Somaliland HIV/AIDS Newsletter " name=keywords> Somaliland Cyberspace

Somaliland HIV/AIDS Newsletter

CONTENTS

By UNAIDS UNAIDS Country Group, Dec 22 2005

This newsletter is a contribution of the UN Theme Group on HIV/AIDS in collaboration with Somaliland National AIDS Commission (SOLNAC) and Somalia Aid Coordination Body partners in order to enhance sharing of data and strategic information among all actors in the HIV/AIDS response in Somaliland. Above all, this forum is intended to give a voice local non governmental organisations (NGOs), religious leaders, young people, women and girls, the local authorities and people living with HIV (PLWH) to disseminate lessons from their HIV/AIDS-related work.

The forum should also be used to invigorate our efforts to ensure that appropriate data and strategic information is being generated and systems put in place to collect it and use it as an evidencebase and community feedback tool for the response.

The newsletter will be issued quarterly, with the release of this first issue coinciding with 2005 World AIDS Day commemoration on December 1st.

We wish you a happy reading of this maiden issue and welcome your comments as well as suggestions on topics of interest for the next publications.

El-Balla Hagona , UN Theme Group Chairman
Leo Kenny, UNAIDS Country Coordinator

Somaliland launches National AIDS Commission (SOLNAC)

Greater coordination of HIV/AIDS response at the national level is recognized as a global best practice in effective HIV/AIDS prevention, control, treatment, care and support. In recognition of the need to coordinate all efforts on HIV/AIDS response, the President of Somaliland, His Excellency Dahir Rayale Kahin, launched on September 15th, 2005 a National AIDS Commission (SOLNAC). This historic occasion was witnessed and supported by the UN Country team. The launch of SOLNAC was preceded by a Presidential policy decree signed on June 28th, 2005 that affirmed the Government's commitment to HIV/AIDS prevention and control. The coming into being of SOLNAC has ushered in a multi- sectoral approach to HIV/AIDS response in Somaliland bringing together the local authorities, United Nations system, development partners, local and international NGOs, religious leaders and civil society organisations.

Commission (SOLNAC) opens its secretariat

SOLNAC has since its launch, opened a secretariat with a full time Executive Director and other staff members. As a show of its commitment to HIV/AIDS response in Somaliland, the Government met the bulk of start-up costs for the secretariat including office rent for the first six months, office equipment and furniture, one 4-wheel drive vehicle and other general office overheads, all estimated at nearly US$30,000.

Within its short life, the SOLNAC secretariat has made a number of accomplishments. The secretariat has developed a quarterly action plan up to December, 2005, organized briefing meetings with international and local non-governmental organisations working on HIV/AIDS, organized and chaired consecutive meetings to plan for World AIDS Day 2005 activities, and held informal meetings to pave way for engaging the media and religious groups in HIV/AIDS response.

Key challenges facing SOLNAC are inadequacy of financial resources, slow process of transfer of funds committed by donors and development partners and inadequate human capacity. These notwithstanding, the secretariat is effective as exemplified in an observation by one of its members that "for the first time, we are able to call ministers and other high level decision makers into meetings even at short notice, and everyone commits fully their skills and talents to discuss and plan for HIV/AIDS response in Somaliland".

Resource-base for HIV/AIDS response

Global Fund against AIDS, Tuberculosis and Malaria (GFATM)

The GFATM is an international collaboration of donor agencies to increase the funds available for tackling HIV, TB and Malaria. In early 2005, the GFATM approved funds for a five-year (2005-2009) HIV grant for Somalia. This proposal was submitted and endorsed by the SACB Health Sector Committee.

UNICEF was subsequently elected as the Principal Recipient for this grant. This fund will enable a comprehensive HIV/AIDS response among Somali populations through the involvement of government authorities and civil society organisations, including women, youth, religious groups and PLWH. Since June 2005, UNICEF has been enlisting implementation partners for different components and developing administrative and coordination structures both at the country level and with the implementing partners.

