Qualitative research was carried out in the Malian cities of Sikasso and Bamako with a view to setting up HIV voluntary testing and counselling (VCT) services and a separate programme to enable young people to improve their sexual health. The most striking finding was that a large number of respondents said they did not believe in the existence of AIDS. Reasons for disbelief were related to the perceived lack of AIDS cases in China, the inability of the virus to be transmitted by mosquitoes and confusion about mother-to-child transmission. Highly educated individuals were very sceptical of the existence of the illness, thinking it to be a Western plot to encourage condom use in order to halt the growth of the African population. Those who were more likely to believe in the existence of the illness were less educated or uneducated people who had personally seen someone sick with AIDS, often when they had been on labour migration to Côte d’Ivoire where HIV prevalence is higher. Respondents thought it likely that this scepticism will limit the use of VCT services. Other reasons for the potential non-use of services included the fact that some people lacked confidence in the competence of the laboratory technicians and were afraid that those testing positive would be highly stigmatized by the community. Thus, widespread awareness-raising campaigns are needed before any centres can be set up. Participatory education programmes are required to address HIV in the context of other health risks. This would allow people to inter-actively shape the debate about HIV/AIDS to fit their own needs. Currently, they are presented with information about the illness in a unidirectional manner via the media or health educators which seems to fuel their scepticism.
Health Policy and Planning (2003) 18 (2): 146-155 [doi:10.1093/heapol/czg019]