Release date
May 11, 2009

Stronger in Gambia, Despite HIV

May 11, 2009, —

By Lane Hartill

Abdulai tried to find Musa, but he'd already fled. That wasn't good. Not

good at all. He knew if he didn't find him soon, things would get bad. Really


Mbaita Sikunga

Students in Africa create AIDS message costumes at school in an effort to raise awareness of HIV and AIDS. Photo by Sean Sprague for CRS

He knew Musa was somewhere in southern Senegal, knocking back traditional

elixirs that he hoped would kill the virus working its way through his body. As

a marabout, an Islamic religious teacher, Musa had always taught his

followers that reprieve was found in the bitter potions prepared by wise men.

But there was no cure. Musa couldn't wash it out, asphyxiate it or pray it

away. It had strengthened, and it controlled him now. He would have to return

to The Gambia. He would have to go see Abdulai.

For months Abdulai and other counselors told Musa that this thing called HIV

was in his body, and if he wanted the drugs that would save his life, he had to

tell someone he had it. That's the law in The Gambia if you want access to HIV

medicine. But Musa wouldn't admit what he had.

But now, given his condition, things had changed. He knew he'd have to do

the unthinkable: Tell his brother he had HIV.

Abdulai gets the call at night. Musa is back, they said, and things aren't

looking good.

He is lying on his side on a foam mattress on the floor. In the dark room

with only a single window, shadow and light caress his face and filter through

his graying goatee, aging him dramatically. A stranger would think he's in his

70s. But this respected Islamic scholar and father of two small children is

only 36.

The Catholic Development Office health team, which is supported by CRS,

tries to reach people like Tacko, a 20-year-old with a glistening gold tooth in

an otherwise perfect fence of white teeth. This gentle young woman will look

you in the eye, flash a smile, and in tender, halting English, tell you one

horrific detail after another about the last three years of her life.

She'll start with how her father forced her to marry a "bumster"

at 17. That's Gambian slang for a young Gambian man who prowls the beaches and

streets of Banjul, the capital, looking for female European tourists to charm

and seduce. The payoff ranges anywhere from dinner to tickets and a visa to Europe. Tacko claims her husband had been with two "white women." She was next.

She soon became pregnant. Then her parents died; her siblings moved away.

Shortly after that, she had a baby boy, who died two years later. Then the

diagnosis: HIV-positive.

Now she works for the Catholic Development Office, counseling people like

Khady. Khady is HIV-positive and mottled with a black, bumpy fungal infection.

Still, she tries to look nice with her double pierced ears and a collection of

beaded orange bracelets on her wrist. It's not just her health that's a

problem, it's her husband. They hadn't talked in two years and they recently

divorced. She's trying to raise three little ones, aged 5, 7 and 9, alone. Now

she's single, losing her hair and covered in something that looks like

ringworm. Will any man, she wonders, want to marry me?

That did it. In her bare concrete room, with her fussing 5-year-old

squirming on her sagging mattress, Khady's life got the best of her: The

ex-husband who sends their kids away when they go to visit him, the pathetic 58

cents she makes a day selling snacks at a school, the itching rash. Her eyes

freeze and a warm glaze of tears coats them. No wracking sobs. No wailing. Just

a 28-year-old mother trying to hold it together as her life falls apart around


'It's Not a Curse'

Across from her, Tacko sits on a stool. Legs out straight out in front of

her, she's rocking back and forth, the memories coming back. She seems to be

waiting for the right moment. The room is quiet. A chicken pecks the dust

outside the front door.

"It's not a curse by God," she says, suddenly. "You are in a

much better position than me. Your mother is living. Your father is living. All

my people are dead. Me, after work, I go home and have to cook. I work all the


Tacko's feet are now out of her sandals, elbows on knees. She leans into

Khady, like a coach consoling a distraught player.

"The greatest problem is to keep thinking about it," Tacko tells

her. "That causes depression. Join people in whatever activity they are

doing so you won't be isolated and discriminated against."

Khady wipes her eyes. She says it helps hearing Tacko's story, to hear

someone who has been in more pain than she has.

Tacko ribs her about her hospitality. They laugh. A connection has been


In 15 minutes, Khady went from a distraught single mother covered in a rash,

to a woman who now sees her life in a different light.

When everyone leaves, Khady is standing with her family in the sun, smiling.

