Daouda is a chief mechanic at an automobile garage near Côte d'Ivoire's economic hub, Abidjan.

He found out he was HIV positive in February 2002. At this time, his company did not have an insurance policy in place for treating employees infected with HIV.

"When I first realized I was HIV positive, I saw my grave," says Daouda. "At this time, people in Abidjan who were infected with HIV and who didn't have the means to pay for treatment left the city to die in their places of origin," he explains.

"In the beginning, I was often absent from work," he continues. "I lost 20 kilos and my CD4 count was between 80 and 100," he adds. CD4 cells are cells that determine the immune system's ability to fight infection.  A normal CD4+ count in  a healthy, HIV negative adult is about 1000 per cubic millimetre of blood.

Daouda could not afford the cost of anti-retroviral (ARV) treatment in the country at this time, a complex regimen averaging 350,0000 CFA ($692) per year. ARV therapy enables those infected with HIV to continue to work and live.

But his boss soon decided he could not do without him. Daouda was the only qualified mechanic he had. Plus, he had already invested a lot of money in his training, having sent him on a mechanics course in Europe.

With the encouragement of Daouda's doctor, Dr Henri Chenal, director of the Abidjan-based private Aids clinic and research center CIRBA, he decided to take on eighty percent of his employee's ARV therapy.

Encouraged by Daouda's example, he has since worked with CIRBA to extend the policy to the benefit all of his employees and to have the company insurance policy cover 100 percent of ARV therapy. The garage now also has an Aids committee responsible for HIV awareness and prevention campaigns.   

In February 2005, Daouda will have been on ARV treatment for three years. While his treatment has helped him to gain twelve kilos and increase his CD4 count, which is now around 380, it has been and still is heavy and hard to follow. At one point he was taking a combination of 8 pills during different times of the day.

"I find it tough to respect my ARV dosage, but my wife keeps me accountable," he says. "She wakes me up in the middle of the night to make sure I have taken my pills," he adds.

Since he was first diagnosed in 2002, the 35-year old has been on several different ARV regimens. 

"Daouda has been forced to change his treatment 4 times in 2 years because of the frequent interruptions in supplies of ARV drugs at the PSP (Pharmacie de la Santé Publique), Côte d'Ivoire's centralized national pharmacy for the order and distribution of medical supplies," explains Dr. Chenal.

"To give you an idea, in 2003, the average interruption period per ARV drug was two months," he adds. "I spend my time switching my patients from one ARV treatment to another," he laments.

The PSP's overdue payments to pharmaceutical companies for ARV drug deliveries are causing these interruptions.

Financing the war is taking priority over financing ARV drugs

Daouda also faces another challenge. He cannot talk openly about his illness with his colleagues.

"If my clients found out, they would not let me work on their cars and we would lose customers," he says.

"When I am fully recovered, I will talk openly about my disease," he asserts.

It was not until three months after he knew his HIV status that he mustered up the courage to tell his own wife.

The strong HIV-related stigma that exists in the country is leading many Ivorians employed by companies to bypass corporate HIV programs and take charge of their illness individually. With the recent drop in ARV prices to 5000 CFA ($10) for 3 months of treatment, many people prefer to pay out of their own pocket rather than run the risk of being stigmatized as HIV positive within their companies.

Note: Interview conducted in October 2004.