While economic pressure increases on Ivory Coast's Laurent Gbagbo to cede power to his rival Alassane Ouattara, AIDS and cholera patients in the country are concerned about the consequences of the breach of drug supply and absence of alternative solutions to their delicate health situation.

By Selay Marius Kouassi, Abidjan

"I was surprised to learn from the DPM (Department of Pharmacy and Medicines) that our pharmacies are almost empty; within the next two months we won’t have any medicine," Dr. Christine Adjobi, Gbagbo’s government minister for the Fight against AIDS, said a couple of days ago on national television.

This is a consequence of the EU embargo on the country's ports. Ivory Coast’s supply of medicines and other products is in serious trouble.

Support from key donors like the World Bank, the United States Agency for International Development (USAID) and the Global Fund to Fight AIDS, Tuberculosis and Malaria took a serious knock by the crisis which arose from the controversial November 2010 presidential elections. These three major donors approved funding worth several millions of dollars towards the fight against AIDS in Ivory Coast. They have even closed their offices in Abidjan.

Powerless NGOs and patients
"The embargo and cases of violence reported here and there have disrupted the supply of ARVs (antiretrovirals)," said Yaya Coulibaly, president of RIP + (Ivorian Network of People Living with HIV/AIDS), a structure comprising 65 NGOs fighting against the deadly disease in Ivory Coast.

Valérie N’Doli (27) is HIV positive since nearly seven years. Her apparently excellent health has been attributed to the regular intake of ARVs and medical advices provided by RIP +. But now, she is deeply concerned by the incapacity of RIP+ to help her in her fight against her disease.

"ARVs are my lifeline. It is now roughly two weeks that I haven’t had my miracle pills. I don’t know where to get them. Whenever I call RIP+, I always get the same answer: Out of stock, call back later. I am getting depressed," said a sobbing Valérie.

Klofas Issa, a taxi driver in Vridi, Abidjan, has just learned that he is HIV positive. Normally, he would go to the Health Center in Vridi Canal for a free counselling session and to obtain ARVs. But, given the situation, he feels a bit lost.

Resurgence of the black market
At the "pharmacie par terre" (pharmacy on the ground, ed), the name given to street pharmacies in Abidjan, ARVs are subject to illicit sales. This began following the announcement of the fall in available stocks and the soon-to-be lack of it. But in one way or another, 'Roxy'and 'Braccodi', the two biggest "health black market" in Abidjan are still benefitting from a regular supply of ARVs.

The '"street pharmacists" tend to keep a low profile on how they lay their hands on these drugs, meant to be distributed almost freely in public hospitals. But they do acknowledge that they "come from state health centers and health professionals" whose identity they do not dare mention.

Destroying cholera
Besides the HIV/AIDS epidemic which affects in a much more subtle way, cholera seems to be moving much faster in destroying lives in Ivory Coast. Recognised by the Ministry of Health in early January, the disease has already caused the death of 70 people and continues affecting countless others. The fast spreading of the disease is due to the piling up of garbage at almost every street corner.

Emile Flan, a nurse at the Health Centre in Adjamé, a popular district of Abidjan, where the first case was reported, blames the political deadlock: "It is true that even here in the capital, many people don’t have access to drinking water. But the fighting between pro-Gbagbo soldiers and rival factions have destroyed many hydraulic systems, leaving people without safe water. This opens the door to cholera!" Emile also believes that the shortage of medicines will worsen the current situation due to the embargo.

104,000 probable deaths
"We talked to Ms. Marguerite Doffou, director of the Fonds national de Lutte contre le SIDA (FNLS) (National Fund for the Fight against AIDS, ed), who confirmed to us that the funds from this organisation are not being used to buy ARVs. If nothing is done by the international community, you are looking at approximately 104,000 Ivorians who would die very soon, due to the deprivation of ARVs," says Yaya Coulibaly, himself HIV positive.

With practically no light at the end of the tunnel when it comes to this ongoing crisis, the vital prognosis for HIV/AIDS and cholera patients is at stake.