Cote d'Ivoire: Giving a mother back her smile: Sometimes it's the little things (March 2011)

For Aïssata, the double HIV diagnosis – her own and her daughter’s – was almost a relief. At least she finally knew what was wrong with little Natenin, so thin, so weak, and still, at 17 months, unable to walk.

But when the doctor announced that her baby girl would need antiretroviral therapy all her life, Aïssata broke down in tears. How would she manage a life of hiding from rejection and gossip? How would Aïssata explain to Natenin later the need for daily drugs? Scared, Aïssata refused the treatment.

The doctor called for help. The staff at the maternity clinic in Abengourou, Côte d’Ivoire had been trained how to discuss challenging issues like antiretroviral treatment with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID partner Johns Hopkins University Center for Communication Programs. Besides training and equipping staff, the program works to ensure client-friendly reception and orientation services, pleasant waiting areas with audiovisual and print materials on HIV, confidential counseling areas, proper storage of medical records, and links to community-based services and community radio outreach. Client surveys suggest that these elements contribute to perceptions of quality service and may make patients more likely to return for care and adhere to treatment.

In the clinic’s counseling room, a social worker and two community counselors from associations of people living with HIV provide counseling on HIV treatment in French and Ivoirian languages. When a counselor told Aïssata about her own experience with antiretroviral treatment, the young mother was able to open up and talk about her fears. The counselor reassured Aïssata and talked through the many benefits of treatment for her daughter.

Two months after starting on antiretroviral, little Natenin put on weight and she has yet to miss an appointment. On Natenin’s second birthday, Aïssata invited the counseling staff and proudly presented her daughter, beaming and pretty … and walking.

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