MALI: Defining a national care plan for kids at risk
The Network of people working with children at risk, RIOEV, tries to take care of about 1,000 street children in Mali's biggest towns
bamako, 3 June 2005 (IRIN) - Noumousso Mariko found the little girl outside her door one morning in 2000 when she was leaving for the office. The child was seven years old, orphaned, and HIV-positive, and her aunt had decided to abandon her there because she could no longer cope.
When the aunt, three months earlier, learned that the little girl was HIV-positive, she asked Mariko: "Tell me, is she contagious?"
Mariko, who works for a women's support group for AIDS widows and orphans known as Afas, remembers that she tried to reassure the aunt, notably by explaining how the HI virus was transmitted.
Little Fatou, which is not her real name, was tested and found positive at the Cesac comprehensive care centre, which does much more than just test for the virus. It provides counselling as well as medical care, while also helping adults find work and putting children through school.
The centre is being held up as an example to follow by Malian health authorities trying to devise a national policy to cater for the country's AIDS orphans and vulnerable children.
Officials say that in 2001, there were between 45,000 and 70,000 children under 18 orphaned or rendered vulnerable by HIV/AIDS. Failing proper care of such children, the National High Council Against AIDS (HCNLS) believes the number of minors infected could reach 150,000 in 2010.
Fatou and her aunt were referred to the privately run Cesac centre after the frail little girl kept coming down with one illness after another.
Mariko, whose women's group works hand-in-hand with the centre, told the aunt at the time that everything would be all right now they knew exactly what was wrong with Fatou. She would get proper treatment and Cesac would look after her.
Anti-AIDS officials in Mali, one of the world's poorest countries, say that 50 percent of the country's women do not know how to protect themselves against the virus.
"One day," said Mariko, "the aunt came back to see me at Cesac, saying she just didn't have the time to look after her. She also asked where I lived." So three months after the test, the aunt abandoned her outside Mariko's house. "She hadn't even put her in school," Mariko added.
Fatou nowadays gets motherly care from Mariko, but medicine, schoolbooks, school fees, and even holidays, are funded thanks to Cesac and Afas. She has been provided with free life-prolonging antiretroviral (ARV) drugs since February 2002.
"Afas," Mariko said, "was set up to support the 100-odd orphans and vulnerable children in the group's care. We are here to help grand-parents and families cope."
Mali, a vast Sahelian country with a population of over 11 million, currently has one of West Africa's lowest infection rates, at 1.7 percent according to the HCNLS and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
It was in the mid-1990s, when there was no national policy on how to help deal with minors affected by the pandemic, that local and international NGOs began working with children.
Currently, Cesac and associations of people living with AIDS provide milk and cereal for under-2s, and school fees, clothing, homecare and psychosocial help for the older ones. This is thanks to funds from foreign partners such as Esther, which stands for Together For A Therapeutic Solidarity Network.
Drugs against opportunistic diseases are delivered free of charge, as are paediatric ARVs and care, which is available in some of the country's public hospitals.
"We also manage to keep an eye on the children's education by passing ourselves off as relatives or members of a humanitarian outfit," said one of Cesac's founder members, sociologist Amadjge Togo. "A child can be rejected because of discrimination at school. We pay special attention to this."Defining a national comprehensive and community care plan
Mohamed Attaher Maiga, who is in charge of prevention and awareness at the HCNLS executive, said the Cesac centre should serve as a model to Mali, which is currently outlining its first action plan to help children vulnerable to HIV/AIDS.
"Looking after children and orphans only became a government priority two years ago," Maiga told PlusNews.
"Up until now, children at risk were looked after by associations, and the community principles that guide their work should, I believe, be maintained and accentuated."
A national plan being drafted by the HCNLS, which is due to be completed by July, largely mirrors Cesac's work methods.
The national scheme is to be financed in part by US $ 145 million earmarked for Mali until 2009 by the Global Fund to fight AIDS, Tuberculosis and Malaria, the World Bank, the African Development Fund and other programmes.
"If we have the means, what we should do is set up around 20 Cesac's in the regions. That would be the best thing for Mali which is going to have to chose now between setting up classical-style test and care centres, or comprehensive care centres," Maiga added.
"I favour local centres that are involved in the community," he said.
International funding obtained by Mali, he said, will enable the country to provide 54 health centres with extra staff and testing, information and care equipment. Around 400 of the country's 600 community-run health centres (Cescom) will also get extra resources to provide care for people at risk.
Maiga said that Mali currently had only 16 testing centres, and that most were located in Bamako.
"We are facing an emergency and need to move swiftly, especially given the high illiteracy rate here which helps the spread of the epidemic," he said.What about street children?
But anti-AIDS activists and the private sector admit they are incapable for the moment of tracking down AIDS orphans or children at risk among street children, young delinquents and migrants or young workers.
"We cannot force children to take a test and not many agree to do so," said Modibo Sango, who is a member of the NGO, Amad-Pelcode. He also works with to help orphans and children at risk with a network called RIOEV. It groups 40 associations and 1,000 street children in Mali's biggest towns.
"We aim to stop children who are vulnerable from becoming infected," said Sango. "We try to identify them, to make them aware of the danger and we take care of them."
But of the 1,000 girls and boys under RIOEV's wing, only 40-odd agreed last December to take a test at the Cesac centre. Sango said that 18 of them turned up HIV-positive and that of the seven girls who tested, three were positive.
"Many around us are sick," said Ali, a 17-year-old who left home five years ago to escape a nasty grandmother and weak mother. He eats at a RIOEV centre where street children come for a little rest and food and drink when the NGOs who work with them have enough money to fund their meals.
"I pick up condoms at the testing centres or emergency medical centres," said Ali.
He said he has twice taken the test. "I don't want to die of that," he said. The tests cost 500 francs CFA (US $1) but are generally given free to the children at the Cesac centre, next door to the street-children's centre.
But Cesac's Togo said that one of the problems facing the authorities was to spell out a minimum age for testing children and a procedure for announcing the results, especially if the child was unaccompanied.
"You can't tell a 15 or 16-year-old to take a test or that he or she is positive, although they're sexually active," he said. "He could make his parents feel guilty or begin to hate them if they're alive, or he could even try and take his own life if there's no support from anyone."
Access to drugs is difficult, moreover, for children who are not living stable lives, Togo said.
"You can't give ARVs to children who are homeless, you can't keep them under supervision, they're alone, don't know where to spend the night, some of them disappear. There's nothing you can do."