The Las Palmas HLM health post in Guediawaye is a small oasis in the hustle and bustle of this densely populated and popular suburb of Dakar, Senegal. Once past the door, this centre resembles a community-based structure like those found far from urban centres and which, far beyond their health mission, also work as a place for meeting, exchange and sharing. As is often the case, the identity of these places is built around those who run them. Here, Mrs Dieumbe Gueye, a midwife in her fifties, has benevolence written in her eyes. The softness of her voice heralds a total devotion to her patients. With word of mouth, the Las Palmas post has quickly become a place where vulnerable people can find a time of peace and empathy. “They know that we are working all the time, and that we take good care of them,” explains Dieumbe Gueye, highlighting the commitment of her team of mediators and nurses.
She has been working at the centre for almost 20 years now. “I used to have ‘stowaways’ in my line of work, and more and more of them, not knowing that they were key populations.” Located in a small, low-traffic street, with a discreet façade and a caring, non-judgemental team, Las Palmas was quickly identified by the most disadvantaged populations as a health, social and economic resource. “I approached my chief, because I was becoming a reference centre for key populations. A year ago, the Las Palmas post officially became a monitoring site for sexually transmitted infections (STIs).” For this woman, who graduated at the top of her class of midwives and worked for a while in the private sector, the personal investment is strong.
“My staff, especially the mediators, need to know the realities on the ground, because we receive many sex workers.” If the first consultations are for a pregnancy or an STI, the care is comprehensive and the follow-up is ensured. Sometimes the follow-up goes far beyond a medical consultation. “If necessary, I help them financially to come to the centre.” Treating patients is a comprehensive approach. Counseling, orientation if necessary, and follow-up are part of her daily life and that of her team. On average, a hundred sex workers consult each month and find confidential and integrated care. “We manage everything ourselves. Sometimes we don’t have enough medicines, but we still have a free stock.” HIV testing is always offered on site. For those who are hesitant, an HIV self-test kit, provided by the ATLAS Project, can be handed over. It is systematically recommended to them for their regular partner, accompanied by counseling: “very good counseling, because that is what guarantees a very good result”. There is no doubt that Dieumbe Gueye and her team, these “devoted mothers”, will continue their mission as long as possible, without any distinction, because as they say, “here, all patients are equal. ”
The ATLAS Project participated in the 19th Conference on AIDS and STIs in Africa, which took place in Kigali from 2 to 7 December 2019. This conference is an opportunity to get together with other actors in the fight against AIDS and to share current initiatives, to learn about innovations and new recommendations. Having started dispensing in July 2019, the ATLAS Project had initial feedback to share, both in terms of acceptability and operational data.
Our team, composed of members of the ATLAS team, a large delegation from the research team and representatives of our institutional partners participated in the symposium: HIV self-testing looking forward: targeted, scalable and sustainable models for Africa.
Clémence Doumenc-Aïdara, Director of the ATLAS Project and Joseph Larmarange, Scientific Coordinator, first spoke on the theme ATLAS Project: adapting HIVST distribution models in West Africa to reach those left behind, before Professor Cheick Tidiane Ndour, Head of the Division of AIDS and STI Control in Senegal, and co-investigator of the ATLAS Project in the country, presented the characteristics and challenges of introducing HIV self-testing in Senegal.
Informal sessions were also held on the HIV Self-testing stand of our partner STAR: on 4 December, on the theme of key populations with interventions by Joseph Larmarange and Anthony Vautier, and on 5 December, with the testimony of our institutional partners. Professor Ehui, Coordinating Director of the National AIDS Control Programme in Côte d’Ivoire, and Dr Dramane Koné, ATLAS Focal Point at the Executive Secretariat of the High National AIDS Council in Mali, presented the reasons for the introduction of HIV self-testing and the first feedback from the implementation of the ATLAS project.
A large audience attended all these events and demonstrated a growing interest in self-screening, introduction and dispensation measures, as well as the link to treatment.