In early November, a team from the Global Fund Secretariat visited Nairobi and met with various parties involved. The main purpose of the visit was to familiarize themselves, along with a senior officer from the UNICEF headquarters, on the progress of the HIV, TB and Malaria grants; status and procedure for Phase II funding; current political dynamics in Somaliland and its likely effect on implementation of the GFATM programme. At a Health Sector Committee meeting, the visitors stated that on the whole they were impressed with the progress of the programme to date and were encouraged by the level of coordination and follow up with and between all concerned parties.

The Global Fund Secretariat representatives also expressed appreciation of all partners' efforts to increase Somalis participation in the Global Fund Management architecture. As a start, SACB's Integrated Prevention Treatment, Care and Support (IPTCS) group, Monitoring and Evaluation group and the Global Fund Management have been trying to hold meetings in Somaliland. The HIV/AIDS Working Group and Somali NGO Consortium are now regular partners in the Global Fund Management Team.ian declaration on support to people living with HIV.

Capacity building

The Algerian declaration on support to people living with HIV (PLWH)

With the support of UNAIDS, three Somali people living with HIV (PLWH), SOLNAC's Executive Director and a Medical Doctor from Hargeisa Group Hospital attended Middle East and Northern Africa (MENA) regional meeting on 'consultation on support to PLWHA' in Algiers from November 13- 17, 2005. The meeting made a declaration to, among others:

* ensure comprehensive treatment, care and support are available;
* address stigma and discrimination;
* ensure regional and sub-regional follow-up initiatives are developed including sharing of best practices; and
* facilitate vocational and other special training to build livelihood capacities of PLWH.

Local partners trained on information management To promote in-country capacity building, UNAIDS organised a training for 32 local partners on HIV/AIDS management information system using the Country Response Information System (CRIS) as from November 8-13, 2005 at Hargeisa University, Somaliland.

Community Feedback

Community groups provide strategic information relating to the status of HIV/AIDS response in their country. The current issue of the Newsletter focuses on community group members': perceptions of the changes brought about by the formation of SOLNAC; perceptions of whether HIV/AIDS is a problem within the communities or not; and suggestions for greater involvement of communities in HIV/AIDS response.

Religious leaders

A religious leaders network of 20 Al-Rhama Sheikhs called (meaning mercy), whose two founder members were supported by UNDP to participate in a capacity building workshop on religious leaders role in HIV/AIDS response in Yemen in September, 2005 is now in place. The UN Theme groupwill, in early 2006, bring this network together with Al-Ihssan network in Puntland and the others from Central South Somalia to plan for their strategic involvement in HIV/AIDS response. The planning process will ensure greater involvement of the religious leaders in identifying and designing strategic HIV/AIDS responses in which they can make an impact.

Youth groups

For the youth, the establishment of theSOLNAC secretariat is a crucial aspect in the response.

They observe that “as youth we believe the establishment of SOLNAC will enhance and contribute to the effective implementation of interventions in the country. HIV/AIDS is a social, economic problem and affects the youth as they are more vulnerable to AIDS” . Their interest is in seeing the development of IEC programmes that are in line with the local context.Local civil society organisations The local civil society organisations note that SOLNAC has showed willingness to work with them and thus see the establishment of the SOLNAC secretariat as a good beginning. They see HIV/AIDS as an emerging problem requiring a quick response. Their greatest concern is timely access to resources for effective implementation of responses.

Status of HIV/AIDS Response in Somaliland

Advocacy and policy support

SOLNAC believes that the media is the most important tool for advocacy. Accordingly, SOLNAC has held meetings with the media companies so as to create a mutual relationship and defuse a negative attitude that has prevailed regarding the need for HIV/AIDS response in Somaliland. The media companies have now built trust with SOLNAC and have also shown full support for HIV/AIDS prevention programs. For instance, in one of the workshops organised by UNDP from November 7-13, 2005, to develop appropriate messages for behaviour change communication in Somaliland, the national Television channel aired live, every evening, the deliberations of the workshop participants. This ignited public interest in HIV/AIDS issues, particularly in Hargeisa.

