In Somalia, isolation has kept AIDS at bay
XUDDUR, SOMALIA -- They have posters. They have training manuals. They have wipe-off markers. The only thing that the earnest band of AIDS educators in this Somali town don't have is, well, any people with AIDS.
At least none they know of.
The breadth of the AIDS pandemic has led to the idea in the West that the entire continent is ravaged by the disease. But Somalia -- isolated for 14 years since the civil war began and populated by devout Muslims -- has an infection rate of perhaps only 1.5 or 2 per cent of the adult population.
Its isolation has helped to keep the infection rate one of the lowest in Africa at a time when countries to the south are reporting infection rates of 40 per cent of the adult population.
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But the 1-per-cent infection rate is the mark at which epidemiologists warn of an impending explosion. Much of the population is nomadic and the growing desperation in the country leads to ever more movement.
Migration and conflict are both key indicators for the spread of AIDS. As well, cultural factors increase the risk as there's a strong taboo against condom use and a widely practised tradition of female circumcision, which makes women more prone to sexually transmitted diseases and more susceptible to HIV infection during sex.
At the same time, no health ministry or media or schools or even civil-society network exist through which to teach prevention and provide education on the disease. The country has had no central government since the dictator Siad Barre was toppled in 1990.
A long and tortured peace process produced a new government late last year, although most of the members of the new parliament remain too frightened of the anarchy and continuing fighting to actually come to the country, and instead lurk over the border in Kenya.
Somalia is run by warlords and clan chiefs, and the sole health-care provider in most of the south and central regions is Médecins sans frontières (Doctors Without Borders), which has a small hospital in Xuddur, 230 kilometres west of war-torn capital Mogadishu.
But a few young people -- a couple of nurses, a few clerics and some concerned women, who heard about AIDS on the BBC Somali service, the only media here -- got together a year ago to form the HIV-AIDS Awareness and Development Organization. Reflecting the degree to which AIDS is perceived as an outside issue here, it has an English name in a town where virtually everyone speaks Somali.
"We can't look and say, We have no central government so we will just sleep," Adan Said Abdi, 27, said. "Maybe we can do half the things that are needed, that a government could do."
A Unicef-sponsored study last year said that "Somalia has a unique opportunity to curb the spread of the HIV-AIDS epidemic within its population but the window of opportunity exists now."
So, at HAADO, they are doing their best, although they are up against the widely held idea that AIDS is not a Somali problem. The UN study found that one of the recurring themes in all interviews was "denial of the presence of HIV in Somalia" and the "perceived protective effects . . . of wide spread practice of Islam."
"We heard it in the press all along, but we've never seen someone who has this disease," Nima Mohammed, 32, said.
There is no one in Xuddur publicly living with HIV. Indeed no one in Somalia; only two HAADO members have met anyone who was open about being infected, and that was in Kenya.
Traffic across the borders is one of the few ways Somalis can get access to education, health care or economic opportunities -- moving into and out of neighbouring Kenya where the HIV rate is 8 per cent, and to Ethiopia, where 1.5 million people are living with AIDS.
The 1.5-per-cent infection rate, though, suggests there are at least 45,000 Somalis with HIV-AIDS; there are gaunt and gasping cases in the MSF wards that are almost certainly AIDS-related.
HAADO members did a door-to-door survey that found half the people in this western region had heard of AIDS, although only 10 per cent knew how the virus is transmitted.
Their survey found that only 1 per cent of people understood the basics of how the disease works, and those who did recommended measures such as quarantine of anyone found to be infected.
In village workshops, the group encourages people to get tested and learn their HIV status, but the nearest place to get a test is Mogadishu, an expensive two-day trip on a bandit-infested road.
They also preach abstinence and fidelity -- but not condom use. Members, particularly women, are strongly against that.
"We don't allow our men to use a condom when they have sex with us -- we simply won't accept that he has other partners and it would be a big family problem if he did," Ms. Mohammed said.
She and the other members grudgingly acknowledged that epidemic levels of syphilis suggest that religious and cultural norms are not producing total fidelity, but they were adamant that condom use was not acceptable, regardless of the risk of AIDS.
Religious leaders in town met late last year to discuss the issue of condoms and concluded that using them was not acceptable under religious law on the grounds that sex outside marriage is also not permitted. Condoms will not always be available, explained Ali Sheikh, 34, who sat on that council. "We say to avoid needing it, and also do tests before marriage."
Condoms are sold, discreetly, in town pharmacies and MSF gives them away, but the UN study found thar less than 20 per cent of respondents had ever used a condom or would do so in the future.
They teach people in their workshops to use clean instruments when they circumcise children -- boys as infants, and the much more radical surgery performed on girls around the age of 7 -- but don't discourage the practice entirely.
MSF reports an "epidemic" of urinary tract infections, caused by poor hygiene in circumcised women, and of sexually transmitted infections, particularly syphilis.
A person with a sexually transmitted disease is estimated to be eight times more vulnerable to HIV infection; the bleeding that so often accompanies sex in circumcised women also jacks up the risk.
There is no question that much of the motivation for this group is the fact that, in abandoned and resource-starved Somalia, there are small bits of money or training to be had for AIDS work, when almost nothing else draws donors to the country.
But there is also sincere conviction here, and fear for the future. "This is my community, and they need to be protected from this disease," said Amina Hassan, 19. "So I had to stand up and say something to them."
source:
http://www.theglobeandmail.com/servlet/ ... nal/Africa
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The moral of this article is that as long as we don't mix with adoons (read stay pure) we can contain the vile disease. Yet another reason to stay away from adoons!!
