Economic growth and a promise for AIDS programs in Burkina Faso

Médecins Sans Frontières staff with members of the AIDS campaign team

Despite Burkina Faso's continued fight against poverty and its escalating AIDS rate (officially at 7%), this West African nation's prominence on the geopolitical arena continues to mature. In the past few years, commercial centers such as Ouagadougou and Bobo Diaoulasso have transformed into crossroads for international trade and investment, helping the economy towards steady growth.

Organizations that operate AIDS programs in Burkina Faso are encouraged. "We are happy with the stability of the country and the willingness of the national government to take an ever more active role in fighting AIDS," says Mr. Walter Lorenzi, the Country Director of Médecins Sans Frontières (Doctors Without Borders).

Médecins Sans Frontières (MSF) began to provide treatment for people living with AIDS fifteen years ago. Today, Mr. Lorenzi reports that MSF provides free medication for approximately 35% of all HIV-positive Burkinabe who are taking anti-retrovirals. He said, "Our agency is the largest supplier of these medicines in the country."

However, MSF does not intend to shoulder this burden indefinitely at the expense of their other humanitarian programs; instead, they are working to transfer the responsibility to Burkina Faso's Ministry of Health, with which they have been working closely. On a global level, an affiliate of MSF called ACCESS in Geneva will offer support to the national ministries by conducting targeted lobbying of international drug companies around the world; MSF hopes to persuade these entities to create sensible anti-retroviral options for patients in the developing world. In Burkina Faso, as in so many other countries, the average citizen earns less than one American dollar per day—on this amount they cannot dream of paying for medical expenses.

While MSF flexes its muscle on the level of international policy, it is also involved with much more modest and localized health issues. In Burkina Faso, they struggle to connect rural towns, such as Sindu in the Banfora province, to the urban centers where developing health programs are the first to take root. While MSF are busily treating fourteen thousand residents of the capital city, many of the regional hospitals are not yet supplied with any anti-retroviral medicine. An AIDS diagnosis in these far-flung locations is typically greeted with total resignation; people know they do not have access to the city drugs. The government intends to make anti-retrovirals widely available at a rate of five thousand CFA (ten dollars) per month, but this has not yet happened, and for many rural people that price is still too high.

"If a patient comes to our office here to ask for anti-retroviral medicines, I have to send them to Ouagadougou. There, they can get on our waiting list to receive free medicines through MSF's national program," states Nathalie Cartier, the Coordinator of MSF's regional Community Health Program in Banfora. But, she explained, most people are too fatalistic to attempt the expensive and time-consuming journey. Also, MSF has temporarily capped the number of people receiving its free anti-retrovirals so as to ensure that they will be able to provide lifelong treatment for everyone under their care (other programs have wrought immeasurable damage by initiating complicated drug regimens for massive populations, only to run out of medicine and quit midstream).

While access to medication remains one of the most significant problems, Ms. Cartier reports that improvements to the regional hospital this year have established AIDS testing capabilities, where before there was not even the laboratory equipment necessary to perform diagnoses.

SIDA (AIDS)-themed billboard in Burkina Faso

This all reflects the significant disparity between the ability of urban and rural communities to respond to HIV/AIDS. A large percentage of people in urban centers are literate and exposed with regularity to mass media; this enables them to learn about AIDS through public awareness campaigns. Such campaigns have the particular strength that they can transmit knowledge about risky behavior while preserving the total anonymity of their audience. In contrast, rural communities have higher illiteracy rates and tend to require campaigns of a more interactive variety, such as movie nights or group presentations.

MSF was specifically requested by village leaders to begin an HIV/AIDS program that could run parallel with its community health initiative in the Banfora region. At first it was the elders who were taught and consulted; now MSF and its local assistants concentrate on children. School teachers of increasingly younger children are approaching MSF representatives to ask for presentations.

Sometimes, though, despite intensive preparation, working on issues of sexuality causes commotion. "In one village, a village elder was very upset that we gave out condoms during our presentation. He chased us out," Nathalie Cartier recalls of one of her outreach group's presentations to a high school audience. In that instance, they had neglected to inform the elder of their standard practice—a lesson learned. Thankfully, misunderstandings of this sort are rare, and groups like MSF are often invited into more communities than they can actually visit with regularity. Despite these challenges, the message about HIV/AIDS seems to be spreading.

In the Banfora region alone, thirty organizations perform AIDS awareness work. Four provide some degree of anti-retroviral medication. These organizations are beginning to meet regularly to strategize about the best ways to increase awareness, reinforce one another's work, expand testing opportunities and increase the availability of anti-retroviral drugs. Participants tend to be positive about these interactions, emphasizing the value in sharing experiences with one another.

If Burkina's economy continues to grow, and if the recent efforts toward debt reduction and increased western aid are managed properly, there is a promising future for the AIDS programs in Burkina's rural and urban communities. Charles Kambou, a nurse in the rural province of Banfora, expressed hope that "debt money will soon begin to filter down to [his] regional hospital. Maybe by October, we can begin to provide AIDS patients with anti-retroviral medications." In Burkina, many people are anxious to see how this money will be redistributed.


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