Mariame Toure* spent her childhood taking medications without understanding why because her mother believed she was too young to be informed of her HIV status.
As a teenager, Mariame began questioning why she had to continuously take medication; her mother only told her she had to remain on medication for life to avoid falling ill. “I stayed in the dark until I discovered it myself through what I learnt in school on HIV medication,” Mariame, who contracted HIV through vertical transmission, reveals with a disappointed look on her face while admitting that adherence to treatment was at times difficult.
In Côte d’Ivoire, many adolescents living with HIV face significant challenges, including stigma, difficulty adhering to treatment and barriers to accessing health care. These issues often result in poor health outcomes and hinder efforts to achieve viral load suppression. The 2018 Côte d’Ivoire Population-based HIV Impact Assessment (CIPHIA) surveillance study found that only 34% of adolescents living with HIV in Côte d’Ivoire had achieved viral load suppression, illustrating the urgent need for targeted interventions.
In February 2023, Mariame’s life changed when she became a peer educator for the Zvandiri-Like Initiative, a community-based program implemented by the Reaching Impact Saturation and Epidemic Control (RISE) project in Côte d’Ivoire. This initiative helps adolescents and young people on antiretroviral therapy (ART) stay in care and achieve viral suppression by engaging them through structured community follow-up and support groups. With encouragement from Dr. Cyprien Nioblé, Chief of Party for RISE-Côte d’Ivoire, Mariame decided to join the project as a peer educator. “This boosted my confidence and strengthened my adherence to treatment,” said Mariame who is now 25 and pursuing a Higher National Diploma (BTS) in Human Resources and Communication.
Mariame became the leader of a support group established by the RISE team in collaboration with the HIV focal point at Adjamé General Hospital. She quickly earned the trust of the adolescents and young people in her group and became a key figure in their support network. Her motto: “If this disease must reach others, it will not be through me.” She said, “I have seen many suffer and leave this world because of this disease. My goal today is to help others avoid it.”
The RISE team trained Mariame and 14 other mentors on topics such as treatment adherence, stigma and discrimination, disclosure and referring peers to additional services. To facilitate communication, Mariame created a WhatsApp group for adolescents and young people, where they could express themselves freely and receive daily encouragement to adhere to their medication regimen.
Under the mentorship of her supervisor, Nessemon Koné, a nurse and HIV focal person at the Adjamé General Hospital, Mariame and her colleagues have become champions in their work, gaining skills to navigate challenges and improve service delivery to their peers. “This group is a space where I am perceived as both a mother and an advisor,” said Nessemon. She added that Mariame’s involvement has been invaluable, as Mariame is often closer to adolescents and young people than anyone else, enabling them to share things they wouldn’t express directly to others.
The impact of Mariame’s work is reflected in the testimonials of support group members. Niara Sawadogo, a 23-year-old living with HIV said, “Since joining the support group, I feel comfortable with Ms. Mariame. She is like a big sister; she always calls to give me advice and encourages me. When I had issues with my sisters, Mariame was there to help. She listens to me, and it feels good.”
Mariame encourages her peers to take control of their health. “My role is to help each one realize that while this disease weakens us, it does not control us. It should not be a hindrance to our development; we must have a brave mentality,” she says.
Her dedication has led to remarkable outcomes. When she first started working with the group in July 2023, only one of 10 adolescents had a completely suppressed viral load. After six months of psychosocial support and encouragement, eight out of the nine others completed their viral suppression, thanks to Mariame’s efforts and the support from the RISE Côte d’Ivoire team.
RISE provides clinical support to 1,015 adolescents and young people aged 15 to 19 years in the Abidjan 2 region, with 90% (916) achieving viral load suppression. Currently (July 2024) Mariame’s peer cohort of 12 adolescents has achieved a remarkable milestone, with all members (100%) successfully attaining viral suppression.
“I am in constant communication with them,” Mariame says. “I lead the support groups at the hospital and manage the WhatsApp group where we discuss health and safety, including the dangers of sexually transmitted infections. For those without smartphones, I call them to understand their daily challenges and encourage them to take their medications every day.”
Mariame confides that her involvement in the project not only helps others but also keeps her spirits up. Looking ahead, Mariame dreams of creating a non-governmental organization to support adolescents and children living with HIV, educate those who cannot afford schooling and financially assist those in business. She also aims to raise awareness among healthy young people about the prevention of HIV.
RISE, a global project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), works with countries to achieve and maintain HIV epidemic control. In Côte d’Ivoire, RISE implements a clinical and community-based HIV project led by Jhpiego in the Abidjan 2 region. To support viral suppression among adolescents, RISE provides adherence support, home visits, ART delivery, medical appointment reminders and therapeutic education.
RISE Chief of Party Dr. Cyprien explains, “The adolescent support group is of paramount importance. Adolescence is a time of uncertainty and it’s often when HIV status is disclosed. In this turbulent period, support groups led by peer educators like Mariame are essential for helping adolescents accept their status, adhere to treatment and achieve viral suppression.”
*Mariame is a pseudonym chosen at the request of the peer educator to maintain her privacy.