Awareness of HIV/AIDS in Mali is relatively low and is surrounded by denial and misconceptions. Many people mistake HIV/AIDS for malaria or tuberculosis. A commonly held belief is that healthy-looking people cannot be HIV-positive. In an effort to avoid social rejection, a common reaction to a positive HIV test is to disappear. Many ill urban dwellers return to their villages where family members witness the final stages of the illness. Villagers have come to identify AIDS with strangers, the world abroad and migration. Many people think it is a "westerners' illness," and it is sometimes called the "Côte d'Ivoire disease." Villagers also associate AIDS with witchcraft and as a punishment for not being God-fearing.
Among sex workers HIV prevalence is high and erratic. In Bamako, the nation's capital, the rate of infection has risen from 39% in 1987 to 56% in 1995. Outside Bamako, in Mopti, in 1995, HIV prevalence was 21%, and in Sikasso, where the situation is especially dramatic due to poverty, the rate was 72%. The most vulnerable group is not the professional sex worker but the occasional workers, the so-called "housemaid AIDS," women, often abandoned by their husbands, who are unable to maintain their families on a daily basis. There is an alarming tendency of mothers who encourage their daughters to support the family through sex work.

SDC's response to HIV/AIDS

To counter the prevailing myths of HIV and to raise awareness levels of transmission, in 1993 the Swiss Agency for Development and Co-operation (SDC) began HIV prevention activities in Mali, starting with awareness-raising workshops for SDC-supported projects. Since then it has incorporated HIV prevention activities in its development programmes in all sectors -- health, forestry, agriculture, hydraulic engineering and the crafts industry. Most of its programmes are in the southern Sikasso region, which borders Burkina Faso and Côte d'Ivoire. As a crossroads for commerce and migration, it is one of the regions hardest hit by HIV/AIDS.
An evaluation in 1997, however, showed that the expected change in sexual behaviour did not take place. Although the people trained had considerable HIV/AIDS knowledge, further dissemination did not take place, because they lacked support material and were not paid for their work beyond attending the workshops, as they had anticipated. Furthermore, in the crafts industry, age differences between artisans and their apprentices hindered open discussion on sexuality. These findings led to improvements in the programme.

Activities since 1997

Since 1997, SDC has focused on rural extension workers and masters of apprentices in urban settings to carry out HIV prevention activities in their personal and professional environments. The participatory workshops target organisations in health and non-health sectors, involving health workers, programme managers and supervisors of extension workers. Issues addressed include sexually transmitted infections and HIV/AIDS, HIV prevention and behaviour change, contacts with people living with HIV/AIDS (PLWHAs), socio-economic aspects of AIDS and communication techniques. During the workshops education materials and condoms are distributed for wider dissemination.
For most participants the workshops provide an opportunity to ask questions regarding sexuality, especially on frigidity, premature ejaculation and sexual pleasure. Women and men jointly participate in the workshops: a big step in pulling down the barriers of taboos and secrecy. There are also some signs that traditional religious authorities want to support the activities; for example, an imam who participated in a workshop promised to introduce HIV/AIDS discussions after Friday prayers. Other people report they have more authority at village level due to their increased knowledge.

Lessons learned and the way forward

Until now, HIV/AIDS activities have been influenced by western concepts of lifelong fidelity, without taking into account different settings, customs and needs of polygamous societies and the context of increasing poverty. SDC plans to adapt its programme according to the insights gained so far. Regular monitoring will take place, days for retraining will be planned and new aspects like female genital mutilation will be introduced. The most important changes, however, will be related to training methodology, increasing socio-cultural sensitivity of the programme and targeting different stakeholders.

While awareness exists in the National AIDS Programme and among development partners, many social actors are still lagging behind. For SDC, raising awareness is therefore the first, indispensable step to involve all sectors in the fight against HIV/AIDS. The next step is the organisation and empowerment of PLWHAs. HIV-positive persons cannot count on solidarity from government, development projects or communities alone: they have to develop their own networks in a society not only struck by HIV/AIDS, but by many other health and developmental problems. Self-help groups can strengthen PLWHAs, orphans and widow(er)s through information exchange, income-generating activities, health-care and communal parcels for agricultural production. In the future, synergies should be built between SDC projects and programmes in different sectors to develop a common strategy for dealing with HIV/AIDS.