Project #4874

Nutrition and peer support for HIV+ patients

by GAIA Vaccine Foundation

Our Hope Center Clinic is an “integrated” clinic. What does that mean? All people seeking treatment are welcome, and thanks to our donor support, we have the capacity to care for HIV+ patients as well. We are the only neighborhood clinic to have this capacity in Bamako while most seropositive patients must find their way to one of the larger hospitals. Sometimes even the low cost of public transportation can prevent someone from seeking treatment, which is why we try to set the example for how HIV care could improve by providing access to medication locally.

 But why “integrated”? Why not support an HIV only clinic? The sad truth of the matter is that if anyone were to walk through the doors of a known HIV clinic, they would live in permanent fear of abuse from their own neighbors. They would risk abandonment by their family members, and permanent stigmatization by society. At the integrated clinic they can fly under the radar; they say that they are “sick” even if they look in perfect health; they say that they have malaria.

 Obviously, it would be better if everyone could disclose their status and receive the proper care they deserve, but that’s not yet a possibility in Mali, although it’s a goal that we are working towards.

 In the meantime, it is of crucial importance to provide people with peer support and nutritional assistance. By creating the Friday lunch at the clinic, seropositive patients can spend time together, and cook a large meal to share with their children as well as their well-loved doctors and nurses. Not only is food of critical importance to these patients, some of whom are living in dire poverty, but it also allows them the dignity of giving a symbolic gift of thanks to those who provide them with care and empathy.

 Last Friday, I had the honor of sharing a meal with our patients. When I arrived early in the morning, the women were already hard at work peeling garlic, chopping vegetables, frying fish, pounding spicy peppers into a sauce, and boiling rice. There were kids everywhere, living proof that our Mother to Child Transmission Prevention program (MTCTP) is so successful that our patients are confidently increasing their families.

 The women told me their stories. They spoke with pride, saying that HIV has not prevented them from living their life to the fullest. They spoke with sadness about the neighbors that insulted them, or even the husbands who had abandoned them. They spoke about living in fear that people would find out their status. They spoke about the misery of not having any food in the house and many children to feed. A young girl, born seropositive, was so shy that she barely said a word. She wanted her story told as well, and with a friend’s arm around her shoulder, she had the courage to let it out: Her mother had died, her father had remarried and his new wife abused her and insulted her because of her status.

I wish I could show you these strong women and their beautiful children. I wish you could hear their words. I need, however, to respect their wishes. They did not want photographs to appear online that connected them to HIV, they live in fear of being recognized as seropositive, although they know in other countries people would never abuse them for their status.

 How many of us would like to support charities, but worry about where our money is going and how it is being spent? The best thing about my job is that I can talk to the HIV+ patients of the clinic directly, and get their feedback about what works, so that I can assure that GAIA’s funds are put towards the most essential issues. We are trying to improve our nutritional education program.  At the Friday lunch the women told me exactly what they needed:

“We need a roof over our heads; nothing protects from the sun or rain as we cook. Look at this broken pot; we need more supplies. Look at this women with the tiny baby; she just started coming and this will be the only time today that she will get any to eat”

 We need to do more. We need to expand the nutritional support to at least twice a week. Our clinic doctors confirm that more nutritional support would help patients adhere to their medication and support their families.

With your continued support, we can provide an essential meal to HIV+ patients and their families. We don’t want to do it just once or twice, we want to keep doing it month after month, year after year, so that these women can keep caring for each other and their families, providing much needed psychological support, as we all work towards a better future. 

All my heartfelt thanks!

Hot peppers
Hot peppers


Although political upheaval in Mali since 2012 has forced many clinics to reduce their programs or close their doors, we are proud that our peer support groups at the Hope Center Clinic have continued to provide companionship as well as nutrition to our HIV+ patients. Food is critically important to the well being of our patients, and in the African context one cannot provide ARV treatment without thinking also about nutrition. Every year GAIA Vaccine Foundation provides a weekly meal to an average of 25 HIV+ patients and their children. We purchase food that is cooked by our patients who share the meal with their peer group, HIV- children and doctors. Sharing a meal with the staff reduces stigma, and there is always a doctor present so that the patients can ask health related questions in a less formal and more relaxed setting. Improving the nutritional status of our patients is an essential aspect of HIV care, and the number of our patients continues to expand despite the challenges that the past 2 years have presented the Malian population.

We could not have accomplished this without your support!


