Senegal has one of the lowest HIV infection rates in Africa, but the central town of Touba, a Muslim shrine where over one million people gathered last week, is a hotspot where prevalence rates have shot well above the national average.
“We don’t know exactly what the HIV prevalence rate is in Touba, but it is considerably higher than the national average of 1.5 percent,” Doctor Mamadou Dieng, who works in a health centre in Touba, told PlusNews.
“Right now, we’re testing some 50 people a month and at least 10 of them are HIV-positive,” he said.
Touba, 180 km east of the capital Dakar, is a shrine for followers of Cheikh Amadhou Bamba, a Muslim cleric and hero of Senegal's struggle against French colonial rule who founded the Mouride Islamic brotherhood there in the late 19th century.
The Mourides, who preach the virtues of hard work and self discipline, have grown to be the largest of several Muslim Brotherhoods in Senegal.
The expansion of their power and influence has seen Touba grow rapidly from a humble village into a bustling town with an officially estimated population of 600,000 people.
But there is no HIV testing centre in Touba, so people living with AIDS have to travel 55 km to the hospital in Diourbel, the regional capital, to seek diagnosis and receive specialist treatment. And the hospital there only began dispensing life-enhancing antiretroviral drugs to those who need them last month.
But what most concerns Dieng is that the holy status of Touba and the conservative nature of the town's society means that all public discussion of AIDS and sexual misbehaviour is suppressed and people living with AIDS there are heavily stigmatised.
He described it as a fertile breeding ground for the pandemic.
Dieng said the holy aura that surrounds Touba does not prevent the town's polygamous men from emigrating to work abroad for long periods and coming home to infect their family with AIDS.
Prostitution is formally banned in the town, but it continues to thrive underground where it cannot be controlled, he noted.
The women of Touba also remain dominated by their men in what is still a very traditional and patriarchal society and they are seldom in a position to press their rights, the doctor said.
“The majority of the inhabitants of Touba are traders and they spend a lot of their time abroad, leaving the women and children behind,” he said, noting that some of the men are away from home for up to a year at a time.
Dieng said that many women in the town were illiterate and their low social status meant they were not in a position to demand that their husbands used condoms when they came home.
Even when wives catch HIV from their husbands, they suffer in silence and their shame remains hidden.
Dieng said that when a polygamous man was diagnosed as having AIDS, it was rare for his wives to come forward for testing or treatment afterwards. And if one wife found she was HIV-positive she would often keep it a secret and fail to tell the others.
Dieng told PlusNews that every time he came across an HIV-positive man in Touba, he simply multiplied his estimate of the number of people infected by three.
The few women who are brave enough to come forward to seek treatment keep their condition well hidden.
“Here, the women hide in the kitchen, the toilets or their room to take their ARV drugs," said Dieng. “Stigmatisation is very strong: to have AIDS is regarded as a curse.”
He complained of a strong religious and social taboo regarding the discussion of sex and AIDS in Touba and accused local Islamic leaders of showing little enthusiasm for involvement with the national campaign against the pandemic.
“At [sensitisation] meetings we can’t even mention the use of condoms, we have to leave that kind of information for discreet discussion in the corridor afterward,” Dieng said.
He complained that sex workers in Touba were not getting the health care they needed because prostitution was illegal in the town, a state of affairs which simply pushed the sex trade underground.
Every year hundreds of thousands of pilgrims flock to Touba where Bamba was buried following his death in 1927 for a two-day festival of prayer and friendship known as "The Grand Magal".
The local authorities estimated that between one million and 1.5 million people from all over Senegal crowded into town for the latest annual gathering.
Sober moral behaviour is demanded of the participants, but light relief is readily available 15 km down the road in the nearby town of Mbacke.
There, many young pilgrims congregate for a spot of drinking and dancing and sometimes too a spot of romance – more cause for the local doctors to wring their hands with worry.