By RFIPosted on 09-10-2019Modified on 09-10-2019 at 04:40

The Sixth Replenishment Conference of the Global Fund against HIV, Tuberculosis and Malaria opens this October 9 in Lyon. One in four people infected with HIV do not know their status. All actors involved in the fight against AIDS insist on one point: to stop the spread of the virus, we must encourage screening ... Being tested is still a taboo in some African countries, forcing carers and NGOs to implement place other practices around the stigma. Reports in Chad, Senegal and Madagascar.

By Aurélie Bazzara, Charlotte Idrac, Magali Lagrange and Sarah Tétaud

Faly, 32, lives in Antananarivo, the Malagasy capital. He comes from a bourgeois family. He has a Catholic education, prefers to express himself in French rather than Malagasy, and takes a manifest pleasure in undermining the stereotypes that stick to the environment from which he comes. On his own, he talks about Tinder and Grinder (two dating apps). " I live with my time," he jokes, " but I never tell my intimate stories to my close friends. "

In Madagascar, HIV testing is a subject that we do not talk about. Tests, Faly did it. The heavy climate that surrounds them, he knows it. " The conservative Christian culture condemns sexuality out of wedlock," he explains. Or if you get tested, in the Merina mentality [ethnie des Hauts Plateaux, Ed] , it is either that you have been unfaithful, or that you are a "drag". In all cases, it is related to sex, and sex, we do not talk about it. "

This stigma is even stronger for women. Miora comes from the south of the island. If each time she informed her female entourage of the tests she was doing, she never addressed the subject with her brothers, cousins, uncles. " I would be judged. My own family would peddle gossip. Our society is closed-minded : what can be said can do more damage than the result of the screening test itself, "she quipped.

Tsiory, a 23-year-old homosexual, regrets the lack of frank talk about the disease: " HIV transmission is part of the SVT course. But even teachers are embarrassed to tackle the subject. We never spread out. This is the kind of lesson that is given the day before the holidays, so as not to have to come back to it. In the 2000s, remembers the young man, awareness campaigns for HIV-AIDS testing were regular on the Island. But for a decade, events have become rare. " On December 1 [date of the World Day Against AIDS, Ed] , we talk about the disease, and the remaining 364 days, we become dumb ... and ignorant, " says Tsiory.

A taboo around HIV? The situation is even more true for the localities of the interior of Madagascar. Oswaldo Razafimandimby, general practitioner travels through the enclave areas of the island with a humanitarian association. " Never in the bush did one person ask me to do a screening. People do not know what AIDS is. A situation reinforced by the medical profession itself: " in hospitals, in the city, in front of patients, we use jargon, we speak of" positive IRV ". Nobody uses the term "AIDS"; it's so scary. It has become a taboo word. "

Discretion and Dedramatization

The Malagasy case is not isolated. In several countries of the continent, what people say will continue to hinder HIV testing practices. Forcing caregivers and NGOs to come up with tailored forms.

One of them was set up in Dakar. Tinder (assumed name) sits anxiously in the waiting room at the Fann Outpatient Center. This 27 year old student does not like bites. He squeezes his books against him while waiting for the blood test. He comes for HIV.

In this light green building located in the University Hospital Center, the circuit is prowled. Here, we talk about " customers ", even if the service is free and open to everyone. One becomes " patient " if the test is positive, and requires a support.

This building located within the University Hospital Center welcomes anyone wishing to be screened. © Charlotte Idrac / RFI

Amadou is not reassured. He has already been tested in 2010, but has since had unprotected sex. It is hosted in a separate area, the voluntary testing unit, separate from the care unit. Clients and patients do not mix. " Everything is done so that there is no contact, " says the coordinator of the center. " For clients who come to be screened, crossing patients can be scary, and demotivate them in their approach. This also guarantees confidentiality. We want to avoid stigmatization, and offer them a discreet but also friendly welcome. "

First step for Amadou, an interview with the social worker. In a closed office, in front of his big register, Astou Diagne takes notes, and reminds the student of the ways of transmission of HIV and the means of prevention. " Do you have heterosexual or homosexual sex ? How often have you had unprotected sex? ". Amadou answers timidly, the social worker tries to put him at ease. Then, the sample: the nurse Mamadou Gueye is used to worried customers. Quickly done, well done: 30 minutes later, Amadou receives his result. He is negative. Amadou is relieved, he will leave with condoms.

On average, Fann's Outpatient Treatment Center conducts 120 screenings a week. The challenge today: reach people who do not travel to get tested, including targeted populations: sex workers, drug users ... He now develops a home screening program.

Self-tests to get around the stigma

The NGO Solthis has launched "Atlas", a self-testing distribution program in different West African countries: oral tests, which can be done at home, in complete confidentiality, with the advantage of not having to go to a health center. More than 500,000 self-tests will eventually be distributed in three countries in the subregion: Senegal, Mali and Côte d'Ivoire.

The tests are entrusted to people targeted by the usual programs: HIV-positive people, sex workers or drug users ... who are then responsible for giving them to their surroundings: relatives, clients or partners. " This allows us to reach people we do not usually touch, because they are not identified in the so-called risk categories ," says Clémence Doumenc-Aïdara, project director.

If this test proves positive, the user must perform a second confirmation test ... He will lead, if necessary, to begin a process of care. Clémence Doumenc-Aïdara is optimistic. " You realize that when people have gone through that first step, and go through the process of getting tested, a process is started, " she says.

Changes in mentality

Mentalities also change. And in some cities, the weight of prejudices starts to be a little less weighty. In N'Djamena, for example. It is to be clearly visible that this medical team has chosen to set up its mobile HIV testing laboratory in the lively district of Moursal. Syringes, plastic gloves and sampling tubes are simply placed on a wooden bar table, exposed to the curious eyes of passers-by. " We offer anonymous testing to young people aged 10 to 24 ," says Judith Lasangue, a nurse from the NGO Center for Youth Solidarity for Training and Development (CSJEFOD).

Since 2014, this association has deployed mobile HIV testing brigades in six districts of the capital. " It was unthinkable to talk about AIDS in the street ten years ago, " recalls Désiré Ngarti Ngarhingar, president of CSJEFOD. " There has been a shift in mentality through school outreach, less-than-guilt posters and community dialogues ," says the man, a hand-screening tape.

So very quickly in Moursal, it's the effervescence. About fifty teenagers flock around the three health professionals. " I passed by chance with my friends and we decided to test who is infected with the virus, " smiles Abakar, high school student of 17 years. Despite this relaxation posted, the blood test result is still revealed in the privacy of a yard. " Even if we do a hundred tests a day, we noticed that getting tested is one thing, revealing an infection is another because the disease is still taboo, " said Aché Mahamat, nurse. About 5800 Chadians discover their seropositivity every year according to the United Nations.

However, there is still some way to go to overcome prejudices. In Chad, one in two people living with AIDS say they are victims of discrimination. This is highlighted by the latest study conducted by the Chad Network of Associations of People Living with HIV in 2017. " There are insults, dismissals, isolations and even drop-outs in some communities where AIDS is prevalent. is perceived as a shame ", reports its executive secretary Ngaradoum Naortangar. A law was passed in 2007 protecting the rights of people living with the infection. If sentences of up to one year's imprisonment are provided in the texts, the associations denounce a lack of application of the law and a laxity of justice. As a result, the majority of infected people live in hiding. " They confide in a family member and decide together to keep quiet so as not to appear in the family where the neighborhood. This secret represents the main obstacle to treatment, "concludes Ngaradoum Naortangar.

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