Libya's AIDs Problem
Ideas & Trends
Quiet. Libya Has an AIDS Problem.
Jehad Nga for The New York Times
AT RISK An AIDS expert says it was clear early on that foreign medical workers, below, had not deliberately infected children like Abdullah Juma Abdullah with H.I.V.
By ELISABETH ROSENTHAL
Published: July 29, 2007
ROME
THE safe landing of five Bulgarian nurses and a Palestinian doctor in Sofia last week, freed of a death sentence after eight years in Libyan prisons, was an apparent victory of diplomacy at long last.
But the drawn-out drama over Libyan accusations that the medical workers had infected children with H.I.V. also reflects how difficult Libya's own internal politics made it to reach an obvious solution far earlier, experts in the case said.
And it calls attention to a sad epilogue that will play out in Libya: an AIDS epidemic that has never been fully acknowledged and that continues to spread, even as the 426 children who figured in this case depend on treatment in a system ill prepared for the task.
Officially, two visits to Libya by Cécilia Sarkozy, the wife of the president of France, Nicolas Sarkozy, precipitated the release of the medical workers, who had been found guilty ?- not once, but twice ?- of infecting the children as part of a purported plot by the Israeli secret service. But hers were only the latest in countless series of pilgrimages by diplomats and scientists to plead with Libya's leader, Col. Muammar el-Qaddafi.
"It was completely clear scientifically since 2002 that they were not guilty," said Vittorio Colizzi, an AIDS expert whom the Qaddafi family invited in 2000 to study the hospital in Benghazi where the infections took place. "But the nurses suffered for years from the incapacity of diplomacy and politics to free them in a timely manner."
He and another expert, Dr. Luc Montagnier, concluded that the AIDS virus was present in the hospital before the nurses arrived, probably carried to Libya by guest workers from countries in sub-Saharan Africa. In many of those nations more than 10 percent of the adult population is infected. Mr. Colizzi concluded that the virus had been spread by the infusion of unscreened blood and blood products, as well as by unsterilized equipment, pervasive problems that have only been partly solved.
A home-grown AIDS outbreak caused by lax practices at a government hospital was not an explanation the government could acknowledge, medical and other experts say, especially when there were convenient foreign scapegoats.
Bulgarians have long provided medical care in Libyan hospitals, and "are very unpopular because of racism," said George Joffe, an expert on Libya at Cambridge University's Center of International Studies. Palestinians are unpopular, too, he said, "so this group provided an obvious target."
Once the doctor and nurses had been blamed, the families of the children had to be placated, which took time. Colonel Qaddafi is unpopular in Benghazi, which is Libya's second-largest city and was the home of Libya's former regime, Dr. Joffe said. Also, Benghazi is a city of extended clans, so each sick child could be related to many residents, if distantly.
"Qaddafi needed to pacify the community there, while satisfying the international community," Dr. Joffe said. "Of course, he exploited the issue for political and economic gain internationally. But basically, a domestic issue delayed international resolution."
The families' immediate needs were also severe. Many of the children are approaching their teenage years, and the potentially deadly disease they carry is difficult to treat because of Libya's poor medical infrastructure. A million dollars ?- the amount each family received in compensation ?- "is nothing" for the lifetime treatment of a child with H.I.V., Dr. Colizzi said. "It won't cover their medical problems, let alone issues of discrimination and their psychological needs."
Libya reported 10,450 cases of H.I.V./AIDS to the World Health Organization by the end of 2006, but outside experts consider that figure low. "There may be a lot out there that's not detected or reported, as is true in many countries in the region," said Gabriele Riedner, regional adviser to the World Health Organization in Cairo.
"There is evidence of increasing H.I.V. infections in Libya, especially among the younger age groups," with many cases, if not most, among users of injection drugs, the W.H.O.'s annual report says.
Early on, European negotiators recognized that winning over the families would be crucial in freeing the doctor and nurses.
Once the death sentences had been handed down, the negotiators felt the best hope for the jailed medical workers would be to invoke Islamic law and custom, under which injured parties accept compensation and express forgiveness, allowing the sentences to be reduced or overturned.
"We were constantly working around two axes: to give signs of attention to the families to show them the world cared, vis-à-vis things like equipping hospitals and providing medical care," the E.U. diplomat said. "And to see how far we could go in helping with compensation. But in many ways this was less important."
In the end, the families received $1 million apiece, almost all of that paid by the Libyan state, Dr. Joffe said, and agreed to the death sentences' being dropped. The European Union and its member states have sent tens if not hundreds of million of dollars in aid to Libya, to create "a positive psychological and political environment" for the families. Furthermore, the children have been treated in hospitals in Italy, France and Britain.
Still, said Dr. Colizzi, who has seen the children during visits to Benghazi and in Europe, some are "really sick" and are not getting good treatment at home. More than 50 have died.
"The tragedy for the nurses is finished; now starts the tragedy for the children," he said.
The last line is the truest.
Joe(also note the lack of power in the city of Benghazi)Nation
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