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Côte d'Ivoire

Community health workers in Côte d'Ivoire play a vital role in preventing new HIV infections among children – and in keeping their mothers healthy

Meet Atanase Koukou Kouakou, a community health worker providing vital support for pregnant women living with HIV, in his rural village of Labo, Côte d'Ivoire.  Download this video


By Chiara Frisone

On 29 November, UNICEF released Children and AIDS: Sixth Stocktaking Report, the first report of its kind since 2010.

An AIDS-free generation once seemed like a far-off dream. But, now, the world has what it takes to make this dream a reality. Advancements in preventing mother-to-child transmission of HIV have greatly decelerated the rate of new infections in babies in low- and middle-income countries. However, the same progress has not been seen in treatment for children living with HIV, and the trajectory of AIDS deaths among adolescents living with HIV remains alarming.

Community health workers in Côte d’Ivoire are bridging the distance between pregnant women living with HIV and the care essential to keeping them and their babies healthy.

LABO, Côte d'Ivoire, 11 December 2013 – A group of pregnant women, young mothers and their partners take shade under the thatched roof, listening to Atanase Koukou Kouakou. Holding an illustrated manual, he explains why it is important that all pregnant women get tested for HIV and attend their antenatal consultations regularly.

Atanase is a community health worker in Labo, a rural village some 100 km from Yamoussoukro, the capital of Côte d’Ivoire. He is a farmer who volunteers during his free time to raise awareness of health and HIV in the community in which he lives.

© UNICEF Video
“[A] pregnant woman … can pass HIV onto her unborn child,” says Atanase (right), “so we monitor her [treatment adherence] and advise her to give birth at the hospital to prevent the child from being infected.”

HIV/AIDS in Côte d’Ivoire

Côte d’Ivoire has one of the highest rates of HIV prevalence among adults in West Africa – 3.7 per cent, according to the Demographic and Health Survey on HIV Prevalence 2011–2012.

It is women who bear the brunt of the epidemic; in Côte d’Ivoire, the number of women living with HIV is twice that of the number of men living with HIV.

Côte d'Ivoire is one of the 22 priority countries of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive. This plan covers all low- and middle-income countries, but focuses on the 22 countries with the highest estimated numbers of pregnant women living with HIV.

Côte d’Ivoire has made remarkable progress in reducing the number of new HIV infections among children – it decreased by 25 per cent between 2009 and 2012. However, efforts to prevent mother-to-child transmission do not reach all; more than two thirds of eligible pregnant women living with HIV are not receiving antiretroviral therapy. 

Reaching rural women

It is essential for women living with HIV to be aware of their status and to have access to the knowledge and care that will ensure that they, their babies and their partners remain healthy. But barriers to life-saving care are great.

In rural areas like Labo, women have to travel a great distance to reach the local health centre. According to HIV Specialist with UNICEF in Côte d'Ivoire Dr. Jean Konan Kouamé, when it comes to rural women, even arriving at an HIV-positive diagnosis or assessing health status post-diagnosis is a long road. “If a pregnant woman has tested positive to HIV, she often has to travel long distances to get to a health centre that can perform a CD4 count,” he explains.

Moreover, he adds, “[O]nly a doctor or a midwife within a health facility can perform an HIV test or prescribe antiretroviral medicines.” Once they are diagnosed, pregnant women living with HIV access antenatal care with difficulty.

Stigma and discrimination are also barriers to care. Fear can discourage people living with HIV from accessing health care – or from being tested, at all. Discrimination can even increase their vulnerability to physical violence. Women diagnosed during pregnancy may not tell their partners because they fear blame, abandonment or abuse. The effects of stigma and discrimination on the health of women and their children can be serious.

© UNICEF Video
(Left, in yellow vest) Atanase with community members. “The role of the community health workers is important because we are close to the people,” he says. “We can gather, mobilize and advise people.”

Community health workers like Atanase can help bridge the gaps in care preventing testing and treatment from reaching all women. What do they do? “A community health worker is a person who’s close to the people on the ground,” explains Atanase. “We advise pregnant women to go to the hospital to see a midwife and register with the national health service, so that they can begin receiving care.”

Atanase’s community work places particular focus on supporting pregnant women living with HIV. He motivates women and their partners to get tested and supports those who have tested positive by monitoring their adherence to treatment and giving them practical advice on how to stay healthy.

A life-saving connection

Côte d'Ivoire is preparing to roll out lifelong antiretroviral treatment to all pregnant women living with HIV. With this new approach, pregnant women living with HIV will be offered treatment for life as soon as they have been diagnosed, thus enabling them to stay healthy and prevent HIV transmission in future pregnancies. New HIV infections among children are expected to decrease further.

The key to success of the programme – and saving the lives of children and women ¬ – is to identify women who require support, offer them HIV tests and make sure they maintain their antiretroviral treatment.

On the ground, armed with knowledge and trained to support rural women in their journey to childbirth and beyond, community health workers like Atanase can be a life-saving connection between communities and health facilities to provide treatment for all women living with HIV and prevent the virus’s spread.



UNICEF Photography: Celebrating community health workers

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