The Project Attracts Job-Seekers and Prostitutes--
Experts Say that Boosts HIV Risk
By Ken Silverstein
Los Angeles TimesJune 18, 2003
Hundreds of African men looking for jobs have congregated in a shantytown here just outside the remote headquarters of a $3.7-billion oil pipeline project. ExxonMobil Corp. officials call the shantytown Kome Atan, from the French word for "to wait," as in waiting for a job. Residents call the place Kome Satan, for its numerous prostitutes and bars.
Health experts say conditions here and at similar settlements along the 670-mile pipeline route are ideal for promoting the spread of AIDS — and that too little is being done to prevent it. "There's been a huge number of prostitutes coming to the area from Chad and neighboring countries," said Grace Kodindo, a physician at the main hospital in N'Djamena, Chad's capital. "When you combine that with the usage of alcohol, it's a recipe for the spread of AIDS."
There is no way to measure the problem precisely, because clinics in Chad's southern oil region lack the means to test for HIV, the virus that causes acquired immune deficiency syndrome. But Lori Leonard, an American researcher who works with the clinics, said health workers have observed a sharp rise in symptoms of sexually transmitted diseases, which provide a rough gauge of HIV incidence. "I would be very surprised if the transmission of AIDS has not seriously increased," said Leonard, an assistant professor of international health at Johns Hopkins University. Health consultants had warned that this would happen. But the governments of Chad and Cameroon, the oil companies building the pipeline and the World Bank, which is supporting the mammoth project, did not take the aggressive steps that experts had hoped for.
When completed in about a month, the pipeline will connect oil fields in Chad to the Atlantic coast of Cameroon. ExxonMobil and its partners, ChevronTexaco Corp. and Petronas of Malaysia, pledged that the pipeline would foster development and help the poor, in contrast to previous African energy projects. Under a plan developed by the consortium and the World Bank, Chad agreed to commit much of its new oil wealth, expected to total at least $2.5 billion over three decades, to health, education and poverty reduction. Cameroon promised to improve social programs with the $500 million it will receive over the same period for allowing the pipeline to cross its territory.
In response to the warnings about AIDS, the World Bank and the consortium sponsored a prevention program that includes distributing free condoms, steering women away from prostitution, and treating sexually transmitted diseases that increase the risk of HIV. But the program offers HIV testing only to pipeline workers and provides no treatment for AIDS. Under the plan, Chad and Cameroon are responsible for identifying and treating AIDS cases related to the pipeline project, but the countries have taken few steps to improve existing anti-AIDS programs, which are underfunded and mostly ineffective.
A health consultant hired by the two governments predicted three years ago that without aggressive measures, the pipeline project would lead to 100 additional AIDS deaths annually within several years. Michele Lioy, who supervises the World Bank's health projects in Chad, disagreed that the pipeline has significantly increased HIV transmission there. She said tests performed in 2002 by Chad's government on more than 4,000 pregnant women across the country suggested that the HIV rate had not increased over the previous year. "It seems, based on preliminary evidence over the last two years, that World Bank financing has helped the government stabilize the spread of AIDS," she said.
The World Bank says it will spend $500,000 on AIDS education and prevention programs, and $1.5 million on developing Chad's health care infrastructure. (ExxonMobil would not disclose how much the oil consortium has spent.) However, an independent panel created by the World Bank to monitor the pipeline's impact recently called the anti-AIDS program "modest and insufficient." ExxonMobil spokeswoman Marcia Zelinsky said that the prevention program was reviewed and endorsed by the World Bank beforehand and that the company is "in full compliance" with its obligations.
Bare-Bones Health Care
As in much of Africa, the first cases of AIDS were reported in Chad in the mid-1980s, but the disease hasn't spread as widely as it did elsewhere on the continent, probably because of the country's isolation.
Chad's government runs a limited testing program and reported 1,704 new AIDS cases in 2000. The World Health Organization estimates that 3.6% of adults in Chad are HIV-positive, roughly one-third the rate in West African countries such as Cameroon and Ivory Coast.
Health experts predicted that the pipeline would cause an HIV rate increase because that is what happened with previous construction projects in Africa: The promise of jobs drew thousands of truck drivers and workers from local areas and neighboring countries. The presence of these men, often single or separated from their families during their employment, led to a sharp increase in prostitution and in HIV rates among women. Chad was deemed vulnerable because its health care system is so rudimentary. The situation is especially bad in the southern oil field area, which already had the highest number of AIDS cases. Around Moundou, the area's biggest town, there are two doctors for 96,000 people, according to the World Bank.
As the consortium was gearing up for construction in 2000, Chad and Cameroon used a World Bank loan to hire Bill Jobin, a Colorado-based health consultant, to analyze the pipeline's likely impact on AIDS cases. Jobin concluded that a sharp rise was all but inevitable, based on health statistics from Cameroon, which has better AIDS testing than Chad. As Jobin recounted in a recent interview, tons of construction material was trucked to the Chadian oil fields from Douala, a Cameroonian port town, where tests found that 17% of truck drivers are HIV-positive. At a border crossing on the M'Bere River, where trucks stop to clear customs, 55% of the prostitutes in a pipeline shantytown were HIV-positive. "You had all the conditions for the virus to work its way into central Chad with the truck drivers," Jobin said.
