Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men. Credit: Robbie Corey-Boulet/IPS

By Robbie Corey-Boulet
ABIDJAN , Dec 1 2012 (IPS)

When Emmanuel Kokou, a 28-year-old sex worker, moved from his native Togo to Abidjan, Côte d’Ivoire in 2010, he knew there was a good chance that he had previously been exposed to HIV. But he had no intention of getting tested.

“I had done a lot of silly things,” said Kokou, whose name has been changed to protect his identity. “But I never got a test because I was afraid.”

That changed only after he visited Clinique de Confiance, a compact one-story facility tucked behind an unassuming blue gate in an upscale section of this West African nation’s economic capital. The test came back positive, and since then Kokou has learned how to manage his health and avoid transmitting HIV to others – namely, by insisting his clients wear condoms.

“If the clinic wasn’t here I wouldn’t have had the courage to do this,” he told IPS, referring to the process of learning his status and how to live with it. “There are people here who give us advice and reassure us.”

Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men (MSM), starting in 2004 with sex workers and their partners before expanding to all MSM in 2007. Although two other clinics offering similar services have opened recently, Clinique de Confiance remains by far the most established.

As such, the clinic has played a critical role in Côte d’Ivoire’s bid to lower the adult HIV prevalence rate, one of the highest in West Africa. Staff members estimate that roughly 1,000 MSM have visited the clinic over the years – only a portion of the total population (for which there are no good estimates), but still a significant achievement.

Activists warn, however, that unless something is done about the heavy stigmatisation that MSM face in Ivorian society – especially those who are HIV positive – it will be difficult to build on progress the clinic has made so far.

Unlike regional neighbours such as Liberia and Nigeria, where the issue of homosexuality has been highly politicised and lesbian gay bisexual and transgender (LGBT) populations have recently been targeted by harsh anti-gay legislation, Côte d’Ivoire does not have a reputation for persecuting MSM. A report broadcast by a Dutch radio outlet last year went so far as to declare that Abidjan was “becoming a gay Eldorado.”

Yet Dr. Camille Anoma, coordinator of the NGO that runs Clinique de Confiance, said discrimination against MSM – at home, at school, at work, in health centres and out on the streets – is common. He noted that no other health facilities were even trying to serve the MSM population before Clinique de Confiance started in 2004.

“Before that, the focus of our activity was female sex workers,” Anoma told IPS. “But the staff at the clinic kept seeing commercial sex workers who were men having sex with men. Our question was, ‘What is the situation of MSM in this country?’ And nobody seemed to know. That’s the reason why we decided to offer services for this group.”

Though the available data is limited, it is clear that HIV prevalence rates are considerably higher for MSM than the general population. UNAIDS, the Joint United Nations Programme on HIV/AIDS, estimates that the national adult prevalence rate was three percent in 2011. Internal numbers from Clinique de Confiance show that figure was 24.5 percent for MSM in 2009.

Claver N. Toure, executive director of the LGBT group Alternative Côte d’Ivoire, said the situation would be far worse without Clinique de Confiance and the two other clinics that welcome MSM. “It would be a catastrophe,” he told IPS. “The MSM are obligated to get their treatment and their prevention from these clinics because they’re not going to the general hospitals,” where they may be treated with derision.

There are a number of factors preventing Clinique de Confiance from expanding its reach, including logistical challenges such as transport costs. But Morley Bienvenu Nangone, head of monitoring and evaluation for Arc-En-Ciel Plus, a group that combats HIV/AIDS and homophobia, said the most formidable challenges were cultural.

He said the stigma associated with homosexuality prevents many men from acknowledging even to themselves that they are gay, making it far less likely that they will seek out HIV prevention and treatment resources. “What needs to be done for health is not just to focus on health, because health problems are linked to socio-cultural problems,” Nangone told IPS.

Nangone said that is why it was essential that Clinique de Confiance maintain a low profile. “If it wasn’t confidential, if there were large signs outside, then it wouldn’t work as well,” he said.

The experience of Kokou, the Togolese sex worker, underscores just how pervasive the stigma can be. He said that even though he had come to terms with his sexuality and his HIV-status, he kept both a secret for fear of how others would react.

“I don’t share my status because people will see me differently,” he said. “You’re seen badly, and people don’t trust you. I haven’t told anybody, not even a friend, not my dad or my mom. Nobody knows outside of the clinic.”

He went on: “As for being open as a gay person, I don’t even know how that would work. I just don’t go out. I just don’t have very many friends.”

Emmanuel Biandjui Diffi, 40, stands outside Abidjan's main prison, where he was held for six months earlier this year. Credit: Robbie Corey-Boulet/IPS

By Robbie Corey-Boulet
ABIDJAN, Jul 26 2012 (IPS)

Eliane Negui knew just what to do when she got word that a group of inmates had escaped from Abidjan’s main prison, MACA, earlier this month. After all, the 24-year-old, who has lived across a dirt road from the facility for nine years, had witnessed the same scenario just two months before. 

