The positive results of disclosure

Thirty-five year old Ivorian Lydie Akesse, who found out she was HIV-positive seven years ago, has become known for her frank and outspoken attempts to "give HIV/AIDS a human face". Although her family has accepted her status, her friends have yet to come to terms with it. "Once, I gave a glass of water to a friend, and she said she'd had some just before coming over - she thought my glass could infect her," she told PlusNews during a regional workshop on drug abuse and HIV/AIDS in Senegal. "If awareness campaigns produced immediate results we wouldn't be victims of such acts, so we have to keep on educating people," the militant activist explained. Akesse is the vice-president of Amepouh, ('We shall overcome' in the local Guéré language), one of the oldest associations of women living with HIV/AIDS in the region. Reluctant to go into details about how she might have contracted the HI-virus, Akesse is quite open about the emotions she went through when she discovered she was positive. After frequent bouts of illness, she was referred to a testing and counselling centre at the Treichville university hospital in Cote d'Ivoire's economic capital, Abidjan. "When I got back to the centre, I was given a sealed envelope to take to my doctor. As I'm curious, I opened the envelope in the street: 'serology HIV positive'." "I was in an indescribable state," Akesse said. After taking leave from work, she walked along the beach trying to clear her head. "I felt as if I'd just landed on another planet." At that time (1998), HIV/AIDS was still regarded as a death sentence in Cote d'Ivoire, with prevention campaigns often showing a bony man with a red cross tattooed on the skull, she recalled. "To be HIV-infected meant to die - and I didn't want to die." Akesse returned to the clinic for more information about her condition, and was subsequently put on antiretroviral (ARV) treatment. THE BENEFITS OF DISCLOSURE It took three months for her to muster enough courage to disclose her status to her husband, by which time she had reached breaking point. "I had to hide all my medical checkups and my drugs from my husband ... which made me feel morally very weak," Akesse said. "I also had to ask him to use condoms for no particular reason - it was unbearable." Like any "good secretary", she forged the date of her results, moving it forward by three months. When she finally told him, "he couldn't believe his eyes. He kept pacing up and down our bedroom. "He threw me on the bed, tore my clothes off and started to make love to me without using a condom," Akesse related. "It was his own way of reacting; of showing his support to me." "Disclosing one's status to one's spouse is very important in an HIV-positive person's life," she stressed. Her husband is still negative, despite the fact that the couple do not take any precautions when having sexual intercourse. "My husband refuses to use condoms to protect himself", said the distinguished-looking mother of three. He also became actively involved in AIDS work, regularly speaking at awareness events. After quitting her job because it was becoming too tiring for her, Akesse now devotes herself to fighting all forms of HIV-related discrimination, and calls for people living with HIV/AIDS to be more involved in policy-making. "We must be associated with all AIDS programmes - the HIV/AIDS expert is the person living with it," she pointed out. However, Akesse acknowledged that "most people living with the virus are illiterate; they face serious difficulties when setting up projects", and called on donors to relax the stringent criteria required for obtaining funds. Access to adequate care and counselling is still a challenge for many of the country's HIV-positive citizens, particularly those living under rebel control in the northern savannah regions. Although a three-month supply of ARVs can be bought for 5,000 F CFA (about US $10) per person, treatment for opportunistic infections is still very expensive, especially considering transport costs to the government-controlled southern urban centres. "HIV-positive people [have to] pay [a lot of] money to come to Abidjan - where they are immediately taken care of - and a great number of women have no means to come to the city," Akesse noted. Amepouh, the HIV-positive women's association, plans to resume its activities throughout the country, which is at present divided in two by United Nations intervention forces, UNOCI. "We've already set up projects for care and support to HIV-positive people in the north," she said. Cote d'Ivoire, with an official infection rate of about seven percent, is the West African country hardest hit by HIV/AIDS.