Tina announces she is 35 years old, but her body and face inspire 15 more. A Nigerian national, she left her country with her pimp to work in Côte d’Ivoire. As a sex worker, she has had some success. “So he decided to take me to Europe,” she explains. But the journey stops in Mauritania. “My pimp then asked me to go to Mali to prostitute myself to finance the trip. “Here she is in Bamako, a city she didn’t know, without a landmark, without a family. Her destiny changed the day she met the late Dr. SIDIBE Garangué SOUKO in 2000. Founder and Executive Director of the NGO SOUTOURA, the late Dr. SIDIBE Garangué SOUKO suggested that she become a peer educator, particularly for Nigerian sex workers, and more generally English-speaking sex workers and their boyfriends. “My life has changed, she took me off the street,” she says, sitting on a concrete bench in the back room of a bar on one of the busiest avenues in Bamako, Mali. Today, Tina has become the surrogate “mother” for girls who have followed the same path as her. Dr. KEITA Aminata Saran SIDIBE, who took over from the founder of SOUTOURA, who died in July 2019, testifies to Tina’s investment: “She is there every day, every time. Even when the NGO encounters financial difficulties and has to reduce its activities, she continues to do so on a voluntary basis. »
Tina AGBONAVBARE, or Momy or Anty, as she is known to English-speaking sex workers, plays a very important role in SOUTOURA where she has worked her way up through the ranks as a community worker, from peer educator to coordinator. In 2005, she was awarded the prize for best community worker in the STI, HIV and AIDS program of the PSI Mali and Groupe Pivot Santé Population consortium, funded by USAID. Sista Tina is very helpful to women in prostitution through the provision of service packages: awareness raising, traditional testing and self-testing, distribution of condoms and lubricant gels, referral of people who test positive for HIV to treatment and follow-up until the viral load is eliminated. Her support also extends beyond the health sector, since she accompanies girls in their relations with the police, the embassy of their country of origin and the opening of bank accounts.
In the establishment, there are about forty of them sailing between the bar and the back room, where there are rooms from 5 to 6 square meters that they share at 3, their privacy being as much as possible preserved by curtains. Day and night, they accompany the men who select them, for quick passes paid at best 2,000 FCFA (3 euros). “On Friday and Saturday nights, they each do up to 30 passes,” explains Dr. KEITA Aminata Saran SIDIBE. Tina is concerned for “her daughters”, their health, mental and physical. “I had the chance to meet help, I try to give it back, to get these girls off the street, and if not to support them. “Tina, who knows her HIV status but keeps it secret, encourages girls to test for it. On this awareness day at the bar, the theme is the HIV self-test. Because if they regularly test themselves at the SOUTOURA Clinic, this complementary screening strategy allows them to offer screening to their boyfriends as they call them, their regular partner. “Above all, we want them to stay healthy,” they explain. The HIV self-test is fairly well accepted by these men, “because they can do it discreetly at home, without having to reveal that they are dating a sex worker.” Tina has all the girls’ confidence. She evolves in the bar as a caring mother, attentive to improving as much as possible a very difficult daily life. Helping these young girls is the raison d’être of Tina, who today calls herself “happy” and eternally grateful to the late Dr. SIDIBE Garangué SOUKO.
On the occasion of a trip to Côte d’Ivoire, a delegation of French parliamentarians, accompanied by Dr Philippe Duneton, Deputy Executive Director of Unitaid, devoted the morning of 2 July to the ATLAS Project. Marion Lenne, Jean-Francois Mbaye, Sira Sylla and Valérie Thomas were present in Côte d’Ivoire at the invitation of Unitaid, in order to learn about the benefits of French investments in global health.
They had the opportunity to discover the Clinique Confiance de Biétry and the Centre d’Accompagnement et de Soins en Addictologie (CASA), one of the implementing partners of the ATLAS project, the NGO Espace Confiance which has been working since 1994 to raise awareness, screening and medical and psychosocial care for key populations.
