Jointly conducted by IRD and INSERM, this research explores the issues of HIV Counseling and Testing in Burkina Faso.
Odette Rouamba Ky-Zerbo, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2016 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Odette Rouamba Ky-Zerbo's thesis highlights the challenges of Counseling and Testing for HIV (CTV) in a low-prevalence country like Burkina Faso. This country, which has an HIV prevalence rate of only 0.7%, finds itself in a paradoxical situation. While antiretroviral treatments are becoming increasingly effective and accessible, only 55% of people living with HIV (PLHIV) know their status. This figure is alarming, especially when considering that in other regions of West Africa, such as Togo or Mali, this rate drops to 35%. These statistics reveal a concerning reality that deserves closer examination.
The WHO guidelines of 2015 aim to improve access to CTV, but their implementation remains problematic in contexts where stigma and logistical barriers are pervasive. For example, in some rural areas of Burkina Faso, health infrastructure is often inadequate, making access to testing and counseling difficult. Health centers lack adequate equipment, and providers, often poorly trained, are not always able to offer quality service.
The study's results reveal marked disparities based on gender, age, and education level. Women and young people are often less informed about their status, highlighting the need for a targeted approach. Indeed, women, particularly those living in rural areas, often face cultural and social barriers that prevent them from getting tested. Young people, on the other hand, may hesitate to go to health centers due to fear of stigma.
Logistical challenges, such as the lack of equipment and training for providers, compromise the quality of services offered. For example, a UNAIDS report highlighted that the absence of rapid tests in certain regions of Burkina Faso delays the diagnosis and treatment of PLHIV. The stigma surrounding PLHIV, in turn, constitutes a major barrier to seeking care and social acceptance. People living with HIV often face discrimination, which discourages them from getting tested or seeking care.
The recommendations made in this thesis are clear: it is imperative to strengthen the capacities of health providers, combat stigma, and adapt national guidelines to local realities. This requires a strong commitment from policymakers and public health actors. For example, targeted awareness campaigns could help change mindsets and encourage people to get tested.
How can we change mindsets and ensure equitable access to health services? The answer lies in collective mobilization and a strong political will. Governments, NGOs, and communities must work together to create an environment where PLHIV feel safe to seek care.
In summary, this research is not limited to a simple analysis of figures. It calls for deep reflection on health policies in West Africa, emphasizing the importance of an inclusive approach tailored to the needs of populations. The stakes are high, but solutions exist. It remains to implement them. For example, initiatives like the community health worker training program in Burkina Faso show that efforts can be made to improve access to CTV. In conclusion, the road ahead is still long, but with collective will, it is possible to advance the fight against HIV and improve the lives of millions of affected individuals.
Key Facts
- 55% : Percentage of PLHIV who know their status in Burkina Faso, revealing a gap in access to testing.
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Sources and Access
Odette Rouamba Ky-Zerbo. Enjeux et limites du conseil et du test du VIH (CTV) dans un pays de basse prévalence en Afrique Subsaharienne : cas du Burkina Faso. Médecine humaine et pathologie. Université Montpellier, 2016. Français. ⟨NNT : 2016MONTT035⟩. ⟨tel-01514386⟩