stands in stark contrast with the HIV prevalence of he general male population of 15-49 years olds which was 1.9% in 2017.

Structural factors that may increase risk of HIV acquisition among female sex workers includes extreme poverty, concomitant lack of familial and social support, gender inequality, stigma, discrimination, physical and sexual violence and legal and regulatory policies penalizing sex work. Sex work is illegal in most west African countries. Structural risk factors associated with arrest and incarceration indirectly heighten risk for HIV infection by restricting access to preventive HIV/ STIs care and treatment services

Information on migrant sex workers is sparse. No information was found on HIV incidence or prevalence among migrant sex workers.

5%

5% HIV prevalence among injection drug users

Limited data are available for people who inject drugs in west Africa and the role of injecting drugs in HIV transmission dynamics is unknown. Reported drug use in this region has predominantly been non-injecting

Information on migrant injection drug users is sparse. No information was found on HIV incidence or prevalence among migrant injection drug users.

HEALTH

Decades after the first reported case of AIDS, sub-Saharan Africa continues to be the most heavily affected region in the world. West and Central Africa is home to 6.1 million people living with HIV, 500,000 of whom are children. This is equivalent to 17% of the global population of people living with HIV, despite the region making up just 7% of the global population.

In West Africa, international migration among fishermen, traders, farmers, other migrant workers and refugees is common. An estimated 3% of West Africa’s population live in temporary housing while they are away from their communities and families. This is important because housing, migration, economic status and education are associated with HIV infection. Most of the migrant population in West Africa are males and HIV is predominantly spread through heterosexual contact. Less than half of those living with HIV in West and Central Africa are aware of their status which means they are unknowingly passing on HIV infection and that they do not access treatment services.

Cote d’Ivoire, the main country of immigration, has the highest HIV prevalence in West Africa. Infection is widespread throughout the country, with larger concentrations of HIV infection in the most attractive destinations for migrants: Abidjan and the agro-industrial centers of Daloa and Bouake. Côte d’Ivoire also has the highest HIV incidence rate in West Africa. Although interventions such as the promotion and distribution of condoms among female sex workers has been effective at averting infections, low coverage of antiretroviral therapy and low prevention of mother to child transmission continue to drive HIV incidence. HIV is the leading cause of death for men and second leading cause of death for women in Côte d’Ivoire.

The Ivorian health care system is mainly provided through the public sector and is divided into three levels:

  1. The primary level is composed of primary health care institutions such as health centers, specialized health centers and clinics. There are 1,870 public primary health care institutions in Côte d’Ivoire.
  2. The secondary level is composed of health facilities such as general hospitals, regional hospitals and specialized hospitals. There are 66 general hospitals, 17 regional hospitals, and 2 specialized hospitals in Côte d’Ivoire.
  3. The tertiary level is composed of health facilities such as teaching hospitals and specialized national institutes. There are 4 university teaching hospitals and 9 specialized health institutes in Côte d’Ivoire.

In order to guarantee health access to its citizens, Côte d’Ivoire has started on reforms by developing a National Health Development Plan. The new 2016-2020 National Health Development Plan (PNDS) envisions a high-performing, comprehensive, responsible and efficient health system that guarantees the best possible standard of health for all people living in Côte d’Ivoire, especially the most vulnerable.

Public health policy in Côte d’Ivoire does not guarantee access to health services for migrants. There do not appear to be any national policies or coordination mechanisms between migration or immigration and HIV.

POLICY

Migration is often motivated by economic, social, political and human rights reasons. The AIDS epidemic in West Africa is in large part shaped by international migration. In rural areas of Burkina Faso, AIDS appears to be widespread among families of seasonal temporary workers.  Ghanaian female sex workers travel between Ghana and Cote d’Ivoire to work and unusually high levels of HIV and AIDS have been found in the rural areas of Ghana. A regional approach to meet the needs of migration throughout their entire journey, before, during and after migration is needed to both manage an curb the spread of HIV. Closing borders and restricting migration flow is a short-sighted policy intervention that  may do little to prevent the spread of HIV and may instead increase economic and social hardship. Seasonal migration will continue to be a part of the West African experience. Policies that provide access to free health care, fair employment standards and ensure adequate housing for migrants regardless of their legal status will likely result in a curb in HIV incidence, among other impacts.

Policy interventions that affect key populations are another important tool in curbing HIV incidence. In Côte d’Ivoire adolescent girls (aged 15-19) are five times more likely to acquire HIV than adolescent boys. The HIV response in Côte d’Ivoire should prioritize girls and young women. In West Africa, girls and women face high level of gender inequality, gender based violence and sexual violence, which increases vulnerability. According to demographic and health surveys, 80% of married adolescent girls in Côte d’Ivoire do not have the final say on their own healthcare.

Between 2011-2018, HIV prevalence in Côte d’Ivoire declined to 3.7% but remains substantially higher among men who have sex with men and female sex workers, both of whom are identified as key populations in the country’s most recent national strategic plan. Côte d’Ivoire has emphasized anti-retroviral therapy as a response to HIV emphasis which has resulted in funding declines for condoms and prevention activities for key population. Even if the United Nations’ 90-90-90 objective was reached by 2020, 27% of infected individuals with unsuppressed viral load would still contribute to HIV transmission in the population.

Although immigration policies in Côte d’Ivoire do not have not have provisions for deporting persons living with HIV, sex workers, men who have sex with men and transgendered persons, they do not include any supportive policies either. Planning, coordination and political will along with legal frameworks that prioritize public health and human rights are needed to ensure HIV prevention, care and treatment programming for key populations in Côte d’Ivoire are accessible to all those living with HIV and for key populations. Given that Côte d’Ivoire is a hub for migrants and seasonal workers, labour policies that protect the rights of both documented and undocumented migrants is necessary to ensure that access to health, housing and fair labour practices are provided to migrants and key populations.

THE RESPONSE

The burden of the HIV epidemic is felt most strongly among key populations (men who have sex with men, sex workers and people who inject drugs) in Côte d’Ivoire. Although the Ivorian national strategic plan recognizes men who have sex with men, female sex workers, and people who inject drugs as priority populations for HIV prevention and universal treatment, key population friendly policies have yet to be implemented. Adequate technical and financial support for strong and viable key populations programs, including service delivery must be prioritized. Services that address HIV prevention strategies, such as peer-led interventions, condom and condom-compatible lubricant promotion and use, STIs screening and treatment services, HIV testing and counseling and HIV care, treatment and support, have a better chance of impacting the rate of HIV transmission significantly, if they are delivered as a comprehensive package.

Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by AIDS, malaria and tuberculosis. The Global Fund raises and invests nearly US$4 billion a year to support programs run by local experts in countries and communities most in need.

Each implementing country establishes a national committee, or Country Coordinating Mechanism, to submit requests for funding on behalf of the entire country, and to oversee implementation once the request has become a signed grant. Country Coordinating Mechanisms include representatives of every sector involved in the response to the diseases.

Burkinabe migrants represent the highest migrant group in Côte d’Ivoire. Please click here for Burkina Faso’s Country Coordinating Mechanism.

-SOURCES

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