Prevention interventions

HIV/AIDS prevention interventions in Somaliland currently consist largely of intermittent awareness campaigns conducted by local NGOs working in collaboration with international NGOs and some United Nations organisations such as UNIFEM, UNICEF and WFP. UNIFEM's activities address the intersection between gender-based violence and HIV/AIDS risks and vulnerability among women, using organised women's groups in Somaliland as the channels for reaching out to the communities.

UNICEF's approach involves building the capacity of school teachers to provide life-skills education. UNICEF has also conducted training on voluntary counselling and testing for participants drawn from maternal and child health (MCH) clinics and other government hospitals and provided HIV test kits to all major hospitals, including one private hospital in Somaliland. A review is currently underway to guide implementation. Real gaps in prevention exist in voluntary counselling and testing, prevention of mother to child transmission of HIV and sexually transmitted infections (STI) services, which are still limited. Blood safety standards are observed in all the health facilities, courtesy of technical support of the WHO. Voluntary counselling and testing is presently available only at Hargeisa Group Hospital.

Hargeisa Group Hospital's pilot ART project A pilot project to provide antiretroviral therapy (ART) to people living with HIV (PLWH) was established in June 2005 at Hargeisa Group Hospital. The project, funded through donations from British Government's Department for International Development (DFID) and United Nations Organisations' regular budgets was started with 50 patients. This project has been integrated into a public hospital and is planned to be sustained through funds from the GFATM, government health budget allocations and community mobilization.

The Senior Health Advisor to DFID and the UN Country Team visited the hospital on October 12th 2005. Lauding the hospital for its impressive work, the team emphasised that “at the current stage of the HIV/AIDS epidemic in Somaliland, primary prevention including treatment of sexually transmitted infections and blood safety standards should be prioritised as this would also contribute to the success of the ART pilot project”.

Status of ART pilot project - November 2nd, 2005

* No. of patients on HIV/AIDS care - 67
* No. of patients already on ART - 34 (13 females; 21 males)
* Number of patients not on ART - 35 (22 females; 13 males). These patients have not yet reached clinical stage requiring ART

UNAIDS new initiative on 'scaling-up towards universal access'

At their July 2005 Gleneagles Summit, the G8 agreed to increase official development assistance and called on UNAIDS, WHO and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of reaching as close as possible to universal access to treatment for all those who need it by 2010. The process has been developing at the global level with the target being discussions at the UN General Assembly in mid- 2006.

Announcements

Up-coming events

* 14th International Conference on AIDS and STIs in Africa (ICASA) Abuja, Nigeria (December 4-9, 2005). ICASA, held biennially, is organized by the Society for AIDS in Africa (SAA). Through the ICASA conference, the continent is able to take stock and analyse various responses and their impact on the management of HIV/AIDS and STIs in Africa. The UN Theme Group will support the participation of representatives of SOLNAC and its member line ministries at this conference.
* 2nd National Conference of Somaliland HIV/AIDS NGO Network - SAHAN Hargeisa (November 27-29, 2005) Call for contributions to the next issue - 31st March 2006

The next issue of this Newsletter will be released on 31 March, 2006. The following types of contributions are welcome:

* short manuscripts of less than 300 words on relevant topical issues such as women and AIDS, religion and AIDS, etc;
* updates with quantitative information on activities implemented from December 2005 to March 2006;
* announcements of upcoming events such as conferences, training, workshops; and
* relevant data and strategic information for HIV/AIDS response.

Contributions for the next issue should be sent on or before March 10th, 2006 at the addresses shown below.

