Breaking the Chains of HIV

“Disclosing my status to my family is unthinkable! is a common interjection at Aboya, a women’s center in Senegal. In many countries across West Africa, the perception of women living with HIV is still tainted with prostitution, promiscuity and a loss of virtue. Here, HIV is not just a serious threat to social and economic development, it is a real threat to women’s very existence.  

Ndéye Astou Diop, Noumousso Mariko, Oumou Diarra and Assétou Keita are among the first and rare women to have bravely stepped forward in their countries to break the silence. They paved the way for others and share the same battle: the right to a positive and healthy life.

The central issue of the HIV epidemic in West and Central Africa is the stigma and discrimination surrounding the disease, which are fueled by myths about HIV transmission, moral judgements and lack of access to appropriate information. The story of HIV in Mali and Senegal is a story of thousands of women who are denigrated, ostracized and rejected. It is a story of women consumed with worry and guilt, and the constant fear of being seen at an HIV clinic.

Ndéye Astou found out about her status at the birth of her second baby in 1998. “It was a total shock,” she recalls. A mother of four, Ndéye Astou is a strong advocate of reproductive health rights for women living with HIV. In West and Central Africa, the number of children born with the virus is disproportionately high, as women – fearing rejection – fail to partake in programs to prevent mother-to-child transmission.

The Global Fund partnership supports Senegal’s commitment to eliminating new HIV infections among children. Between 2010 and 2016, the number of new infections in children was halved, and 55 percent of pregnant women had access to antiretroviral treatment in 2016.

After noticing the absence of women in several HIV groups, Ndéye Astou decided to create Aboya, an oasis of hope where women share, in total freedom, their joys and sorrows and take care of each other. About 350 women meet weekly in a secret location hidden in the suburbs of the capital city to benefit from counseling services, financial and social support.

The majority of women attending the sessions confessed that they prefer to hide their status to avoid being shunned by their relatives. Stigma significantly affects the HIV response. The fear of the social disgrace undermines the ability of individuals and families to protect themselves and seek treatment. Prejudices shown by health professionals also discourage people from having an honest discussion about their sexual life and from seeking care.

Noumousso, better known as Joy, says access to treatment is indeed important, but a positive attitude toward the disease is essential. “We have to live, not just try to stay alive. And laughing brings the CD4 count up,” she jokes. “I smile because I have hope and I am happy to see other women living with HIV going on with their lives. I have a job and can provide for my children. I am a mother like any other mother.” Noumousso’s commitment to spreading joy and hope in affected communities has earned her a medal of honor from the former president of Mali. 

“People living with HIV have the power to break the chain of new infections,” says Oumou, who leads a women’s group in Bamako. According to her, without the elimination of HIV-related stigma in families, communities, workplaces and health care settings, the effects of the current epidemic will be felt for generations to come. HIV thrives in secrecy.

Oumou moderates a peer-to-peer session at the CESAC, an HIV clinic in Bamako that provides care to hundreds of patients per day, of which 60 percent are women. During her session, she addresses misunderstandings and false rumors about antiretroviral therapy, which have led to poor adherence and treatment failure.

HIV brings to light realities that people feel uncomfortable addressing. In a conservative country like Mali, the support of religious leaders, like Thierno Thiam, an imam in Bamako, has been instrumental in enabling Oumou and her peers to speak up publicly. Religious and community leaders are trusted, and can play a significant role in achieving meaningful social change.

Thiam leads a coalition of faith-based organizations that use radio programs and weekly sermons to advocate for a better inclusion of people living with HIV. The coalition shares information on the latest progress in HIV science in local languages, offers counseling for serodiscordant couples (where one person is HIV-positive and the other is HIV-negative) and addresses cultural practices, such as forced and child marriage, that exacerbate women’s and girls’ vulnerability to HIV.

In rural communities, informal peer-to-peer sessions have proven to be effective in debunking old myths about HIV. By sharing publicly her status, Assétou has encouraged 400 women in 30 villages – who relied heavily on traditional healers – to seek care at the CESAC. 

“Women are less scared and more comfortable to talk about HIV. They can see I look healthier since I started being on treatment,” she says. In Mali, the Global Fund partnership contributes up to 70 percent of prevention and treatment services.

In West Africa, the low HIV prevalence in the majority of countries has meant that HIV is less visible in society and mainstream media and often gets lost among other health priorities. Recent studies highlighted that comprehensive and correct knowledge about the disease continues to be alarmingly low, particularly among young people.

When people are able to participate with dignity in their daily lives without fearing discrimination and possible prosecution, they are more likely to seek health services. Courageous women and forward-thinking religious leaders are leading the way, and saving lives.

Learn more about how Global Fund investments are helping women and girls.

Women & Girls

Published: 01 December 2017