Cheikh Ndiaye, one of the laboratory technicians responsible for administering the HIV tests

Concerning AIDS in Senegal

The Senegalese government was quick to acknowledge the reality of the AIDS epidemic and worked to achieve one of the lowest infection rates on the continent. It boasts an all encompassing, pyramidal national program (PNLS) that targets the entire population, from the regional level to the individual village. For the parts of this system that do not rely on volunteers, the Senegalese can thank the World Bank.

Dr. El Hadji Malick Ndaw, a supervisor in the hospital of Sedhiou, Casamance, explained that the rate of infection throughout Senegal is estimated at 2%, with a few transport hubs registering official rates closer to 5%. He was quick to acknowledge the difficulty of determining these numbers with accuracy. His hospital, the premiere health center in a small department of around 400,000 people, offers free voluntary testing; but Cheikh Ndiaye, one of the laboratory technicians responsible for administering the tests, confessed that only three or four people take advantage of this service per month and they tend to be young men. The people from whom the 2% figure is derived are predominantly pregnant women who are tested during pre-natal care and patients who are directed to submit to the test by their doctors. One Peace Corps health volunteer echoed a popular opinion when he suggested that early success in checking the spread of AIDS may have resulted in some complacence among the Senegalese populace and that the official figures are unlikely to include those most likely at risk. He referred to the region as "a powder keg" that is "ready to go off."

Patients waiting at the Sedhiou Clinic

The national program intends to contain the disease through sensitization initiatives. Community leaders bring forward their plans of action to department centers in order to receive materials and funding for their own sensitization activities. According to Dr. El Hadji Ndaw all 890 of the villages in his department had come forward with such plans and 100% participation does not seem to be an exception. Despite these impressive intentions, there are problems that prevent the program from functioning as effectively as it might. Dr. Ndaw suggested that the most affordable and available materials provided by the national program can sometimes fail to hold the attention of more youthful audiences. One of the more imaginative alternatives to the simple text and video approach is a roving bus full of what is essentially an AIDS awareness party that involves the entire village. The lively and participatory nature of this program makes it more effective and puts it under high demand. Unfortunately, there is only one bus in the entire Casamance region, in which there are thousands of villages and more than one million people—funding appears to be the problem.

Since AIDS infection rates have remained fairly low, the families and communities of AIDS carriers are not yet experienced with how to treat and care for the unfortunate among them, which represent a second challenge to the people of Senegal. At the regional hospital of Tambacounda, in Eastern Senegal, a group of committed doctors and social workers have helped to pioneer a way of addressing this shortcoming. In conjunction with NGO workers from Switzerland they formed a group called the Association Clinique Counseling (ACC), whose sole purpose is to work with carriers of AIDS. The ACC is comprised of fourteen health care professionals all of whom volunteer time from their busy schedules to provide support for AIDS patients. The group organizes counseling prior to the diagnosis of a patient, helps patients and their families to understand the complicated requirements of medical treatment and organizes a regular discussion group where patients with AIDS can come together and talk about the issues that they face. So far, three associations have been founded in other regions of Senegal; they are taking the team in Tambacounda as their example. Now, the four different associations network, help to organize training sessions from which they can all benefit and help to give momentum to their progressive work.

Dr. Nomez Bah, a founding member of the ACC agrees that sensitization is going to be the issue on which the future of AIDS in Senegal depends. While free testing may be available, while counseling opportunities may exist and while the expensive retroviral drugs are entirely paid for by the government there are still obstacles. Dr. Bah referred to the problem of AIDS by saying, "Right now there is a lot of uncertainty; it is a taboo." He and other members of the ACC applaud the various efforts to sensitize the population but remain aware of the logistical nightmare of reaching so many people in so many languages who have such different cultures. Nevertheless, all of the Senegalese health care workers consulted during the preparation of this article seemed proud of and generally enthusiastic about the way that their nation is confronting the disease.

Al Hadji Malik, Supervisor of the Sedhiou Departmental Hospital, with Tuuli Saarela


Members of the Association Clinique Counseling in Tambacounda with African AIDS Awareness team