HIV+ patients cooking meals together
HIV+ patients cooking meals together
Mom with twins
Mom with twins

GAIA Vaccine Foundation is launching a new program which is primarily focused on HIV prevention, HIV testing and access to care for the most vulnerable sector of the Malian population – young women and men, especially teenagers. The decision to focus on youth follows an evaluation of the impact of our programs that was performed with your support in 2011. We recently determined that there has been a steadily increasing incidence of new HIV infections among girls and women presenting at our clinic with their first pregnancy.

This increase occurred despite our ‘village-wide’ focus on HIV. So, what we were doing was not reaching women and young girls at risk. For 2013, we’re going to focus on this especially vulnerable group and therefore plan to:

  • Develop targeted prevention tools for young men and young mothers
  • Reach out to young mothers to reduce their rate of HIV acquisition.
  • Provide incentives to get tested, participate in education, and use condoms.
  • Educate: hire expert “youth” peer educators for the new program
  • Use the nutrition program for HIV+ mothers and their families as a model; develop a similar program for teenagers and very young mothers.

These sessions will also address the topic of cervical cancer and HPV.  We have a new focus on cervical cancer in addition to HIV/AIDS because Cervical Cancer is a big killer of women in West Africa.

GAIA is lending its expertise in field site outreach to help with the distribution of available doses of cervical cancer vaccines.  Right now in Mali, amidst a political crisis, there are 33,000 doses of the HPV vaccine, that can’t be distributed because public health dollars are supporting the military instead. However, the vaccine is perishable, and time is running out. If not utilized within the next few months, the vaccine and with it the possibility of more than 10,000 lives, will be wasted.

We have expert fieldworkers ready to distribute the vaccine, under the supervision of local healthcare providers. 11,000 adolescents will be vaccinated with one of the two vaccines that is currently approved for cervical cancer prevention. This vaccine is safe (no significant adverse events) and nearly 100% effective.  (For detailed information please see our HPV Vaccine project posted on GlobalGiving).

GAIA VF’s vision for a healthier West Africa does not end with the HPV vaccine campaign. In fact, this trial will serves as a pilot for all clinical studies to come, and including our eventual HIV vaccine trial. We will pilot protocols for future trials, and put an infrastructure in place of processes and personnel, and to train those personnel with the skills needed to sustain a vaccine trial site. That way, when we have the GAIA vaccine ready, we can distribute it in West Africa eventually distribute the HIV vaccine that is currently being developed at no cost in developing countries like Mali.

Participating in this campaign to stop cervical cancer means that you are a true visionary.

Thank you for your support! 


2012 is GAIA Vaccine Foundation’s 10th anniversary! 10 years ago, we first set out to establish collaborations with Malian HIV researchers. GAIA VF was subsequently established to coordinate networking among HIV/AIDS governmental organizations, non-governmental organizations, and HIV care providers, as well as to tackle the problem of misinformation about HIV/AIDS treatment among clinicians and patients that could impair the ethical conduct of HIV vaccine trials in Mali.

With your help, we have been able to support the treatment of HIV seropositive women and their families at the Hope Center Clinic and at “Chez Rosalie”, our successful mother-to-child HIV transmission prevention (MTCTP) program, since 2005! We have established strong local and regional partnerships in Mali, performed vaccine readiness research, and implemented a comprehensive HIV care program in anticipation of performing HIV vaccine trials.

With approval from the Malian Ministry of Health, GAIA VF has addressed the issue of access to care by setting up a model village-based HIV care and treatment clinic. The Hope Center Clinic now features HIV case management, outreach to identify new patients, referral to care, and promotion of medication adherence. GAIA VF also partners with local organizations to improve access to specialty HIV care at the clinic.

Our goal is to leverage innovative HIV management techniques, expand HIV treatment, and increase HIV knowledge in order to improve access and adherence to care, a model that could be implemented to expand village-level HIV care throughout West Africa.

Coup d’Etat in Mali

Unfortunately, 2012 was also the setting for a military coup, which took place in Mali in March. While there is ongoing civil unrest in the northern part of the country, our onsite director Dr. Karamoko Tounkara reports that all is calm in Mali’s capital of Bamako. Our patients and staff are safe, as are GAIA VF’s collaborating scientists.

In spite of this unrest, we are still providing access to HIV testing, care, and prevention, as well as food for HIV-infected patients, at our clinic in Sikoro. While we have had to reduce the scope of our programs to cut costs, the current political crisis has had no other impact on our activities at the Hope Center Clinic.