Compiled and produced by the UN Theme Group on HIV/AIDS (Somalia) UNDP Somalia, Springette, Spring Valley, P.O. Box 28832-00200 Nairobi www.undp.so.org leo.kenny@undp.org (UNAIDS Country Coordinator); or gboun.michael@undp.org (UNAIDS M&E Adviser); willis.odek@undp.org (HIV/AIDS Data and Strategic Information Officer, UNDP)

For enquiries, comments and contributions, please contact: leo.kenny@undp.org (UNAIDS Country Coordinator); or gboun.michael@undp.org (UNAIDS M&E Adviser); or willis.odek@undp.org (HIV/AIDS Data and Strategic Information Officer, UNDP)


Somaliland launches National Aids Commission

UNITED NATIONS
Office of the United Nations Resident & >BR> Humanitarian Coordinator for Somalia

Press Release

Nairobi (16 September 2005) - Somaliland1 yesterday launched a National AIDS Commission which aims to increase and improve strategies for the prevention of HIV/AIDS and the treatment, care and support of those infected and affected with the virus. The event was led by the President of Somaliland, Dahir Rayale, and attended by members of the UN Country Team, Somaliland authorities, religious leaders, civil society organizations including women’s and youth groups and development partners. An HIV+ man also spoke out on the need to involve infected and affected people in the response. The Somaliland National AIDS Commission will be a multi-sectoral partnership which will include the private sector and civil society.

President Dahir Rayale called on all sectors of society to work together to stop the spread of HIV/AIDS, saying, “It’s real that the HIV/AIDS epidemic is in the country and already contributing to increased mortality, morbidity, fear, family disintegration, orphans, stigma and discrimination in our society. Denial serves as a negative fuelling factor of the epidemic and creates environment of more stigma and discrimination in the society.” He added that his administration will provide matching funds towards the establishment of the Commission.

Acting Resident and Humanitarian Coordinator, Elballa Hagona praised the President for his personal commitment to the development of strong, accountable and transparent leadership structures. He also commended the President for addressing, head on, the factors fueling the epidemic globally, namely: denial, stigma and discrimination. Asking Somaliland to draw on the strengths of its religious community to bring about a change he said, “It is essential that we tap into the guidance and prominent placing of the religious leaders in our society to form a united front against HIVAIDS.”

UNICEF Representative for Somalia, Christian Balslev-Olesen underlined the need for the Commission to address the needs of the most vulnerable, women and young people of Somaliland. He urged the Commission to make the programmes pro-active in seeking 1 All references to Somaliland pertain to the self-declared but unrecognised Republic of Somaliland. solutions and addressing the potential explosiveness of the epidemic. In outlining that UNICEF had a special accountability as Principle Recipient of the HIV/AIDS component of the Global Fund on AIDS, Tuberculosis and Malaria (GFATM), Mr. Balslev-Olesen said these resources would help to build Somali governmental and civil society capacities. As the UNICEF Representative further noted, “The first in-country management meeting of the GFATM was held in Hargeisa [on Wednesday] and this launch is indicative of our commitment to ensure that Somaliland authorities are fully involved in the management of the funds”.

The large audience attending the launch was also addressed by UNAIDS Country Coordinator for Somalia, Leo Kenny, who cited the Presidential Decree on HIV/AIDS of July 2005 as an important and commendable step in building a comprehensive response to HIV/AIDS in Somaliland. He gave assurances that the UN and other international partners would also support the Somaliland government and civil society in establishing strong, transparent and inclusive monitoring and evaluation mechanisms to ensure that resources for HIV/AIDS work for the benefit of all Somali people.

Following the completion of the 2004 sentinel sero-prevalence study by WHO and Ministry of Health, Somaliland, among specific sub-population groups, the findings showed an overall average prevalence of HIV among Antenatal care attendants in Somaliland as 1.4%, which is a significant increase from the mean prevalence of 0.9% in 1999. The HIV prevalence among STIs patients was 3.5% and among TB, 5.6% in Somaliland.

Several vulnerability factors exist that are fueling the epidemic. These include low awareness on HIV/AIDS, high mobility; negative cultural practices related FGM, concurrent relationships for economic and cultural reasons and vulnerability factors related to long distant truckers and transporters.