Jobin urged ExxonMobil to treat pipeline employees found to be HIV-infected. "My point was that this was the hottest health issue of the project, that if they didn't deal with it then it wouldn't matter what they did about fighting malaria or preventing truck accidents," he recalled. But the company said the cost would be prohibitive, he said. The consortium's position was that it was sharing oil revenue with Chad and health care was the government's responsibility, according to Jobin.
"Once the oil starts flowing, the companies want to pack up and leave," he said. "They don't want to have to deal with the cost or the responsibility of dealing with an AIDS problem."
As predicted, job-seekers have poured into encampments such as Kome Satan, whose population quadrupled to nearly 2,000 people between mid-2001 and early 2002. People live in mud-and-thatch huts, and garbage is strewn everywhere. Twice, the community burned nearly to the ground after cooking fires got out of control, only to be rebuilt by residents. A second shantytown 10 miles away, near a smaller oil consortium base, also takes its name from its thriving prostitution business: Forget Me Not. On a brutally hot day, a row of trucks were parked alongside the community. At one restaurant, Congolese music blared from a portable cassette player hooked to a truck battery. A plate of grilled chicken and a beer could be purchased for the equivalent of a few dollars. So, too, could the services of a Forget Me Not prostitute.
The consortium has offered voluntary HIV testing for project employees. At seven villages near the consortium's base camp at Kome, ExxonMobil conducted screening and treatment for curable sexually transmitted diseases other than AIDS. ExxonMobil also conducted "focus groups" where women discussed how to avoid prostitution by taking advantage of economic opportunities brought by the pipeline. Some women set up roadside stands and sold snacks to oil consortium workers. The firm helped pay for AIDS awareness billboards and backed a theater group called Les Benjamins that performed at dozens of villages. The troupe's skit centered on a deathly looking character called "Mr. AIDS," who is put on trial by village elders after a young woman dies of the disease. Mr. AIDS is found not guilty after the elders determined that people who become infected have only themselves to blame because they failed to use condoms.
Disease Prevention
At Bero 1, a village not far from Kome Base, an AIDS education group announced its arrival from a loudspeaker atop a white SUV. Three volunteers hopped out and walked hut to hut distributing brochures that offered tips on how to avoid AIDS and, for those who asked, blue boxes of condoms subsidized by ExxonMobil.
"You can't change human behavior, so we have to try to modify the impact," said Ellen Brown, an American anthropologist who first came to Chad in 1968 as a Peace Corps volunteer and who was hired by ExxonMobil to work on pipeline-related social initiatives.
Despite such efforts, Chad's health care system is woefully unprepared to deal with AIDS — or any serious medical problems. The main hospital in Doba, a major town in the oil region, has no electricity and is lighted at night by kerosene lamps. Medical instruments are not sterilized, but rather washed in warm water, and disposable syringes are routinely reused, say health specialists who visited the hospital recently.
The pipeline consortium built a health center in Kome. It was inaugurated in 2000 as part of the pipeline groundbreaking, a ceremony attended by the presidents of Chad and Cameroon and officials from the World Bank. But the local community lacked the means to run the center — which came supplied with a single bed — so it remained closed for almost two years. The government took over the clinic last year, but it is staffed solely by volunteers. Leonard, the American researcher, visited the Kome center last summer and said its equipment was limited to a single microscope and the only drugs available were a hodgepodge of antibiotics and painkillers. "The clinic isn't capable of conducting basic examinations," she said. "Even the blood pressure cuffs weren't working."
For those with AIDS, effective treatment is available only in N'Djamena, hundreds of miles from the oil region. There, 80 patients are currently receiving free treatment under government programs. A pre-construction World Bank appraisal of the pipeline said there was a "significant" risk that Chad's government would break its promise to spend its oil revenue on social services. In fact, the government did not use any of its first infusion of pipeline money — a $25-million "signing bonus" from the oil companies — to improve health care in the oil region.
Last year, members of the World Bank panel on the pipeline traveled to Chad and Cameroon after receiving complaints from local organizations about problems stemming from the project, including AIDS. The members reported that conditions at Kome Satan placed the village "at high risk" for the spread of AIDS. The panel reported a "growth of prostitution among young women around [pipeline] encampments" in Cameroon, which it deemed "likely to accelerate" the spread of AIDS. The report said construction had passed through a number of Cameroonian cities "with no special health education or direct-action measures having been taken by the authorities on behalf of local populations."
Jobin predicts that bigger problems are likely now that pipeline construction is winding down. "The truck drivers and workers and prostitutes are going to head home and take the virus back to other parts of Chad, or Angola or the Central African Republic, or wherever else they came from," he said.
*This article was reported with assistance from the Center for Investigative Reporting and its Fund for Investigative Reporting on the Environment.
More information on the Chad-Cameroon pipeline is available at www.latimes.com
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