Mali - © 1998 National Geographic Society
Paolo Pellegrin found that in Mali, stigma against HIV is still so strong that many people refused to be photographed outdoors. The challenge of preventing transmission is compounded by a tradition of polygamous marriage, yet efforts to prevent and treat AIDS have expanded rapidly. Living far from the capital, Bamako, is no longer an obstacle as health centers are now able to provide free testing and antiretroviral treatment throughout the country.
Ousmane Sow, 32, worked in a garage near the town of Kayes when, already very ill, he came to Bamako to seek his mother's care. Finding it hard to accept his status, Ousmane only returned to the clinic for treatment three months later, gravely ill. By the time he began antiretroviral treatment, it was too late. "He did not have the chance to get cured," Ousmane's mother said, when Pellegrin returned. "I see people who get cured. I was not expecting him to die. But that was his destiny; that was God's will."
20 Massaman Keïta, 31, and Fatoumata Camara, 20, married five years ago, and made their living farming. Both HIV-positive and too weak to work, they left their rural village for Bamako to be treated. "We are the first case in our family. In our village, there are quite a lot of people who have it but they are hiding it, like we are," Massaman says. They began antiretroviral treatment together and both have thrived. "I feel like I was awakened from the dead," Massaman says. "I never imagined that I could be how I am today."
Kassi Keïta, 3, had been sick for 18 months before being diagnosed HIV positive. His mother, Mariam Dembélé, 31, is also being treated for AIDS. She has two other children and she struggles to make ends meet on her salary as a government tax accountant. Mariam is heartened, though, by Kassi’s rapid response to treatment: “One day, Kassi saw a tricycle and said ‘Mom, will you buy me a bicycle? I can ride it.’ He climbed on the bike and began to play with his cousins until evening. That made me very happy.”
Fatoumata Moro, 26, is one of several wives in a polygamous marriage. Afraid to tell her husband that she had tested positive, Fatoumata never returned to the center to begin treatment. Her doctor says there is little chance she can survive without treatment. "For patients in Fatoumata's situation, it's difficult because trust does not come during the first contact," says Dr. Fodé Diallo. "It is generally after the second or the third consultation that patients give us their correct phone number or their address."
Téné Kané, 33, lost her husband 12 years ago, most likely to AIDS. At first, Téné did not tell her family that she is HIV positive but then decided, "I am going to tell them the truth. It's not easy, but I'll say it anyway." Téné has a daughter, Djénéba, 8, whom she has not seen since 2004 due to lack of money. Téné has become an activity leader for an association of people living with HIV/AIDS and fights against stigma by not hiding her status.
Fatoumata Yébessé, 35, is from a village of the Dogon tribe in Mali. Expecting her second child and having tested positive, she was receiving treatment to prevent transmission of HIV to her baby. She was married once before, but both her first husband and child have died. Expecting her new husband to reject her, she kept her HIV status a secret, confiding only in her older sister.
© Paolo Pellegrin / Magnum Photos
In Mali, HIV is transmitted mainly through sexual contact, and about 1.5 percent of Mali’s population of 13 million is infected. The stigma surrounding AIDS is still strong, but a tradition of polygamous marriage adds to the challenge of preventing transmission.
Yet efforts to prevent and treat AIDS have expanded rapidly, and health centers are now able to provide free testing and treatment throughout the country.
View story: Access to Life / Mali
Paolo PellegrinItalian, b. 1964
Paolo Pellegrin initially studied architecture before discovering his passion lay in photography. Known for his ability to traverse distinct subjects and themes within photography, Pellegrin maintains an eye for images that are both spare and dramatic.