He's so thin his hands appear overgrown. His knees are as big as

grapefruits, his legs as thin as baguettes. He opens his mouth, but nothing

comes out. His voice disappeared yesterday, says his older brother, also a

marabout, who sits next to him acting as an interpreter. He says Musa hasn't had

food or water in three days.

A bad smell fills the room. Nobody says anything. Musa's wife will come and

change him soon. She will wonder what he has; he still hasn't told her. Men

rarely tell female members of their family they have HIV. Men say they're too

chatty, they gossip too much. Men confide in men; they say they keep secrets


Caring for the Neglected

Abdulai deals with people like this every day. When Gambians' savings dry

up, when their friends don't stop by on weekends for tea, when the virus starts

to win and they start to give in, they turn to people like Abdulai. He, along

with a team of 11 others, works for the Catholic Development Office, a Catholic

Relief Services partner that works with HIV-positive Gambians and orphans and


They do what few others are willing to do: pay attention to those with HIV.

They roll them over and teach their families how to clean bedsores; they push

needles into their arms and let IVs drip into their veins; they fill cups of


Weekends are often given over to caring for others. They drive on the

washboard roads and sit in patients' dank rooms all day long. They counsel

them. They laugh with them. They tell them HIV is like any other disease; you

just have to manage it. They also pay for orphans to go to school; they even

buy them shoes. They also help those who are ill but not HIV-positive.

Villagers just know them as people who care for the sick. Confidentiality of

patients is a priority.

Abdulai and the others work in Bassé in the eastern end of The Gambia, a

country shaped like an appendix that worms its way into the side of Senegal, on

Africa's west coast. For many Africans, Bassé is just a stopover on their way

to someplace else.

The rusted buses that disgorge Africans into Bassé also bring HIV and

misperceptions. Many people here will tell you HIV is a two-step disease: You

get it. You die. While the HIV prevalence rate in the country is officially

only 2.5 percent, the rate in Bassé is almost certainly higher, say HIV


Impromptu Classrooms

That's why you'll find Sister Alexis, Catholic Development Office's team

leader, and the rest of her crew hauling speakers into villages, cranking up Youssou

N'Dour and Jaliba Kuyateh, popular Senegalese and Gambian singers. At a recent

music night, just as the crowd had swollen to 500, just as it had worked itself

into a lather, they cut the music. Then they pumped up the HIV messages. Come

and get tested for HIV, they encouraged the crowd. Couples, before marriage,

you need to do this, they told them. With several testing centers in eastern

Gambia, in 10 minutes, anyone can know if they have HIV.

That's not all. A touring question-and-answer game show also makes the

village circuit. They talk to kids and adults about HIV and promise prizes—cooking

pots, bed nets, soap—if they answer questions correctly. In this poor region,

free household items are much appreciated. People pay attention.

Caritas community educators use illustrations

Community educators from Caritas, a CRS partner, use illustrations to explain how HIV is spread. Photo by David Snyder for CRS

The Catholic Development Office also has a monthly radio program in which a

panel talks about HIV. It's translated into three local languages. The outreach

seems to be working. In December of 2008, 127 people were tested, up from 19 in


New Ways, New Lives

Back in the dark room, Musa is still in the same position, his hand

elegantly poised under his chin, like a sage considering a request. Abdulai

will return later this evening with an IV drip for him. They'll get him started

on medicine. Musa's strength will return. He will even start talking again.

"We are very compassionate," says Sister Alexis, sitting next to

Musa. "We bring ourselves to their level."

The care—the body powders, the sponge baths, the quiet conversations—are

essential. But more important is Abdulai's willingness to hold a man most

people won't go near, to sit in a foul-smelling room and not flinch. Gambians

see this. They appreciate it. They now are able to see themselves living to old


Take Jawo. Not long ago HIV had shrunk his athletic body to 88 pounds. All

he could think about was his children, and who would take care of them when he

died. When HIV is with you, he used to think, you can't survive.

Now, with the help of Sister Alexis and the team, he's back driving taxi

again. He's regained that loose gait of a retired basketball player. He even

thinks about retirement: He will build up his herd of cows and milk them as the

sun sets in the evening. He will mix the milk with sugar and millet. Then he'll

sit back with his porridge and watch his grandchildren swirl around him.

Musa, Jawo and Khady are pseudonyms. Their names have been changed to

protect their privacy.

Lane Hartill is the West Africa regional information officer for Catholic

Relief Services. He is based in Dakar, Senegal.