Inaugurated in October 2004, the clinic is a site for the prevention and management of STIs and HIV/AIDS in key populations, as presented by Drs Anoma and Fofana, respectively Director of Espace Confiance and Director of the Clinic.
Positioning its action on the principles of non-judgment, gratuity and discretion, the staff of the Cliniques Confiance (4 in total), including 12 doctors, 4 nurses, 110 community counsellors and peer educators, offer services in fixed and advanced strategy, which made it possible to reach more than 20,000 beneficiaries in 2018, including more than 10% at the Biétry site.
The visit then continued at CASA, where Dr. Zahoui, site manager, presented this structure dedicated to the care of drug users (DU).
In Côte d’Ivoire, according to a study carried out in 2017 by Médecins du Monde, which accompanied the establishment of the centre, the prevalence of HIV/AIDS is 5.64% among IDUs, and that of tuberculosis is 9.8%, which is higher than the national average, in a context of low access to healthcare, high stigmatization and repression.
CASA was therefore born out of the need to provide a community care centre for DUs, where information, awareness, testing, primary health care and HIV and tuberculosis care are provided in a non-judgmental environment.
After less than a year of operation, CASA has already welcomed more than 730 people, 11% of them women, with the arrival of more than 70 new DUs each month. Of these, 2.3% are HIV-positive and 4.1% have tuberculosis. The CASA team has also organized 34 screening outings since its opening.
These two sites are partners of the ATLAS Project, and will provide HIV self-testing, in advanced strategy for the Confidence Clinic in Biétry and in fixed strategy for the CASA.
 Marion Lenne, LREM deputy for Haute-Savoie, Jean-François Mbaye, LREM deputy for Val-de-Marne, Sira Sylla, LREM deputy for Seine-Maritime and Valérie Thomas, LREM deputy for Puy-de-Dôme, sit on the French National Assembly’s Foreign Affairs Committee.
With the ATLAS project in Mali, a major innovation as close to the field as possible to achieve the global target for HIV testing by 2020
Bamako, June, 19th 2019 – The HIV self-test will be introduced more widely and promoted in Mali so that people most at risk of contracting the virus can access their HIV status discreetly and be connected to health care or prevention services.
The ATLAS Project was officially launched today in Bamako in the presence of Michel Hamala Sidibé, Minister of Health and Social Affairs, Professor Moussa MAIGA, Executive Secretary of the High National AIDS Council, Félicité Nsabimana Ndimira, UNAIDS Country Director, Clémence Doumenc-Aïdara, ATLAS Project Director, Laurent Vidal, IRD Representative in Mali, and Odé Kanku Kabemba, ATLAS Project Manager in Mali.
Supported and funded by Unitaid, the project is implemented by the Consortium Solthis (Solidarité thérapeutique et initiatives pour la santé) and the French Research Institute for Development (IRD), in partnership with the Malian Ministry of Health and Social Affairs, the Executive Secretariat of the High National AIDS Council, the Sectoral AIDS Control Committee, AKS, Amprode Sahel, ARCAD Sida, Danaya So, PSI and Soutoura.
Over a period of 3.5 years, ATLAS will not only enable the distribution of 150,000 HIV self-test kits in Mali, but will also lay the foundations for the large-scale deployment of this testing strategy by the government and other partners, with the support of institutional, community and research partners.
« ATLAS is part of Unitaid’s broader investment strategy to promote HIV self-testing in Africa, including West and Central Africa, as a way to achieve high rates of HIV testing, and thus help reverse the epidemic. » said Lelio Marmora, Executive Director of Unitaid.
Knowing your HIV status : an essential step in ending the epidemic
At a time when UNAIDS is advocating for universal access to HIV testing to defeat the epidemic by 2030, the stakes are high because in Mali, only just over 40% of people living with HIV know their status. Stigma and discrimination against people living with HIV are major barriers to achieving the global goal of testing. It is therefore essential to innovate to diversify the supply of screening and thus be able to reverse the course of the epidemic.
