Even when companies commit to HIV care, getting message across can be difficult

The Senegalese Sugar Company (CSS) provides free condoms for its 7,000 workers but there are few takers, with many male employees seeing accepting condoms as an admission of promiscuity or having a sexually-transmitted infection. "The workers can't bring themselves to take the condoms that are at their disposal in the company pharmacy," explained Boubacar Gassama, the head doctor for CSS, the biggest industrial company in the West African country. "When asked about it, most of them tell me that they are married. They think I'm implying that they are leading the lives of naughty boys," he told PlusNews in Richard Toll, the small town where the company is based that lies more than 500 km from the capital, Dakar. For the last 30 years, CSS has been harvesting fields of sugar cane that stretch along the banks of the River Senegal in the north of the country as far as the eye can see. For the last six years, the firm has been providing HIV/AIDS education to its employees. Discussion groups and workshops take place at the company's headquarters and Gassama's surgery door is open to all -- the 4,000 full-time workers, the 3,000 seasonal workers and their wives and children. He also goes the extra mile, heading out into the fields to talk to the sugar cane cutters about prevention methods. But the doctor admits he has his work cut out. "I wanted to see the condoms disappearing like hot cakes but it's been in dribs and drabs," he said, opening his drawer where the unwanted contraception has been languishing for more than a year. "We did think about slipping condoms in with the pay slips but we were worried about offending the sensibilities of our employees," Gassama said. Senegal is often cited as an African model in terms of its fight against the disease which is ravaging the continent. And CSS has taken its HIV education responsibilities very seriously, having signed up to Senegal's December 2003 charter to provide care for people living with the disease. But there is still much reticence. Batoura Thiaw has been working at CSS for 10 years and while he uses condoms readily, he knows many people who won't. "A lot of people will tell you that it's not right," he said, adding that he's been to some workshops where many participants didn't even believe that AIDS was real. In September 2004, the Senegalese Ministry of Health allowed CSS to open its own HIV-testing centre. Gassama reckons this pilot project, if successful, could be rolled out to companies across the country, making it easier for people to know their HIV-status. "I lost a lot of patients because they had to go to St Louis [the regional capital some 110 km away] for their medical care," he explained. To date around 500 people have been tested. Fifteen have discovered they are HIV-positive, most of whom are family members of employees, five of whom are directly employed by CSS. Of these five employees, two are single seasonal workers who came from neighbouring countries in the region like Mali and Guinea where the HIV prevalence rate is higher than Senegal’s 2004 rate of 1.5 percent. AIDS activists believe that the rate around the Senegal River valley may be more than 2.5 percent, and that is borne out by the CSS data which shows a prevalence rate of 2.8 percent among its employees. According to Gassama, two employees, one of whom is retired, are currently receiving treatment at Richard Toll's hospital which, for the last month, has been offering anti-retroviral drugs (ARV). Meanwhile back at the company, there is no chance of stigmatisation as no-one has the slightest idea who they are except the doctor. "We stick rigorously to the confidentiality ... even the administration people don't even know who they are," Gassama said.