[Community organizations and fighting STDs, HIV and AIDS in Montreal: lessons for sub-Saharan Africa].
The HIV/AIDS pandemic is one of the most important public health problems in the world. In Benin as elsewhere in Africa, the combination of some sociological and sociocultural factors with socio-economic realities have led this pandemic to progress faster in some farming regions than in urban areas. This survey was performed during a three-month internship researching community-based organizations in Montreal that care for HIV/AIDS patients.


OBJECTIVE
to analyse the actions taken by community-based organisations to combat this pandemic and point out the strengths and weaknesses of this system; - to draw useful lessons to apply in Africa.


METHODS
more than one hundred organisations play a direct or indirect role in the combat against HIV/AIDS in the city ofMontreal. The choice of organisations to visit was determined by their interest for HIV/AIDS prevention and treatment or for the struggle against social exclusion. After a visit and guided tour of the premises of each organisation, one of its officials was interviewed for 20 to 30 minutes (according to a semi-structured outline, appendix 2. The data were analysed manually.


RESULTS
the survey showed that even in high-income countries, the same risk behaviors, equally influenced by poverty, social exclusion andvulnerability, lead to this disease. Further, its chronic nature, related to essentially permanent antiretroviral treatments makes it harder for vulnerable groups to maintain healthy behaviours. The concentration of disease in vulnerable groups gives a false sense of security to most of the population, which does not feel concerned, ignores messages intended to raise awareness, and does not participate in voluntary screening. The organisations and actors involved, with the support of public health facilities, battle this vulnerability while providing information and resources to the target groups to help them protect themselves better. This struggle thus remains too focused on these target groups. Efforts must be made to make the discourse on AIDS legible to broader populations, for the borderlines between these target groups and the rest of the population is very fuzzy. Discussion and lessons: This analysis of the process of fighting HIV/AIDS inMontreal identified some positive experiences that can inspire concrete actions in African setting. One is the experience of the Farha Foundation, an organisation specialized in community fund-raising, which puts its collections at the disposal of other community organisations, and is independent, receiving no funding from local, provincial or federal public authorities. Transposition of this experience to Africa would require contextualisation and would need to mobilize the resources of not only the local community but also the national and international communities. The "Ruban en route" organization provides useful awareness programs for the young, visiting primary and secondary schools to debate HIV/AIDS issues with students with games, and demonstrating condom use. In the African context, given the limited educational system and the extent of school quitting, such an organisation would need to find a means to reach young apprentices and young farmers in informal structures. Action Séro Zero and Stella target male homosexuals and sex workers, respectively, and work to have their rights recognized by the community. The application of their policies would not be possible in our societies, for sociocultural reasons. Instead efforts must be directed toward making the community understand the need to encourage and tolerate recognition and aid for prostitutes, for the good of all. To a lesser degree, the experience of "Spectre de rue" with the TAPAJ project (Travail Alternatif Payé A la Journée or alternative work paid daily) is also importable, although only in urban environments where "street kids" are an important phenomenon. In some cities, where their number is increasing, this activity can be connected to an organisation working on awareness campaigns among the young. Contact with these street children should help them to become more socialized and to find the means to earn their living more legally. Finally, the usefulness of providing anti-retroviral treatment to people living with HIV is the most important lesson we learned during our Montreal stay. This very useful experience will nonetheless be very difficult to undertake in a rural African environment. Indeed, making antiretroviral cocktails available to patients might risk consuming the quasi-totality of the budget available for prevention. Work on this aspect is possible only if the local, national and international community mobilizes to provide the resources necessary. The international community is, however, starting to do so, by means of the Global Fund, to fight malaria, HIV/AIDS and tuberculosis. This survey has thus allowed us to learn some useful means of combatting AIDS in Africa.
Agonnoude
Maurice T
MT
Université de Montréal Département Administration de la santé 2350, boulevard Edouard-Montpetit Studio 8236 Université de Montréal Montréal (Québec) Canada H3T 1J4. amaurte@yahoo.fr
Mesenge
C
C
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control; D003479:Curriculum; D004196:Disease Outbreaks / Q000517:prevention & control; D005006:Ethnicity; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D007182:Income; D008297:Male; D011340:Problem Solving; D011792:Quebec / Q000453:epidemiology; D012309:Risk-Taking; D012424:Rural Population; D012574:Schools; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D012919:Social Behavior; D012923:Social Class