“Whenever there is an escape we are always running into our rooms and closing the doors,” she said in a recent interview with IPS from her stand outside the prison’s main entrance where she sells fried bananas. “Whenever there is an escape the guards are shooting, so we enter our rooms so as not to be hurt or killed.

Twelve inmates escaped from the prison that day, eight of whom were soon caught. The total paled in comparison to the earlier escape, on May 4, when about 50 inmates broke free from the facility, prompting a statement of concern from Côte d’Ivoire’s United Nations mission.

This West African nation is still rebuilding after six months of post-election violence sparked by the November 2010 election, when former President Laurent Gbagbo refused to step down after losing to current President Alassane Ouattara. During the violence, the country’s 33 prisons were emptied, and infrastructure and equipment was largely destroyed.

Prisons began re-opening in August 2011, and 31 are now operational. But the recovery has been marred by a rash of prison breaks. Since August, there have been 17 separate escapes involving about 250 prisoners, according to Francoise Simard, chief of the U.N.’s rule of law section.

The problems dogging the country’s prisons mirror larger problems with the security sector — especially when it comes to personnel. Complaints about prison conditions also highlight room for improvement in the country’s post-conflict recovery.

Prior to the violence, which claimed some 3,000 lives, prison guards alone provided security at the country’s penitentiaries. These guards were armed, but there was a shortage of weapons and not all were functional, Simard told IPS.

When prisons began reopening in August, the Republican Forces of Côte d’Ivoire (FRCI), the national army, was the only security force allowed to have weapons. Soldiers began to work alongside prison guards.

More than one year after the conflict ended, prison guards are still unarmed. “The current government is very reluctant to give weapons to prison guards,” Simard said.

This reluctance underscores the lack of trust among the different security forces. Because the number of prison guards nationwide nearly doubled during Gbagbo’s 10-year tenure, there is a perception — whether accurate or not — that most guards are loyal to the old regime.

“There is a suspicious atmosphere in the prison,” said Stephane Boko, a supervisor at MACA Prision in Abidjan, told IPS. “The power no longer rests with the prison guards because they are considered to be pro-Gbagbo.”

A similar division has been evident in the broader security sector. The FRCI is largely composed of forces loyal to Ouattara, including leaders of the Forces Nouvelles rebel group, which controlled northern Côte d’Ivoire when the country was partitioned from 2002 to 2010. The government has long been wary of police and gendarmes, and in some parts of the country — notably the volatile western region — the FRCI remains the only security force with access to weapons, meaning it has taken the lead on general policing.

Recently, though, police and gendarmes have been re-armed in some places, and they now have a permanent presence in the prisons. Under a policy established after the May escape, five police officers and five gendarmes are supposed to be posted in each facility, Simard told IPS.

The presence of multiple security forces in each facility can sometimes lead to a lack of coordination. Earlier this year, for instance, some 93 prisoners were able to escape from a facility in Agboville, a town located roughly 80 kilometres north of Abidjan. In the three days leading up to the escape, Simard said, no security forces showed up to guard the prison.

Boko and other staff at MACA said they believe responsibility for protecting Côte d’Ivoire’s prisons should be returned to the guards. But Serges Kouame, head of communications for the Justice Ministry, said after the prison break earlier this month that a central command center was being established to respond to prison escapes, and that it would involve the FRCI, guards, gendarmes and the police.

Conditions

Meanwhile, concerns persist about conditions facing Côte d’Ivoire’s inmates. The national prison system was dramatically overcrowded prior to the post-election violence, with more than 12,000 prisoners crammed into facilities that have a total capacity of about 5,500, according to the U.N.

The current prison population is much lower – 5,945 as of Jul. 20 — but it recently surpassed the total capacity and is rising by the week. Though Simard noted that “the situation is not as dramatic as it was before with overcrowding,” she said that certain aspects of detention conditions — among them access to food — remain problematic.

The U.S. State Department addressed poor prison conditions in its most recent Human Rights Report for Côte d’Ivoire. Though the report took note of some improvements under Ouattara, it said food provision remained “inadequate.”

This was the main complaint of Emmanuel Biandjui Diffi, a 40-year-old who was held in MACA for six months since January after he sold a plot of land to two different people.

“The conditions were OK, but the quality of the food was very poor,” he told IPS. “There was nothing in the soup – no meat and no fish.”

Diffi also complained about the prison’s policy of feeding inmates just once a day at around 2pm, something Simard said that the U.N. was pushing the government to remedy.

Diffi said the general atmosphere inside the prison was tolerable. “We were living normally,” he said. “We could play football. Some of us were working as tailors. Most of us were spending a lot of our time praying.”

But he singled out one problem that highlights just how far Côte d’Ivoire has yet to go in getting its institutions back on track: prolonged pretrial detention, something the Ouattara government has previously blamed on “a lack of judicial capacity,” according to the U.S. State Department.

More than anything, Diffi said, this issue, and the impression it left of a system that was broken, was fueling desperation within MACA’s walls.

“Most of the people in there have not been prosecuted,” he told IPS. “Some are charged, but many are not. They want to go out. They want to be released. And so they are asking for judgment.”