For more information, please contact:
Leo Kenny, UNAIDS Country Coordinator for Somalia
Phone: +254 20 4183640/2 Email: leo.kenny@undp.org


SOMALIA: Prevention of mother-to-child HIV transmission starts

© John Nyaga/IRIN

Just 30 percent of Somali women use skilled medical staff during childbirth

NAIROBI, 18 August 2005(PLUSNEWS) - Somalia's health care system is virtually nonexistent after fifteen years of violence and lawlessness, leaving HIV-positive pregnant women without the services and knowledge they need to prevent them from transmitting the virus to their unborn babies.

"Most Somali women use unskilled traditional birth attendants [TBA] during childbirth - hospital delivery is very rare," Fadumo Qasim Dayib, Somalia focal point for prevention of mother-to-child transmission (PMTCT) of HIV at the United Nations Children's Fund (Unicef) in Kenya, told PlusNews. "Women aren't comfortable in hospitals, which are often unsanitary and have poorly trained personnel."

Only 30 percent of Somali women use skilled birth attendants, and the country's estimated 7,000 TBAs are largely ignorant of HIV transmission and safe birthing practices.

"A midwife in Somalia recently told me she had spoken to a TBA who had assisted in delivering a baby to an HIV-positive woman; she did not use any special precautions against passing on the virus ... [and] immediately used the same instruments on the next woman ... so you can see they have not even the minimal knowledge about HIV transmission."

UNAIDS estimates Somalia's HIV prevalence at 0.9 percent, well below that of neighbouring countries, but has warned that it is "approaching a generalised epidemic". UN agencies have set up one site providing antiretroviral (ARV) drugs in the self-declared republic of Somaliland in the northwest, and four voluntary counselling and testing (VCT) sites around the country.

UNICEF is in the process of rolling out PMTCT services and has been training political leaders in advocacy, community and religious leaders in awareness raising and health practitioners to provide the services.

"We have come up with a training package that will include counselling for all women at ante-natal clinics, where the women will receive health talks focusing on HIV and PMTCT," Dayib said. "If they feel comfortable to take a test, we will carry out rapid tests for syphilis and HIV, initially with written consent, until the testing becomes routine."

CULTURAL CHALLENGES

Somalia is a conservative Muslim nation with a deep-rooted aversion to discussing sexual matters and HIV/AIDS. However, Dayib said the reality of HIV/AIDS had eroded much of this.

"People in Somalia are aware of HIV and how it is spread. If discussions are held by people who understand the local culture, religion and language, then Somalis - both men and women - are willing to open up and discuss any issues related to sex and HIV/AIDS," Dayib said.

Local involvement in programme implementation was critical. "The Somali people need to own the process of PMTCT, right from the planning stages to implementation." They were an "oral society" who relied on word of mouth, and if the clinics were poorly equipped or had poorly trained staff, it would have a significant impact on women's uptake of services.

Dayib stressed the "need to move beyond the awareness-raising stage and start providing treatment, care and support services, otherwise it's like a chain with a link missing".


SOMALIA: Youth-friendly magazine passing on HIV/AIDS message

HARGEYSA, 5 July (PLUSNEWS) - In the self-declared republic of Somaliland, where discussions about sex remain taboo, a group of young people have been passing the HIV/AIDS message on to their peers through a youth-friendly magazine, Koor.

The name is the Somali word for the wooden bell worn by herd camels to avoid them getting lost. Created in 2003, Koor provides basic information on HIV/AIDS to the youth, who in turn can use the knowledge to protect themselves from contracting the virus.

"We realised that the youth have very little basic knowledge of HIV/AIDS, they had few facts and a lot of fiction about the disease," said Koor's editor, 22-year-old Ilham Sheik Muse. "It made us realise that they needed a leader to pass vital and comprehensive information on the disease, we therefore established Koor to lead them."

Although Somalia's HIV infection rate remains low at 0.9 percent, UNAIDS nevertheless says Somalia is "approaching a generalised epidemic". Ignorance about HIV persists in this conservative Muslim country, and many Somalis perceive HIV/AIDS to be a "foreign" problem that is unlikely to affect them.

