Despite the low rate of HIV/AIDS infection in Mali today, USAID's Synergy project reported indicators that HIV could spread very rapidly. Less than 10 percent of Malian women know how to avoid AIDS, and only 2 percent of women use condoms to prevent transmission of HIV. A second factor is the high level of HIV in commercial sex workers; 52 percent of prostitutes tested in urban areas were HIV positive. A third area of concern is the seasonal migration of farm workers to and from Cote d’Ivoire, the West African country with the highest rate of HIV infection. Finally, the practice of female genital mutilation (FGM) is widespread, leaving the 90 percent of the female population having undergone FGM at greater risk for HIV.

Mali’s current low rate of HIV prevalence is in part due to political commitment at the top. Former President Alpha Oumar Konare (later elected head of the African Union) appeared on television to promote the use of condoms to prevent the spread of HIV/AIDS. The social marketing of condoms, a typical part of HIV prevention programs, has been complicated by Mali’s extreme poverty and the opposition and criticism of Muslim clerics and conservative politicians.

Mali reported TB detection, notification and treatment information to the WHO in 2000, but did not report data in 2001. The United Nations Statistics Division reports that in 2000 Mali had 235 TB cases per 100,000, and 56 TB deaths per 100,000. The DOTS detection rate that year was 14 percent, and the successful treatment rate in 1999 was 68 percent.

Malaria is endemic throughout Mali; if malaria prevalence has remained constant since the United Nations Statistics Division's last reported data in 1998, Mali has approximately 440,000 reported malaria cases each year. More than 10 percent of those cases are fatal. USAID has reported that an estimated 85 percent of pregnant women in Mali contract malaria. Reducing this statistic is a major objective of USAID's country health program.

Sources: Synergy Project; BBC country profile; WHO Report 2003: Global Tuberculosis Control; United Nations Statistics Division; World Bank; USAID mission in Mali

• Expanding and improving the network of community health centers that provide primary health care for most Malians.
• Providing management and technical training for health professionals.
• Increasing affordability of health care through insurance and cost-sharing programs.
• Improving the technical capabilities and cost efficieny of government hospitals.

In the 1990s the World Bank convinced Mali's government to end the monopoly on pharmaceuticals held by Pharmacie Populaire du Mali (PPM). This has had the beneficial effect of cutting drug prices in Mali by as much as 80 percent. According to the World Bank, while the government of Mali preserved PPMs monopoly status, PPM restricted the availability of generic drugs, inflated prices, and padded its payroll. The introduction of generic drugs and a competing NGO drug distributor has led to the reduced drug prices. Mali is also one of 13 nations taking part in the UNAIDS Accelerating Access Initiative (AAI), allowing it to purchase HIV/AIDS drugs from pharmaceutical companies at reduced prices.

Sources: World Bank, USAID, Centre de Cooperation Internationale en Santé et Développement (CCISD)

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

The health infrastructure in the northern half of the country, which extends into the Sahara Desert, has been and continues to be much weaker than in the southern region and along the Niger River.

The World Bank reports that the average Malian receives care from the formal health sector only 0.16 times per year. This low level of utilization is a result of several factors, including inability to pay for services, inaccessibility of health facilities, and poor outreach.

Sources: World Bank, World Health Organization, Roll Back Malaria.

University of Mali, Malaria Research and Training Center

The Malaria Research and Training Center (MRTC) at the University of Mali in Bamako is the most important medical research facility in the country. MRTC’s mission includes pharmaceutical research, especially research in developing a vaccine for malaria. NIAID works closely with the MRTC. Secretary of State Colin Powell’s visit to Mali in summer 2001 included a brief visit to the MRTC.

Tulane University and the Ecole Nationale de Medicine et de Pharmacie at the University of Mali worked with the Center for Health Applications of Aerospace Related Technologies (CHAART) of the Earth Science Division of NASA to use satellite imagery to better understand the epidemiology of malaria in Mali. Researchers from Tulane are also conducting epidemiological studies on the ground in two villages where the malaria parasite is endemic for about half the year. Researchers hope to identify factors that lead to severe illness in some children when the malaria parasite is present in the bloodstream of virtually the entire population.

Sources: MIM, Tulane University

1. ESTHER, a European AIDS initiative launched in Rome in 2002 with support from France, Italy, Luxembourg and Spain, aims to build partnerships between European hospitals and health care systems in the developing world. Mali is one of the nations in which ESTHER plans to begin its work.

   Source: ESTHER Network fact sheet

2. The Global Fund has approved roughly $23.4 million in funding to combat HIV/AIDS in Mali. $2.7 million has been approved to fight tuberculosis. The grant agreements have yet to be signed.

   Source: Global Fund agreements and disbursements spreadsheet