July 19, 2012

NOUAKCHOTT, Mauritania/GENEVA – Fatimata Ball recalls that when she first learned she was HIV positive, all she wanted to do was die.

She had already quit her job as a nurse and sold her valuables so she could afford to look after her husband, who had contracted the virus. When she found out that she was HIV positive as well, she felt paralyzed by the diagnosis.

Today, however, she takes every opportunity to share her experience to combat the stigma associated with the disease. Ball is the first Mauritanian to publicly disclose her HIV status. She campaigns tirelessly so that people living with HIV and AIDS can receive testing, treatment and preventive care.

"HIV is associated with two things – death and exclusion. Those who are diagnosed are traumatized. It feels as if life is over, like there is no turning back. And society is afraid. People do not know the difference between sick and infected. A woman who is infected will have to get herself tested but also her family, and that is not easy. It requires counseling," Ball says.

She gives testimonials at training sessions and talks about HIV, how she became infected, how she copes with the disease, and the discrimination associated with it.

"HIV is not a sign of imminent death. We can live with the disease and still function," she emphasizes.

Ball works at the National Executive Committee in the Fight against HIV and AIDS, an organization closely related to the Association in the Fight against AIDS (ACLS), which is a partner of The Lutheran World Federation (LWF) and its Department for World Service (DWS) program in Mauritania.

The list of HIV and AIDS cases at the ACLS office is long and sad. Ball noted, HIV is often seen as a death sentence, and a person living with the virus is considered worthless. But with access to medication those infected with the virus can live a long life, and with support they can feel valued.

ACLS was founded in 2007 and today is the only non-governmental organization in Mauritania working with people living with or affected by HIV, regardless of their race, ethnicity or religion.

The association operates in all provinces of the country. Everyone working for the association is living with or affected by HIV. They work without pay but with passion and commitment. Moktar Salem Ould Lehibe, ACLS president, says it is important to know that everyone is welcomed.

"Muslims don't have the right to discriminate; it's against the first principle of Islam. I respect everyone," says Lehibe.

The Most Needy

ACLS reaches about 1,500 infected or affected persons, targeting women, homosexuals, male and female sex workers, and children orphaned by AIDS.

There are women cooperatives, groups for male and female sex workers, and a school for girls.

It is estimated that of the over 14,000 people living with the AIDS virus in Mauritania, only one in four have been tested and are under treatment.

Lehibe says the needs are great and that today there is no possibility of assisting everyone.

Patrick Elis, program director at ACLS, says the organization's primary goal is to make sure that anyone testing positive for HIV gets access to the free medication offered by the government.

Secondly, ACLS tries to assure that those fighting the virus have access to nutrition by distributing food and vitamins. ACLS also runs income-generating activities like the cash transfer project it sponsors together with the LWF, distributing money to 2,500 households.

ACLS can also provide counseling and psycho-social support to infected people and their families. But, Elis says, the needs are great. People living with HIV are exposed to so many other opportunistic infections and are often poor, which puts them at greater risk of exposure.

"ACLS has to choose from among those who are in need and that is terrible but unfortunately necessary," he says.

Those who discover that they are infected often leave their village and move to the capital city, along with a family of between seven and 12 people, a very precarious situation. They need all the support, training and money they can get.

"When there are severe cases, we can assist with an apartment or a hostel, and basic needs like food and clothes. And we can help with mental health relief through counseling," Elis adds.

Mauritania is in drought-stricken northwest Africa, where famine is a reality. With a global acute malnutrition rate of 10.7 percent, 10 percent of rural households are undernourished. The annual food deficit is about 50 percent and cereal prices have increased by 50 to 75 percent due to imports and declining production.

This is a lethal situation for someone living with HIV as undernourished individuals are more susceptible to HIV infection than those who are well nourished. Conversely, good nutrition delays the progression from HIV to AIDS, and is essential for effective antiretroviral treatment.

The Only Ones

According to Lehibe, the Mauritanian government is very supportive and recognizes the work ACLS does following years of struggle by the organization to make its case. Today, there is a law protecting people living with HIV and all antiretroviral medication is free in the country.

The LWF is the only permanent partner but ACLS gets money from the United Nations and partners in Canada. Lehibe says that whenever the need is great, he starts knocking on doors.

"I recently got Chingitel, the largest phone company in Mauritania, to pay for a school for girls, which is now up and running. There are so many orphans left with nothing and in great need," he adds.

Lutheran World Information
By LWI correspondent Thomas Ekelund, during a visit to Mauritania.