Although the rate of HIV infection remains moderate in West and Central Africa, the HIV epidemic is concentrated in certain population groups such as sex workers and men who have sex with men. ATLAS will provide a complementary screening offer strategy, allowing, through self-testing, to reach populations at high risk of contracting the virus who do not access existing screening services.
The ATLAS project, at the crossroads of technological and societal innovation
By targeting at-risk populations, ATLAS offers people who have never been tested before or whose practices require frequent testing, the opportunity and a tool to know their status and refer to appropriate prevention or care services. The self-test, an oral device for detecting HIV antibodies that consists of passing a spatula on the gums and then immersing it in a reagent, allows for simple and rapid screening in complete discretion, and strengthens the ability of each person to be an actor in their own health.
The project will help to create the conditions for the introduction and large-scale deployment of HIV self-testing and generate the necessary demand for self-testing among these target populations.
Finally, the ATLAS project includes a scientific component involving the IRD, pilot of the research and evaluation component, the London School of Hygiene and Tropical Medicine and the Imperial College of London. Five studies will be conducted to document the impact of HIV self-testing as an essential complementary testing strategy and determine the most cost-effective distribution models. The results of the studies will be shared with countries in the region to facilitate the adoption of the screening self-test and its widespread deployment.
By 2015, Unitaid had taken a pioneering role in promoting HIV self-testing with the STAR project implemented by Population Services International (PSI) and its partners in six southern African countries. To date, nearly 30 countries have integrated HIV self-testing into their testing programs.
 National Strategic Framework for HIV and AIDS (CSN 2017-2021)
 UNAIDS ’90-90-90′ goals set for 2020 : 90% of HIV-positive people know their status, 90% of people tested positive for HIV are on antiretroviral therapy, 90% of people on treatment have a viral load Undetectable.
« Carnets de santé », a project of the Presidential Council for Africa (CPA) and the NGO Action Global Health, aimed at highlighting African innovations to make health accessible to all, made a stopover in Senegal from 20 to 25 May 2019. Led by Dr Yvonne Mburu, immunologist and member of the CPA, the delegation visited two partner structures implementing the ATLAS Project. In Dakar, first of all, Dr Bâ, Technical Coordinator, presented CEPIAD, the Dakar Integrated Addiction Care Centre, which will participate in the distribution of HIV self-test kits as part of the implementation of the project. At the origin of the creation of the Centre, explains Dr Ba, « a 2011 survey that shows a very high vulnerability of drug users to HIV, with a prevalence of 9.4%, and to HCV, with 23%. » CEPIAD, the first specialized unit in West Africa, now has « an active line of 500 users, 275 of whom are on methadone ». This unit of the psychiatry department of Fann Hospital also offers community and advanced strategy activities. Ousmane, community mediator, recalls that « risk reduction (RoR) is one of the centre’s priorities, as is advocacy with the security forces and advanced strategy screening. »
The delegation also went to Ziguinchor, to the health centre, formerly Silence Hospital, where it was welcomed by Dr Jean-Jacques Malomar, Chief District Physician. Dr Sanata Diallo, Head of the ATLAS Project in Senegal, then presented the project and its innovations, together with Dr Boubacar Diouf, Enda Santé’s representative on site and implementing partner. Stressing that « the end of the epidemic begins at the front door, testing », Dr. Diallo introduced participants to the oral HIV self-test device that will be provided as part of the project. Meetings were held with the beneficiaries, including a group of sex workers from the Diamorane association. Sokhna Rokhaya, mediator, stressed in particular the need for them to be tested every three months. « The conditions are so difficult that we have to accept many things », she explained, half acknowledging that she and her sisters often had to accept to practice their profession without protection. « I didn’t want to test myself first. But the talks and awareness convince us, the “official” sex workers as well as the informal or hidden », she explains, adding that « the self-test perfectly meets the needs of our profession. »
Another innovation of the ATLAS Project is that secondary distribution will make it possible to provide HIV self-assessment kits to key populations for distribution to those targets who do not wish to travel to health centres, particularly because of the strong stigma that still prevails in Senegal.