Nearly 70 percent of the world's 42 million HIV/AIDS-infected people live in Africa.  In West Africa, seven countries are thought to have an HIV prevalence rate of five percent or higher within their general populations, an alarming statistic given that AIDS epidemiologists predict that a significant proportion of the population will succumb to the disease when its prevalence surpasses that mark. 

To discuss this pandemic, nearly 7,000 people from all over the world met in Nairobi, Kenya last week at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA). 

While ICASA was in full-swing, so too was the HIV Mini-Fellowship for Health Care Providers in Providence, R.I.  There, The Corrections Connection interviewed Salamatou Alzouna who is visiting the United States from Mali, Africa, where she is a pharmacist.  In Mali, Alzouna also works as a representative for the Global Alliance for Immunization against AIDS (GAIA), a Rhode Island-based non-profit foundation that supports the development of an AIDS vaccine and its provision to people around the world, regardless of where they live or their ability to pay for it. 

Q: What is the history of HIV infection rates in Mali?

Alzouna:  The first case of HIV was recorded in Mali in 1985.  Since then, it has been on the rise.  In 1993, we started detecting HIV in certain groups, like prostitutes.  In 1999, there was a national survey of the prevalence of HIV in Mali and it showed that 1.7 percent of Mali's 10 million people were infected.  Of these, five percent were pregnant women and 25 percent were prostitutes.

Q: Do the rates of HIV infection in Mali's prisons/jails differ from the rates of infection of general population?

Alzouna:  As it is here in the U.S., I imagine it's higher [in the prisons in Mali].  The socio-economic group that is imprisoned-poor people, especially people with no education-tends to have higher rates of infection.

Q: Is access to medication a major problem for treating HIV/AIDS in Mali?

Alzouna: It is a huge problem.  Most people in Mali live below the poverty line.  Before 2000, nobody had access to medication because it was too expensive.  After 2000, there was an access initiative and the pharmaceutical companies lowered the prices of the medications by more than 25 percent for countries that took specific steps to get that done.  It was a real huge reduction in cost. 

Also, the government put in place a policy that said that funds should be allocated for [medication] in this country each year.  It was called the Malian Initiative for Access to Anti-Retrovirals (ARV).  Since then, the price per person for ARV drugs is $150 per month.  Not everyone has access to this but the government has started a program where they will do social surveys to target certain populations to receive these drugs for 50 percent less, at a cost of $75 per person per month.  The program was started in 2001 and to the present day, it has treated 360 people.  This program affects the people who live in Bamako, Mali's capital, because there are three HIV/AIDS treatment centers there.  People have to travel there because they are the only treatment centers in Mali.

Also, there is a critical lack of doctors in Mali who are qualified to treat HIV-positive patients.  There are only 13 doctors in Mali who treat HIV patients, about one per 10,000 patients, which is very low.

Q:  What do you hope to gain from attending the HIV Mini-Fellowship for Correctional Health Care Providers?

Alzouna: This is a very important question.  There aren't doctors who will go into prisons to treat patients in Mali.  It just doesn't exist.  What I hope to achieve here is to create an exchange between the clinics in Bamako and the prisons in Mali by learning from similar connections here in the U.S.

Translation from French provided by Julia Noguchi of the HIV Education in Prison Project at Brown University