A behavioural study conducted by the United Nations Children's Fund (Unicef) in Somalia in 2004 found that just 26.6 percent of women in Somaliland had heard of condoms. Only 13 percent of men and three percent of women in the region had ever used one.

"During a survey we conducted last year about the use of condoms in Somaliland, some boys said that they think condoms are not safe and they instead use polythene bags when having sex," Deq Saeed, of UNAIDS Somaliland, said recently.

The free, quarterly magazine - supported by Unicef and a local nongovernmental organisation, HAVOYOCO - is run entirely by young people, who report on HIV-related issues and interview people in the region to find out their views on the pandemic.

Following increasing demand among young Somalis, Koor expanded to the semiautonomous region of Puntland in the northeast and to southcentral Somalia, bringing together the youth in a country deeply divided by clan loyalty.

Koor also tackles health, development and entertainment. For instance, it highlights the health risks - including higher HIV risks - posed by female genital mutilation, which is practised almost universally in the Horn of Africa nation.

In its third year now, Koor's editor says the magazine has registered positive impacts in terms of influencing behaviour change and prevention and control.

"After the youth got the knowledge of how HIV is spread, an overwhelming number have employed precautionary measures, which include abstinence and the use of condoms, so most of them are not ready to risk contracting HIV," Muse said.


SOMALIA: Free ARVs, but stigma hampers HIV/AIDS fight in Somaliland

Women can be at increased risk of HIV infection in highly conservative Somaliland

HARGEYSA, 1 May 2005(PLUSNEWS) - Patiently waiting for her monthly dose of antiretrovirals (ARVs) at an HIV clinic in Hargeysa, capital of the self-declared republic of Somaliland, Amina Hassan, a widowed 26-year-old mother of two, is one of 110 people benefiting from free treatment in the region.

"I started taking the ARVs five months ago. I'm feeling stronger than before and have added six kilos in my body weight," she said. "I intend to continue taking the drugs as the doctors are saying."

Hassan said her husband had died four months earlier from an AIDS-related illness, and when she too started falling sick, she had herself tested for HIV and was diagnosed in December. Mercifully, her two daughters - aged two and four - are negative.

The authorities in the self-declared republic - in the northwest of the Somalia - joined the fight against the pandemic by establishing a commission in September 2005 to plan and coordinate efforts against HIV/AIDS.

Free ARV provision began when dozens of internally displaced people in Somaliland tested positive for the HI virus. Their appalling condition triggered an appeal by the United Nations refugee agency, UNHCR, which saw the delivery of the drugs to the HIV clinic in June 2005.

The provision of free ARVs by UN agencies has given hope to HIV-positive people in the region, and encouraged more to volunteer for counselling and testing. Hassan said it was the knowledge that the ARVs were available that gave her the courage to get tested.

Despite the progress made in treatment, health authorities in Somaliland are worried that significant challenges remain. Although HIV prevalence currently stands at 1.4 percent, relatively low compared to neighbours Ethiopia and Djibouti, insufficient information about the virus, and deeply entrenched cultural and religious beliefs, continue to fuel the spread of the epidemic.

"We presume HIV first reached Somaliland over a decade ago and it has increased tremendously over the past four years, but still a majority of the population are not serious about its consequences," said Dr Deq Saeed, of UNAIDS Somaliland.

Alarming misconceptions still exist - even among the educated - with some believing the disease is "foreign" and cannot be found in Somaliland, because the country is a strong Muslim nation.

A behavioural study conducted by the UN Children's Fund in Somalia in 2004 found that just 26.6 percent of women in Somaliland had ever heard of condoms. Only 13 percent of men and 3 percent of women in the region had ever used one.

"During a survey we conducted last year about the use of condoms in Somaliland, some boys said that they think condoms are not safe and they instead use polythene bags when having sex," said Saeed.

