I don't understand why regions with stability have more AIDS cases per capita!
Northwest aka Somaliland 1.4%
North East aka Puntland 1%
Central South - the rest of the country 0.6%.
ER
http://somalinet.com/news/world/English/2021
UNAIDS - Uniting the world against AIDS
AIDS in Somalia – An overview
The Epidemic
The results of the WHO 2004 sero-surveillance survey showed a mean HIV prevalence of 0.9% in 3 regions of Somalia. These data indicate that Somalis are approaching a generalized HIV epidemic. HIV prevalence varied between the different zones of Somalia: Northwest showed average HIV prevalence of 1.4%, North East of 1% and Central South of 0.6%. Experience from Sub-Saharan countries shows that when the rate of HIV exceeds 1%, it could be doubled or tripled in 2-3 years.
HIV epidemics are categorized into three stages; the generalized epidemic stage is characterized by an HIV prevalence that is consistently above 1% in pregnant women; in concentrated epidemics it is consistently >5% in at least one defined sub-population and is <1% in pregnant women in urban areas and in low level epidemic HIV prevalence has not consistently exceeded 5% in any defined subpopulation.
In Somalia (6) out of the (13) sites where pregnant women were tested, the average rate of HIV positive cases was above 1%. Berbera stands out as the highest HIV rate in the country. This could be explained by the fact that Berbera is a very busy port serving Djbouti, Ethiopia and Somalia. The rate of HIV infections in the other two ports of Somalia Mogadishu and Bosaso is also relatively high.
The young work force coming from the rural areas to the ports is living away from their family social bonds, a phenomenon that is well known for increasing vulnerability to HIV. In Hudur and Jowhar the average rate of HIV infection is 0%, 0.3% and 0.3% respectively. This could be due to limited population mobility because of the difficult security situation with low levels of HIV transmission. However, there should be no complacency in view of these relatively low rates. As soon as peace prevails, mobility and thus vulnerability to HIV may increase.
HIV prevalence among blood donors at the same 15 hospitals in Somalia in 2003 was (1.1%) and in 2004 (0.9%).
The average rate of HIV infection among patients complaining of sexually transmitted infections in Mogadishu, Bosaso and Hargeisa is 4.3%. Clearly this is higher than the average rate of HIV infection in the general population. STI patients among other sub-populations are one of the most famous bridging groups transmitting the HIV virus to the general population. When examining the burden of curable STI (Gonorrhoea and Chlamydia) among pregnant women and STI patients in Mogadishu, Bosaso and Hargeisa, the results showed average rate of 2.5% among pregnant women. Syphilis prevalence was found to be 1.1% among pregnant women in Somalia.
HIV among TB patients from Mogadishu, Bosaso and Hargeisa showed an average rate of 4.5%. HIV increases the risk of activation of latent tuberculosis and aggravates the disease. HIV among tuberculosis patients is an indicator of the level and maturity of the epidemic and hence the increasing burden of HIVrelated disease in the health care services.
The current drought situation in the central south and with it the significant number of populations who are in search of water (and food) and moving to urban centres (Wajid, Baidoa etc) can further increase the HIV infection rates. It’s critical that HIV prevention intervention will be integrated into the current emergency drought response.
The importance of the AIDS Commissions and a Roadmap: the (3 ones)
The HIV/AIDS response has been the first sector to bring the 3 Somali entities together in a common struggle to avert a major epidemic. Key to this process has been the establishment of AIDS Commissions in Somaliland, Puntland and south central Somalia.
A roadmap is being developed to scale up the work of the Commissions and establish one Somali HIV/AIDS Coordination Authority with one agreed strategic framework, one integrated prevention treatment care and support plan and one M&E framework.
The statutory existence of the 3 AIDS Commissions serves to elevate the response above politics through technical and information exchange.
This will be a pre requisite for building Somali institutional and human capacity to play a greater management role in the use of current resources and to develop resource mobilization strategies.
Until the PAC, SOLNAC and SCAC capacities are in place and the 3 ones are in place, the response will remain dependent on Nairobi based international community leadership.
GFATM, UN and DFID and other bilateral funding hold over $30 million for the Somali response over the next 5 years. The current UN-led Joint Needs Assessment process for Somalia will outline funding needs till 2010. Somaliland and Puntland have allocated some own resources in 2005 and made budgetary provisions in 2006. The response is adequately funded by the Global Fund Against AIDS, Tuberculosis and Malaria (GFATM), the UK Department for International Development (DFID) and UN regular budgets for the next two years. HIV/AIDS has been mainstreamed into the Joint Needs assessment and Consolidated Appeal Process.
There is commitment from development partners to support the response. An articulated UN Implementation Support Plan and Integrated Prevention Treatment Care and Support work plan has aligned project financing more strategically but this needs to be revised and greater attention paid to prevention with a focus on most vulnerable populations.
In review meetings, primary structures, roles and responsibilities of the Commission, secretariat and implementing bodies were delineated from policy functions and technical coordination and M&E and implementing responsibilities. It was agreed that the secretariat role is one of coordination, M&E and strategic oversight of the response - rather than implementation. The Commission functions at a policy level through its membership of line ministries, PAC secretariat Ex Dir, civil society, PLHIV, religious leaders etc. These structures in no way limit or subsume the relationships and bilateral activities between line ministries and partners. The imperative is that the secretariat and the commission are fully cognizant of the HIV/AIDS related work by all partners.
Global Fund on HIV/AIDS, TB and Malaria
Substantial resources have now been mobilized to help support a major national response to the emerging HIV epidemic in Somalia. Of note are the considerable resources made available from the Global Fund. The GF TM HIV grant focuses on achieving three main objectives:
*- To establish and strengthen management structures for coordination, monitoring and evaluation of programmes.
*- To reduce the transmission of HIV/AIDS in adults, children and high risk groups through a strengthened support to preventative services
*-To ensure that People Living with HIV/AIDS in Somalia and their families have access to high quality, affordable care and support services.
Universal Access and Uniting for Children, Uniting Against AIDS
The Universal Access initiative provides new momentum to the Somali response to comprehensively scale up and integrate prevention, treatment, care and support within the context of a multi-sectoral HIV response, as well as broader development processes for Somali populations. This will also help focus the response around most vulnerable groups and especially children through following approach.
Primary prevention
Prevention of Mother to Child Transmission (PMTCT)
Paediatric treatment
Protection, care and support for children affected by HIV/AIDS
The approach seeks to ensure that children and young people are not being missed out in the response to HIV and AIDS. The majority of the Somali population is under the age of 18 and must have access to correct information, skills and services to prevent HIV infection, and treatment, care and support for those in need.
