Dr. Diallo Bassirou, the Coordinator of the CESAC center in Mopti

Targeting women to contain HIV/AIDS in Mali

Mali officially reports a 1.7% AIDS rate, which is among the lowest in Africa. Despite the low incidence of AIDS, the government, international aid organizations and the social service sector are actively involved in preventing future proliferation of the disease. Malian organizations such as CESAC (Centre d'Ecoute, de Soine, d'Animation et de Conseils; Center of Listening, Healing, Outreach and Counseling) have formed to provide those living with AIDS the medical attention they need. Since 1995, CESAC has grown to operate two branches that make AIDS testing available to millions of people and serve nearly six hundred regular patients.

The line of patients at CESAC Bamako confirmed research findings of the Center for Disease Control, which found that the majority of people seeking medical care for HIV/AIDS in Mali are women over thirty. Many women here held their children or arranged their day's trading goods while they waited to receive their free dose of anti-retroviral medications. In Mopti, three hundred kilometers north, Dr. Diallo Bassirou, the Coordinator of the CESAC center, confirmed the same trend: "Between 60% and 70% of our patients are women," he reported.

SIDA poster

The reasons for this tendency are mainly practical: women are more likely to come into contact with the health sector through prenatal medical appointments, during which they are routinely tested for HIV/AIDS. There are also many social and cultural factors which exacerbate risk and make women more vulnerable to contracting the disease.

"In Sub-Saharan Africa and in Mali in particular, women are more vulnerable, as they are often illiterate and not always in control over sexual decisions. These are practical realities in Africa," states Ali Djerma, the pharmacist at CESAC Bamako. Dr. Diallou Bassirou in Mopti suggested additional reasons. In the Mopti area, many ethnic groups uphold the traditional practice of female genital mutilation, which increases the likelihood of vaginal bleeding and vulnerability during sexual intercourse. Another contributor to the proliferation of sexual diseases within a family unit is the Muslim practice of polygamy combined with the hesitancy or unwillingness of wives to make demands of their husbands with regards to safe sexual practices.

As most HIV/AIDS services are utilized by women, it is women who suffer much of the discrimination associated with the disease. Common misconceptions about AIDS include that it is a disease that afflicts prostitutes or loose women. In smaller communities like Mopti, where anonymity is difficult, many patients are afraid to be seen walking into CESAC's clinic. Dr. Bassirou suggested another hurdle; well-intentioned public awareness campaigns that attempt to warn communities about AIDS often perpetuate a disproportionate sense of fear about the disease and deter people from getting tested, "It is not uncommon for people to think that they will die as soon as they know their status." The work of such campaigns, in some sense, has to be undone for CESAC's positive message to be heard.

CESAC Bamako

To combat these fears and to educate people about the availability of treatment, CESAC has encouraged the development of informal associations such as Bamako's l'Association Feminine d'Aide et de Soutiens aux Veuves et Ophelin du SIDA (Women's Association of Aid and Support for the Children and Orphans of AIDS). This Association offers a wide range of support for its members, often training them to perform outreach about AIDS within their communities or helping them to learn practical skills such as small enterprise development. In Bamako, the association also organizes social events, such as weekly family nights where patients, families and friends meet at the clinic to share a meal together.

These activities and programs are tailored to support the decisions that Malian people make about sex, which are sometimes very different from realities in the West. Ali Djerma states that, "African perceptions about sexuality must be central in any communication of messages about AIDS." The steady growth of CESAC over the past decade is indicative of the advancement of a genuine understanding about the disease in the communities where they operate. When this work is combined with the commitment of the Malian government to provide anti-retrovirals free of charge for any citizen or resident, the generally hopeful attitude of about the threat of HIV/AIDS begins to make sense.


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AIDS Testing in Mali: A First Hand Experience