Stigma and discrimination are also enormous barriers to the fight against the epidemic in the self-declared republic. Health experts report that people have even been physically attacked by family members for being HIV-positive.

"Recently we got a report that an HIV-positive girl was being attacked by neighbours. When we visited her, we found she was staying in shanty house that collapsed after neighbours and family members hurled stones at it," Saeed narrated. "The girl was accused of spreading HIV/AIDS in the area and had we not gone to collect her, she could have been killed."

The campaign to combat stigma was dealt a major blow when Olad Dorre, an AIDS activist and the only person in Somaliland to publicly declare his status, passed away in April.

"Owing to the stigma surrounding the disease, the majority of the patients are not willing to open up and admit their positive status," said Saeed. "We need a workable strategy against stigma to be developed by all, including AIDS activists."


SOMALIA: Fighting HIV in a chronic emergency

NAIROBI, 7 April 2005(PLUSNEWS) - Severe food shortages and continuing conflict in large parts of war-scarred Somalia have stretched people's coping strategies to breaking point, but for those who are HIV positive every day brings another struggle to survive.

"The country is in the grip of a severe drought at the moment, which means millions of Somalis are going without food - they have to move from place to place with their animals to find pasture and water," said Ulrike Gilbert, HIV project officer for the Somalia office of the UN Children's Fund (UNICEF).

About 400,000 internally displaced people are now living in camps, where they depend on their host communities and relief agencies for food and protection. The few health services that exist are stretched to capacity, and populations on the move in search of pasture and water may find there are no health services at all.

Water shortages have heightened the risk of waterborne infections, and resisting and recovering from diarrhoeal diseases is much harder for people living with HIV, so progression from infection to AIDS can be greatly accelerated.

Women and children living in the camps are also at greater risk of HIV infection. "Displacement and conflict have damaged these people's support networks, exposing them to the risk of sexual exploitation, which in turn exposes them to HIV/AIDS," Gilbert pointed out.

When women and children are raped or abused, access to emergency post-exposure prophylaxis is limited, and trauma counselling rare. To make matters worse, there is little basic education about how to avoid HIV/AIDS.

Discussions about sex are traditionally taboo and conservative Somalis have been in denial about the existence of HIV and its ability to affect them for years. "At first we thought that AIDS was a foreign disease, but we now know that AIDS is here," said Sheikh Mahamud Aw Abdulle, a senior religious scholar in the capital, Mogadishu.

HIV diagnoses are becoming increasingly common. "We see HIV positive people at the hospital - many more than we did years ago. Increasingly we see AIDS patients, who obviously contracted the virus several years ago, before we knew we had a problem," said Dr Mohamed Mahmud.

"Our geographical position, and the fact that our populations are very mobile - travelling around the region, where HIV is more prevalent - means we need to be on guard about the epidemic growing here [in Mogadishu]," he added. An estimated 350,000 Somali refugees live in neighbouring countries, with millions more in the diaspora.

UNAIDS estimates the HIV prevalence rate in Somalia at 0.9 percent, well below that of its east African neighbours, such as Ethiopia with 4.1 percent and Kenya with 6.7 percent. However, according to UNAIDS, Somalis are "approaching a generalised epidemic".

Some cultural practices have also aggravated the situation, according to human rights activists. "AIDS is spreading in Somalia. One of the main factors is the continued practice of FGM [female genital mutilation] on our young girls," said Marian Hussein Awreye, co-director of the country's largest rights group, the Ismail Jumale Human Rights Centre.

Close to 100 percent of Somali girls undergo FGM, traditionally seen as a rite of passage into womanhood, and perceived as a procedure ordained by the Koran. It is rarely carried out in a hospital, and unsterilised instruments are often used to cut several girls.

Deep-rooted stigma is an underlying reason for the continued failure to recognise HIV/AIDS as a problem.

"Somali people do not like to hear about AIDS, and that is why they are always negative towards HIV-positive people, simply because they believe that such an 'immoral' disease befalls only those do not comply with Islamic religion," said Mohamed Abdi Osobleh, a musician.

