KOME, Chad — 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.