What Salif lacks in size, he makes up in confidence as he points out what support children like himself need.
He is small for his 13 years, but otherwise looks healthy and full of life, and accepts that he lives with HIV. The problem, he says, is that others do not. “The most difficult thing for me is to know that people could make fun of me if they knew I am HIV positive,” says Salif, talking to a small group of young people living with HIV. “I want the world to see AIDS like any other disease,” says Salif, with the composure of someone well beyond his years.
Like the other children and young people gathered in the room at the Association of Research, Communication and Home-Based Care of People living with HIV/AIDS, he goes to great lengths to hide his HIV status from his family , friends and his teacher for fear of being rejected. He does not even tell his older brother. His mother supports his secrecy. “I’m scared,” says his mother, when asked why at least she does not let her older son know.
Mali has a relatively low prevalence rate of HIV/AIDS with about 1.3 per cent of the general population living with the virus. UNICEF assistance focuses on strengthening the psycho-social support to children living with HIV provided by Gabriel Toure General Hospital, the biggest health facility providing care, treatment and support for children living with HIV and AIDS. During 2008, some 1,800 young people and adolescents living with HIV were under the care of Gabriel Toure General Hospital and 800 were taking anti retroviral drugs (ARVs). In 2008, UNICEF, together with its partners, conducted a situation analysis on youth and adolescents most at risk and vulnerable to HIV.
Salif has been sick throughout his childhood and had lengthy stays in hospital. However, he was only tested for HIV in 2007, and began taking anti retroviral drugs last year. He says that he has no problem remembering to take his ARV drugs everyday at 7a.m. and 7p.m. “I don’t need anyone to remind me.” He is now back at school and as testimony to his brightness he is now in the eighth grade. “I love foot ball and reading,” he says.
Most children living with HIV were infected by their mothers either during pregnancy, childbirth or whilst breastfeeding. HIV develops fast among infants and children, and without treatment, a third of infected children will die of AIDS before they are one year old. The World Health Organisation now recommends that all children diagnosed HIV positive should start treatment with antiretroviral therapy regardless of symptoms or CD4 count.
But stigma and ignorance about HIV is rife in Mali, and it is the biggest obstacle to supporting children living with HIV at all ages. Newborns, who have been admitted into hospital, have been easier to keep track of. There has been follow up care provided to 4,288 newborns of HIV positive mothers in 2008, which represents over a 300 per cent increase since the programme began in 2006. Orphans are the most difficult to reach, as when their mother dies, the families are not always able or willing to give them that extra care, especially when they are poor and have large families.
“The orphans have the biggest problems with their medication,” confirms Lowntan Sissoko, of ARCADSIDA, who is responsible for psychosocial support for children with HIV. “They do not have enough supervision when it comes to taking the medicines. And they are often malnourished, which is particularly serious when taking ARVs, as they are even in more need of good nutrition”. Sissoko prioritises home visits for orphaned children living with extended families or foster parents; otherwise many would not receive their treatment.
Noumousso Mariko, a foster mother of 15-yearold Fatima, agrees that stigma is a huge problem. Fatima’s parents died, but her extended family rejected her when they knew she was HIV positive.She was only seven years old when Mariko, who also works for ARCAD-SIDA, took her in. Mariko put her in school. She has adapted well to her new life, but is now having to address the issues of sexual relations. “I worry about her as many young men are already looking at her,” says Mariko. Another beautiful, composed 18-year-old girl, who has been taking ARVS since she was 14 years old, smiles in agreement. “I keep my distance from the boys, although many are interested,” she says confidently. “I focus on my studies at university. I’m studying law.” Salif is also dedicated to his studies. Asked what he would like to be in the future, he does not hesitate. “I would like to be an ambassador.”