Djibouti is a small country of less than one million, located on the Horn of Africa in the east of the continent.
Despite enjoying economic growth during the last decade, 21 percent of its people live in extreme poverty and don’t have adequate HIV and health care. It’s estimated that around 7,000 people live with HIV and they, especially women, are often subject to stigma and social exclusion, and may avoid treatment or even diagnosis.
Halima Youssouf is a referring doctor at the Yonis Toussaint AIDS centre in Djibouti City, which provides care to patients living with HIV. She sees around 25 patients a day, but thinks that many people with HIV, or who suspect they may be infected, do not seek treatment.
“It’s mostly the stigma,” she says. “Patients do not come to the centre because they are afraid that people will see them come in. So sometimes the patients call us and stand next to the centre, so that we go deliver the medicines to them.”
To ensure that people can be tested and treated in the face of societal stigma, innovative ways to reach those at higher risk of HIV are needed. Mobile brigades are one such approach. They are teams of medical staff who take testing into communities by vehicle, as well as sharing information on how to prevent the spread of HIV. In 2019 they brought information to more than 26,000 people at risk of HIV and carried out nearly 6,000 tests.
“The mobile brigade is the best solution,” says Dr Youssouf, “because they bring HIV services closer to the community and reach people who do not come into the centre.”
Over the last year, with the COVID-19 pandemic and lockdowns, the mobile brigades brought another benefit. “During the period of COVID-19, our work was adapted so that we not only helped HIV patients, but also tested for COVID-19,” Dr Youssouf says.
With a Global Fund grant, UNDP, in partnership with UNAIDS, has trained health providers and network leaders on stigma, discrimination and human rights.
Isnino, 59, from Balbala in Djibouti’s capital city, is President of the National Network of People Living With HIV. She is in a good position to understand the stigma that prevents people from seeking help because she has HIV.
“I don’t remember the exact date I found out my HIV status,” she says. “I was married, and my husband’s health was getting poorer day by day. Then he found out he was HIV-positive. “I found out my own status some time before he died,” she says.
Isnino thought it was a death sentence. And for many people living in poverty in Djibouti, particularly at that time, it could be.
“At the time I was diagnosed, the disease was highly stigmatized, and a lot of false information was being circulated in the community. People sang songs about how the disease would kill you. You heard that some people would try to kill people with HIV, and those who had the illness were treated very differently by their families, eating from different plates for example,” she says.
“I told myself that if tested positive for HIV, my life was over. I would throw myself from the top of the highest building to die. You heard of many people committing suicide because of HIV.”
“The first time I was tested, I didn’t even go back to get the result. I just convinced myself that I was negative. I didn’t have symptoms at that time. It was my sister who encouraged me to get tested at the Yonis Toussaint clinic, as she had heard of a man with HIV who was treated there and whose condition had improved. I went and there I took another blood test. It came back positive.”
“The doctor there explained HIV to me. He made me realize I could live with HIV and even have a long life if I took the treatment as I was supposed to,” she says.
After accepting her own diagnosis, Isnino was determined to help others. She works as a volunteer and president of the Network of People Living with HIV, which delivers antiretroviral medicines to those who are unable to leave their homes. The Global Fund grant provides the network with IT equipment and dedicated resources for legal support, for those who report human rights violations.
“I decided to start volunteering,” says Isnino, “because a person living with HIV listens more to a person who also has the virus than to someone who does not. So I have a new family. We are five volunteers and we work without compensation. We try to help as many people as possible and some of them come with their family and their loved ones.”
According to Isnino, things have improved in Djibouti for people living with HIV, but there is still work to be done. “Today, access to treatment is easier, but the stigma has not disappeared.”
In line with UNDP’s Strategic Plan 2018–2021 and its HIV, Health and Development Strategy 2016–2021: Connecting the Dots, UNDP partners with the Global Fund, governments and civil society to support and strengthen multi-sectoral national responses to HIV, TB and malaria, by providing integrated policy, programme and capacity development support.
Under the Global Fund-supported HIV programme in Djibouti, 26,500 people were tested for HIV and received counselling in 2019, and 2,900 people currently receive HIV treatment.
Photos: UNDP Djibouti/Margot H. Quinty