Rural areas in Côte d'Ivoire seem to have fallen off the map in HIV/AIDS prevention efforts, and although the HIV prevalence rates are still lower than those found in cities, experts fear they could climb.
"We have observed an imbalance in terms of the approach to the fight against AIDS in rural and urban areas," Professor Bassirou Bonfoh of the Swiss Centre for Scientific Research (CSRS) told IRIN/PlusNews.
"Attention is focused a bit too much on urban areas, while rural areas remain a reservoir for the disease," said Bonfoh, who will speak at an international conference on health in poor urban areas, to be held in Abidjan, the commercial capital, next month.
He warned that if nothing was done to address these inequities, this could cause greater complications for the country's HIV/AIDS epidemic. "Despite the strong fight against AIDS in urban areas, we cannot reach the results we seek if [this] disease eventually comes from the rural zones into urban areas."
A failed coup in September 2002 sparked months of civil war in Cote d'Ivoire, eventually splitting the country into a rebel-held north and government-run south.
The country's political and military crisis has led to huge population movements, disrupted social and health services, including health services in the war zones, and the slowdown of prevention and control programmes.
As a result of this crisis, there are disparities in both infrastructure and health coverage. According to UNAIDS, in 2005 the country's HIV prevalence stood at seven percent, one of the highest rates in West Africa.
The "extreme poverty" of the rural population made things even worse, as villagers unable to eke out a living were leaving for the cities in large numbers.
"At this level, if migration is not controlled ... [it] will exacerbate the situation as a result of their ignorance towards the pandemic," Bonfoh said.
There is also a regional dimension. In neighbouring Mali, for instance, HIV/AIDS was labelled "the Abidjan sickness" as people believed the virus had come from the formerly prosperous port city, where people migrated for economic reasons. Many local Malians do not consider they are at risk, he explained.
But efforts are underway to target the neglected countryside. According to Bonfoh, one solution has been to offer young people in rural areas the necessary tools for agricultural production. "The income they can make will allow them to take charge of their lives, and they will be less likely to migrate to cities," he said.
With literacy levels affected by poverty and the war, a rethink of orthodox information campaigns would be required. "Current communication campaigns miss a large part of the rural area," said Nathalie Konan, national coordinator for the National Agency for Support to Rural Development (ANADER), a programme funded by the US President's Emergency Plan for AIDS Relief (PEPFAR).
One of the goals of the ANADER project is to educate 300,000 people about the virus that causes AIDS. More than 700 villagers are being trained in prevention techniques and an AIDS committee is to be created in each of the 12,000 Ivorian villages targeted. It also hopes to broadcast more than 300 radio programmes and 4,500 information spots in eight different languages.
"We'll keep trying as long as we can transmit messages of prevention, abstinence and fidelity to the population," Konan told IRIN/PlusNews.