In Somalia, diagnosing AIDS can be risky

[musika man]

it is like diagnosing dawladsade with hiv. he will blame his doctor and kill him.

In Somalia, diagnosing AIDS can be risky
By John Donnelly, Globe Staff | February 27, 2006

JOWHAR, Somalia -- There may be no harder place in the world to fight AIDS than Somalia.

For the United Nations and Western charities, some areas are off-limits because it is so risky. But even in places where they operate, the basic task of testing someone for the virus is widely considered too dangerous.

''If we tell someone that they are HIV positive, they might take revenge," said Josef Prior Tio, general coordinator for Doctors Without Borders in this central Somali town and in Mogadishu, the capital.

''You could get killed," said Halima Hasan Osmani, a supervisor at a Doctors Without Borders clinic that specializes in care for pregnant mothers but does not test for HIV. A nearby hospital does offer tests, but the Doctors Without Borders staff will not ask whether a patient knows his or her status.

Faiza Narbeth, a Somali native and consultant to the UN Development Program's HIV/AIDS initiative, explained the problem by telling a story she had heard earlier this month at an educational HIV/AIDS seminar. She said that one participant told the group about a birth attendant who had tested a pregnant woman in the southern city of Kismayo, learned that the woman was HIV positive, and then gave the result to the woman and her husband.

''The participant in the seminar told us that the husband accused the birth attendant of infecting his wife," Narbeth said. ''The birth attendant was hidden by the community and had to flee from Kismayo. But the husband found her and shot her dead. These stories are commonplace."

http://www.boston.com/yourlife/health/d ... _be_risky/

[musika man]

this was 6 years ago, today arround half a million somalis are hiv positive.

In many places in Somalia, we are not just talking about people who do not know how HIV/AIDS is transmitted, we are talking about people who have never even heard of the disease"

MOGADISHU, 29 January (IRIN) - "HIV" and "AIDS" are words hardly ever heard in Mogadishu, the capital of Somalia. But the deadly disease is certainly present, according to local and international humanitarian workers.

"If you know you have even one case, it means HIV/AIDS has arrived and you have to address it," Eban Taban, a UNICEF AIDS researcher, told IRIN.

The biggest problem is to get people in the wrecked city - where there have been no government health services or institutions for a decade - to believe it. At present, the prevalence of HIV/AIDS in Somalia is believed to be under one percent, Mehret Gebreyesus, UNICEF programme officer for HIV/AIDS told IRIN. But Somalia is surrounded by high-risk countries, like Kenya, Djibouti and Ethiopia, and has a huge diaspora outside Africa.

"In many places in Somalia, we are not just talking about people who do not know how HIV/AIDS is transmitted, we are talking about people who have never even heard of the disease", one Somali humanitarian worker told IRIN.

Lounging against the wall of his house holding his gun, with belts of ammunition wrapped round his neck and waist, a young militiaman shrugs away any talk of AIDS.

"We are a Muslim country and we do not have this problem," he asserted. He is from one of the high-risk groups. "You can be sure that many of these young, sexually active youths do not have a clue what HIV/AIDS is," said one Mogadishu resident.

The UN estimates there are at least 20,000 militiamen in Mogadishu.

Most are young, aggressive and lack the most basic education in a country fractured by civil war and lack of governance. They have lived an isolated existence since the collapse of the state in 1991. Many have no access to television, radio, newspapers or magazines - let alone health and education services.

And it is not just the young and armed who shrug the problem off. It is also a typical reaction from the well-educated, the well-travelled, and the well-provided for in Mogadishu. "That makes everyone dangerous," said one humanitarian worker.

A threat overlooked

On 11 January 2001, the UN Security Council approved plans for a peace-building mission in Somalia, saying the new interim government faced "massive challenges". High on the agenda for assistance was demobilisation with "special attention to measures to combat HIV/AIDS and other communicable disease," said the Security Council statement.

Poor security in the country and disengagement by the international community has meant Somalia has been overlooked in a decade that otherwise saw a push to combat the deadly spread of the disease in Africa.

