IRIN Focus on community mobilisation

Marie Konkobo only discovered she was HIV-positive after her three children and husband died and she plucked up the courage to take an AIDS test.

"My husband's relatives were convinced that there was something, like a witch, that was taking away my children," said Marie, a secretary in a government agency. "As a Christian I did not believe in such things."

When her husband was sick she asked him to go for a test but he refused. When he finally died two years ago, his family insisted that his death was caused by a non-existent boyfriend of Marie's. Marie, in her 40s, was disowned by her husband's family and now lives alone with the support of her boss at work, to whom she revealed her status, and the association Vie Positive, an NGO that provides counselling and care to HIV-positive people and their families.

"We have set up this centre where we care for HIV-positive persons because in our country, because of ignorance or culture, AIDS patients are stigmatised and excluded from their community," Moumouni Kabore, the chair of the association told PlusNews.

"Many HIV-positive people come who accept they have AIDS but still believe in the idea that they have been given the disease by a sorcerer or a witch," he said. The centre cares for about 200 HIV-positive people and 300 orphans.

Burkina Faso is a landlocked Sahelian country with among the worst HIV infection rates in West Africa. An estimated 7 percent of its 10 million people are infected. But the authorities fear that the figure could reach 10 percent by the end of this year. According to UNAIDS, from 10 persons known to be HIV-positive in 1986, today some 370,000 Burkinabes are believed to be living with the disease.

"The disease progression has gone beyond all projections. Even if this propagation is stopped today the effects will be felt for years by the population, health systems and the economy of the country," the UN Development Programme (UNDP) said in a recent report.

"A lot of vulnerability factors exist in less developed and poor countries like Burkina Faso," explained Paul Thomas Sanon, the director of the Ouagadougou-based National Treatment Centre, the only medical facility for HIV-positive people in Burkina Faso.

"Besides these factors of poverty, illiteracy and denial, we have the socio-cultural factors we must stress because they constitute the main obstacles to sensitisation of AIDS," Sanon said. "The fact that HIV is still attached to witchcraft or to something supernatural is an important obstacle and we must tackle it along with the stigmatisation of HIV-positive persons and the discrimination they suffer."

To help tackle stigma, posters were printed for World AIDS Day on 1 December that showed President Blaise Campaore sitting next to an HIV-positive woman. Along with the official UNAIDS slogan "I care ... do you?", Campaore wrote: "We must pay special attention to HIV-infected people."

"For the first time the head of state has officially expressed his commitment to fight AIDS. This is an invitation to all to combat the disease," commented Khalifa Soulama, head of projects at Initiative Privée Communautaire (IPC), an anti-AIDS NGO. "It is giving hope to people with AIDS and can contribute to end the stigma around the disease and allow patients to speak out openly and speak about their experience."

Since last month Campaore has been chairing the National Council Against AIDS (CNCS), in a move to coordinate efforts to address the pandemic. To better tackle issues of discrimination and awareness, the government has included local traditional healers, opinion leaders and even women circumcisers - a controversial practice that still persists in Burkina Faso - to help in the sensitisation campaigns.

"Despite campaigns the figures are bad, that means we need to sell more condoms, and sensitise better, but as it is something linked to sex, its success depends on a change in behaviour," said Antoine Tiendrebeogo, permanent secretary at CNCS. He announced that from next year, the government was going to set up committees in provinces, departments and villages "to intensify" the campaign against AIDS.

More than 1,000 "opinion leaders" have been trained by NGOs to help lead community discussions. And already there are some results. For example, in many villages in Burkina Faso a widow is not automatically remarried to a male relative according to custom, but symbolically to a small boy.

In villages around Ouagadougou in the conservative land of the Mossi (the majority ethnic group), several traditional chiefs have refused to continue with the compulsory marriage of a widow to her husband's tribesman. Instead, if the woman consents to marry, an HIV test must first be done.

The introduction of opinion leaders in the campaigns has also eroded taboos around the discussion of sexuality in rural areas. "We know that within the traditional setting it is shameful for a woman to have sex with several men. The
circumciser teaches girls she is circumcising that she becomes like a naked woman after sleeping with someone before marriage, and we use this positive aspect, that is in fact teaching fidelity to one man and abstinence," Soulama at the IPC said.

"The introduction of volunteers and other peer counsellors is proving positive as far as sex education is concerned," confirmed Moumouni Kabore of Vie Positive, whose 100 square/meter office becomes too small on Thursday afternoons when students and school boys rush in to receive information on safe sex and the use of condoms.

However NGOs and even government officials working in the anti-AIDS campaign think that the removal of taboos, though key factors, will have to be accompanied by access to affordable treatment for AIDS infections.

"We need to decentralise our services in the provinces and villages levels if we want to reach more people and care for them with appropriate and well trained staff," said Sanon at the treatment centre in Ouagadougou, where 80 percent of all registered HIV-positive people in the capital are assisted.

"It is only when people know that they can find a medicine and a structure to care for them that they will accept the disease as any other, like leprosy and the plague, whose victims were afraid and rejected in the past, before a treatment was discovered," Sanon added.

In May, the government reached an agreement with key pharmaceutical companies that reduced the price of some drugs by up to 96 percent in certain cases. The monthly treatment bill could now cost US $75, against US $600 three months ago. But even that price remains out of reach for most people in a country where 45 percent of the population live below the poverty line with an annual income of just US $100.

However, to provide financial backing to the government's efforts, UNDP made Burkina Faso the subject of a pilot study in June. Several donor countries met in Ouagadougou under the UN agency's auspices and agreed to fund a five-year US $100 million anti-AIDS project.

Vie Positive can be contacted at [email protected]