Although circumstances have been hard, enrollment in the MTCTP program has been steady over the past months. Voluntary HIV testing requests have skyrocketed in the past year, increasing from 226 in 2011 to 412 in 2012! This reflects not only GAIA VF’s resilience in keeping its programs open when other programs were forced to close due to the current political turmoil, but also an awareness and appreciation for the services provided by our clinic. We believe that continuing to operate our programs will instill hope in the citizens of Mali to sustain them through these difficult times.

Our Malian collaborators are continuing the fight against AIDS, and we need to bolster their optimism that peace and prosperity will be restored. More than ever, GAIA VF, our staff, and our patients need our, and your, support.

HIV Care Program

Since the launch of our antiretroviral (ARV) access program in 2009, more than 200 patients have enrolled in care at the clinic. In the past 2 years, GAIA VF was able to reduce the cost to patients of HIV screening and provide supplies and material for HIV screening activities. We reinforced our staff to levels appropriate for management of persons living with HIV/AIDS and hired a full-time pharmacist (full-time) trained in the management of care for HIV-positive patients, as required by the government of Mali.

2011-2012 Hope Center Clinic Achievements

438     Voluntary HIV test requests

221     HIV-infected adults and children in care

42       HIV-infected children in care

118     New HIV-positive patients on treatment

1040   Meals distributed to our patients

Hope is a Vaccine Award Dinner

Dr. Myron Cohen and Dr. Julio Montaner were awarded the 2012 International Hope is a Vaccine award for their ardent support of the “Treatment as Prevention” approach to ending AIDS, in the absence of an effective vaccine. The National Hope is a Vaccine award was given to Jon Cohen (correspondent with Science) for covering HIV/AIDS from every angle, and the Local Hope is a Vaccine award winner was Dr. Paul Loberti for his unfailingly devoted advocacy of HIV prevention as a means of addressing the HIV epidemic. Our 2012 awards attended the World AIDS Conference in Washington DC and gathered for a friendly award dinner together with Congressman David Cicilline.

Treatment as prevention: “The new vaccine for AIDS?”

The GAIA Vaccine Foundation held a satellite session at the AIDS Vaccine Conference in Boston in September 2012. Guest speaker (and 2012 Hope is a Vaccine Award winner!) Dr. Myron Cohen discussed the potential for implementation of the “Treatment as Prevention” (TasP) approach to ending AIDS, in the absence of an effective vaccine. Dr. Zoumana Koty, our Malian HIV specialist, was the recipient of both a scholarship and a travel grant, enabling him to attend the conference and present his work on improving clinical outcomes for HIV-positive patients at the Hope Center Clinic in Mali.

December 1st is World AIDS Day!

Your support for GAIA could not be more important than it is right now – we cannot continue without your help. Help us preserve our HIV care, treatment, and education programs in Mali! Please stand strong with GAIA VF and make a donation today.

As you know, a military coup took place in March 2012, and there is ongoing civil unrest in Bamako. The US embassy remains open, but Peace Corps volunteers have been withdrawn. Accordingly, we have reduced our own presence in Bamako to the minimum; however, we remain committed to continuing support of access to HIV care at the village level, which – in this time of unrest – remains a significant, if not more critical need.

We compiled the results of our work over the past four months in order to measure the impact of the political crisis on our activities at the Hope Center Clinic. Our monthly reports show that in spite of the difficult circumstances:

1) 150 pregnant women on average are still getting tested monthly. Enrollment in the PMTCT program has been steady over the past four months.

2) 30 families are still receiving nutritional support every week. Enrollment has been steady over the past four months.

3) 40 babies are currently being followed.

4) 55 patients on average are coming for voluntary HIV testing every month. Enrollment has skyrocketed in the past four months, increasing from 47 in January 2012 to 83 in April 2012. This increase in voluntary testing shows that our reputable management techniques and efforts to provide free high quality HIV care are reliable.

Our onsite director, Dr. Tounkara Karamoko, also said that significantly more HIV tests have been requested recently by people living in surrounding communities due to the closures of medical infrastructure and clinics in the past weeks.

Despite ongoing unrest in Mali, we remain committed to supporting humanitarian aid and preserving the program that has been one of the most successful interventions in Mali, over the last 10 years. We believe that it is critically important, at this juncture, to sustain hope. We must encourage our Malian colleagues to continue to fight against AIDS, and buttress their optimism that peace and prosperity will be restored.

Thank you!

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Organization Information

GAIA Vaccine Foundation

Location: Providence, RI - USA
Website: http:/​/​
Project Leader:
Anne De Groot
Founder and Scientific Director
Providence, RI United States