Even where international agencies have established HIV/AIDS projects for Somalia, a significant number of these programmes are managed outside the country, in neighbouring Kenya.

In a recent UNICEF study on HIV/AIDS in Somalia, the alarm was sounded over a chronic lack of services and the very low level of awareness of the disease. The study, conducted September-October 2000, said "free condom distribution and their use is not very popular or common in Somalia."

An earlier study, conducted December 1999, reported condom use as "extremely low" and the rate of Sexually Transmitted Diseases (STD) in the general population "unacceptably high". The most recent study collected information from 28 non-governmental organisations and international agencies with Somalia programmes.

Regions canvassed included Benadir, Beletweyn, Hudur, Baidoa and Bardera in the Central and Southern zone; Bossaso, Garowe and Galkaio in Puntland, northeastern zone; and Boroma and Hargeisa in the self-declared state of Somaliland, northwestern zone.

Another more detailed study was carried out in December 1999 in Somaliland, where stability and development is good compared to most other areas, particularly Mogadishu. Authorities in Somaliland and the autonomous region of Puntland had adopted HIV/AIDS prevention and control work plans, and expressed "high political commitment" to combat the disease, said the study. But despite this, very few Somalis know how to prevent HIV/AIDS, found the study.

Many thought avoiding public toilets and mosquito bites helped prevent infection. Knowledge about condoms was low. Most believed they were not at risk, yet the rate of STDs was very high.

There were known cases of HIV/AIDS in Somaliland, which has an international port at Berbera, and strong overland trade links with neighbouring Ethiopia. "In general, Somalis appear to be tolerant to persons who are already infected" and expressed willingness to care for persons living with HIV, found the study. But it also warned that anecdotal information from local NGOs suggested the opposite: "relatives of patients usually remove the infected persons from hospital to abandon them far away from home". There was a need for community structures to care for and support to people living with HIV, urged the report. It also noted that Somalia has a very high prevalence of tuberculosis (TB), closely associated with HIV/AIDS, said the survey.

In a country that has been isolated in the international community, HIV/AIDS researchers found that the canvassing and work done for the study had an impact in its own right. Figures given to regional authorities and health workers on the number of people who had died of AIDS in Africa had worked as an eye opener. It had "made Somalis realise that they live in a glass house", said the report. Controlling the spread of AIDS

"I have seen at least 20 cases of HIV/AIDS and there is no denying that the disease is here"

In Mogadishu, Dr Muhammad Mahamud Ali 'Fuje', a consultant with the World Health Organisation, runs a private medical clinic. "I have seen at least 20 cases of HIV/AIDS and there is no denying that the disease is here", he told IRIN. He said he had dealt with orphans who had lost both parents to AIDS, but that there were few even in the medical profession who acknowledged the problem. There is a stigma attached to discussing anything related to sexually transmitted diseases.

"The potential for an outbreak is real, unless we take appropriate measures" Dr Fuje said.

Madina, the main hospital in Mogadishu, supported by the International Committee of the Red Cross (ICRC) began screening for HIV/AIDS in June 2000. Head of the laboratory department Mohamed Ali told IRIN that four cases of HIV had been identified. But he said it did not reflect the presence of the disease because it was taken only from those who agreed to be screened, or through compulsory screening done at the hospital for blood transfusions. Most of the private hospitals and clinics (see Somalia: A Health System in Crisis) do blood transfusions without screening or proper procedures. Dr Muhubo Gure of the United Nations clinic in Mogadishu believes it is one of the most dangerous practices in the private clinics. Dr Fuje agrees that if blood transfusion safety is not instituted, it is one of the easiest ways to spread the disease.

Another major concern in Somalia is the high rate of other sexually transmitted diseases (STDs). Mehret Gebreyesus, UNICEF programme officer for HIV/AIDS, warns that STDs are "precursors of HIV". She points to a study carried out jointly in Mwanza by the Tanzanian Government, the Institute of Tropical Medicine in Antwerp, Belgium, and the London School of Hygiene and Tropical Medicine, UK, which indicated that treating STDs cut down on the transmission of HIV by 40 per cent.

