At 66
years old, Maman Koffi shows inexhaustible energy to work to improve the status
of women around the San Pedro region of Côte d’Ivoire, which includes 10
administrative regions and 24 health districts. “I have been through a lot
myself,” she explains. “I bore eight children, but lost four before their fifth
year. I have experienced school pregnancies, home deliveries without medical
assistance, and one of my children died of malaria because he was not taken to
hospital but to the village. “Mama Koffi chose not to let her pain overwhelm
her, but rather to enter midwifery school. “I chose to be a midwife to prevent
this tragedy from happening to others, and I chose to work in the community to
raise awareness and help these mothers. “After her initial training, Maman
Koffi also graduated from the Ecole des Cadres in Côte d’Ivoire and then from a
University Diploma in Mother and Child Health obtained at the René Descartes
University Paris-V in 1996. At the beginning of her career, she and her
colleagues used to contribute when resources were lacking to organize awareness
sessions on women’s, mother and child health, but also on malaria and
tuberculosis prevention, or obstetric fistula. In 1998, “with some of my
sisters, I undertook the creation of the Association for the Management of the
Bardot Delegated Municipal Maternity Hospital (AGEMAB), the only maternity
hospital at that time in the large slum of Bardot, with the aim of relieving
congestion at the Regional Hospital Center (CHR) and contributing to the reduction
of maternal and infant mortality. »
With a view to optimizing the participation of the female community in the
management of the maternity hospital, in 1999 she initiated the creation of the
Association for the Promotion of Women’s, Mother, Child and Family Health
(Aprosam), of which she is still Executive Director today. Also President of
the Women’s Union of San Pedro, Côte d’Ivoire, Maman Koffi continues her daily
community work which has enabled her to reach thousands of women, mothers and children
and has recently integrated HIV self-testing kits, as a partner of the ATLAS
Project, into her activities. “We have two mobile clinics to reach female sex
workers (SWs) who are in the agro-industrial areas where the seasonal workers
are working. Self-testing is very well received, especially because these sex
workers did not come to the health centre for fear of being seen. Self-testing
really complements our service offer. “Since October 2019, 980 people have been
made aware of this complementary screening strategy, including 715 women.
Around 50 people have learned their HIV status and have been able to receive
treatment.
These community activities also include the development of income-generating
activities, so that these women can become empowered and fight against the
discrimination they face on a daily basis. “If one, two or three women get
involved in this way, they save children, they save mothers,” says Maman Koffi
while answering one of her incessant phone calls. A community resource, but also
a sympathetic ear and a devoted friend, Maman Koffi has put her life at the
service of women, so that they can free themselves from the barriers that
patriarchy imposes on them. “Today I am a grandmother, twice. But above all I
am the mother of all children in Côte d’Ivoire,” she concludes with a
mischievous smile.
*The month of March was “Zero discrimination against women and girls” day (1st March) and International Women’s Rights Day (8th March). On these occasions, the ATLAS Project chose to highlight the work of Maman Koffi, who, after growing up in a disadvantaged environment, chose not to resign herself and to fight for the health of women, mothers and children.
From 10 to 13 February, all the partners of the ATLAS Project met in Abidjan, Côte d’Ivoire, for the second consortium meeting. While the first meeting, held in July 2019 in Saly, Senegal, clarified the standards, procedures and implementation methodologies, this second edition was an opportunity to make an initial assessment of the progress made as the distribution of HIV self-test kits has begun in the three countries where the project is being implemented, Côte d’Ivoire, Mali and Senegal.
Institutional, implementation and research partners were all gathered to present the progress of their work, their good practices, the difficulties encountered and to reflect on the challenges ahead, particularly in terms of transition and dissemination. As recalled by Dr Blaise Kouamé, representing Professor Eboi Ehui, Director Coordinator of the National AIDS Control Programme in Côte d’Ivoire, “self-screening appears as an opportunity to reach targets that are difficult to reach with routine services. … We are aware that early diagnosis and treatment of HIV infection offers many benefits at both individual and population levels. This second consortium … provides a forum for discussion that will allow us to take stock of the project’s implementation in order to better guide strategies to achieve the objectives. “Objectives are on track, in that all partners have begun dispensing, and are showing increasing dispensing figures: by the end of December 2019, more than 26,000 kits had been dispensed, and all partners have demonstrated their confidence in achieving the objectives by the end of the project. An important part of the consortium meeting was also devoted to research, the various components of which, coordinated by IRD, began in the second half of 2019, and the results of which will feed the operationality of the project. Finally, group work, around three key questions relating to monitoring of self-screening results, notification and delegation of tasks, was organized over half a day in order to reflect together on the main issues for the coming months.
MTV Shuga Babi, our partner in Côte d’Ivoire, presented first season of the show
These meetings between partners remain crucial moments of sharing and exchange in the conduct of the ATLAS project, because its success depends on coordinated and concerted action by all the actors involved. This is a success that everyone hopes to achieve, since access to screening remains the gateway to the other stages of the fight against HIV, access to treatment and viral load control in particular. As emphasized by Dr Brigitte Quenum, UNAIDS Country Director in Côte d’Ivoire, represented by Dr Isabelle Kouamé, “HIV testing gives people the knowledge they need to choose the best treatment options and prevention methods. Knowledge is real power: the power to make the right choices to stay healthy, but also the power to lead a long and productive life. »
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.
ATLAS speakers in the gallery with Robert Matiru, Director of Operations of Unitaid and Peter Godfrey-Faussett, UNAIDS Senior Scientific Advisor and Chair of the STAR and ATLAS Technical Advisory Committee
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, in the backroom of a bar, in Bamako. Jean-Claude Frisque / Solthis
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.
The late Dr Sidibé Garangué Souko, Founder of Soutoura
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[1] 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[2] 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%[3], 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.
[1] 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.