Not much is known about HIV/AIDS in Somalia, admits Mehret Gebreyesus - but UNICEF and other humanitarian agencies have started putting plans into place this year.

UNICEF have identified 11 sentinel sites in hospitals, large clinics, and mother and child health centres (MCHs) throughout Somalia to collect information, which will be compiled in a quarterly report. UNICEF is also planning this year to "strengthen laboratories, counselling, and embark on an awareness campaign", Mehret told IRIN. Health professionals are being trained by UNICEF on a "syndromic" approach to STDs, which treats the symptoms immediately in an attempt to avoid further spread.

Campaigning carefully

One of the most difficult aspects of raising public awareness is the deep-seated belief in Somalia that HIV/AIDS is a "non-Muslim disease" and a "foreign" affliction. Religiously and culturally there is little public familiarity with, or acceptance of, sexually explicit debate or sexually explicit images. Attempts to raise public awareness about HIV/AIDS are by definition "not appropriate" culturally or religiously, pointed out one humanitarian worker - and will have to be introduced with caution.

One humanitarian worker described showing a group of Somali elders sexually explicit campaigning material designed to raise public awareness of how HIV/AIDS is transmitted. She said she had to leave the room so that they could look at the material and decide whether it was possible to use it. It was "impressive" that they accepted to look at it at all, she said. Religious leaders vowed to mobilise their Sheiks and Mosques to address HIV/AIDS during Friday prayers after UNICEF held a series of seminars in Somaliland and Puntland in September and October 1999. The promise came after the presentation of "staggering statistics of HIV infections and death rates as a result of AIDS (in Africa) stunned seminar participants," said the UNICEF survey. The seminars were attended by government officials, religious leaders, elders, women and youth groups as well as local and international NGOs and UN agencies, with the broad objective of raising levels of awareness on STDs and HIV/AIDS.

Despite high commitment by the authorities in Somaliland and Puntland to address HIV/AIDS, the surveys conducted found a lack of data for programme planning and development in all sectors of government. UNICEF, the World Health Organisation (WHO) and the International Cooperation for Development (ICD) agreed to conduct a joint sero-prevalence survey, and monitor local knowledge, attitudes, beliefs and practices. With an interim government establishing itself in Mogadishu and the south, there are hopes for new opportunities to launch campaigns and conduct surveys in areas that have long been neglected.

However, security concerns and the fragmented political map mean there are still formidable obstacles - on top of the religious and cultural ones - to implementing urgently needed public awareness campaigns.

Improved security and prospects for peace will put even greater pressure on the race against the disease, however. While the prevalence of HIV/AIDS is at present very low in Somalia it is very high in surrounding countries, such as Ethiopia, Kenya and Djibouti, warns the UNICEF report. An "increase in the number of returnees in the north from refugee camps in Ethiopia and Djibouti is likely to change the situation (in Somalia) unless there is strong support to carefully designed HIV/AIDS prevention and control programmes." In Somaliland, thousands of refugees have been repatriated over the last few years, or commute regularly from camps in Ethiopia.

After the new interim government was established in Mogadishu, the Kenyan government expressed hope that thousands of Somali refugees in Kenya would soon be in a position to return to their homeland. Many of the diaspora are hoping to return one day from even further afield. One of the consequences of the collapse of the Somali state in 1991 was massive population movement. Regardless of social standing, Somalis returning home from neighbouring countries, North America or Europe may bring back more than hope for the future - making HIV/AIDS awareness programmes a vital priority for any authority in the country.

http://www.aegis.com/news/IRIN/2001/IR010107.html

[musika man]

UNAIDS: Aids Epidemic in Somalia
Tue. March 14, 2006 04:33 pm.

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.

http://somalinet.com/news/world/English/2021

[musika man]

http://somalinet.com/news/world/English/2021

UNAIDS: Aids Epidemic in Somalia
Tue. March 14, 2006 04:33 pm

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.

http://somalinet.com/news/world/English/2021

[Shilka Jr.]

Typical self-destructive Gaaljecel mentality.