"Nobody dares to disclose his/her HIV status to people for fear of humiliation, so they continue to infect others, unidentified."

In a frank acknowledgement of the problem, Dr Mahmud noted: "When these people come and discover they are HIV-positive I do not know where to send them ... We have no VCT [voluntary counselling and testing] services; we have no ARV [antiretroviral] services at the hospital."

Financing for HIV/AIDS programmes is slowly beginning to arrive. The Global Fund to Fight AIDS, Tuberculosis and Malaria has provided funding - with UNICEF as the principal recipient - to implement a "framework" for the prevention and control of HIV/AIDS and sexually transmitted infections.

"In areas where there is relative stability we are able to provide some services - Somaliland and Puntland both established AIDS commissions in 2005 to coordinate the effort in those regions," Gilbert said. "Most recently, the government and partners established the South Central AIDS Commission, in March, in an effort to deal with the pandemic."

The northeastern self-declared autonomous region of Puntland and the northwestern self-declared republic of Somaliland are relatively stable compared to the southern and central regions of the country, where the drought is worst and factional fighting continues to disrupt the flow of humanitarian aid to those most in need.

"We now have one site providing ARVs in Hargeisa [capital of Somaliland], and have two more planned by June in Puntland and the central-south region," said Gilbert. "We have set up four VCT sites around the country and have trained counsellors to expand the services."

UNICEF has also established child protection prgrammes in the camps to shield orphans and vulnerable children from potential abuse. Other measures include basic steps like ensuring that bathrooms and toilets, which are outdoors, are well lit to ward off potential attackers.


SOMALIA: Interim govt launches south-central AIDS commission

NAIROBI, 15 March 2005(PLUSNEWS) - Somalia's Transitional Federal Government on Tuesday launched a commission to coordinate HIV/AIDS activities in the central and southern regions of the war-scarred Horn of Africa nation.

"Somalis everywhere must be educated on how to protect themselves from the virus but, even more importantly, we must support our brothers and sisters who already are infected, so that they are cared for and are not marginalised," Prime Minister Ali Muhammad Gedi said at the launch of the South Central AIDS Commission in the southern town of Baidoa.

"This is an opportunity for all of us to work together to stop, and even reverse, the spread of HIV/AIDS among Somali men, women and children," said Christian Balslev-Olesen, country representative for the UN Children's Fund. "We cannot fail in this, or else the consequences will be devastating, as we have seen in other parts of the world."

A 2004 UN World Health Organisation survey showed an average HIV prevalence of 0.9 percent in the country.

The commission's work will incorporate initiatives to provide universal access to treatment, care and support for all Somalis, while focusing on the most vulnerable groups, especially children, who make up the majority of the population.

The self-declared republic of Somaliland in the northwest and the self-declared autonomous region of Puntland in the northeast both established similar AIDS commissions in 2005.

After the 1991 overthrow of former President Siyad Barre's administration, Somalia lacked a legitimate central authority for close to 15 years, during which time the country was carved up into factional fiefdoms. It is widely hoped that under the interim leadership of the current transitional government - set up in Nairobi, Kenya, in 2004 - peace and stability will return to Somalia.

All three commissions are now expected to work towards a coordinated HIV/AIDS response, with an integrated prevention, treatment and evaluation framework.

"Primary prevention, prevention of mother-to-child transmission, paediatric treatment and protection, care and support of children all ensure that the next generation of Somalis can make informed choices from an early age and protect themselves," said Leo Kenny, UNAIDS country coordinator for Somalia.

Somalia is currently in the grip of a severe drought, with an estimated 1.7 million people in the northern, central and southern regions facing either conditions of acute food and livelihood crisis or humanitarian emergency.

"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 will be integrated into the current emergency drought response," UNAIDS said in a statement on Tuesday.

Gedi agreed, saying, "We recognise that HIV/AIDS can derail our efforts to harness our human resources for the reconstruction of our country."


HIV, AIDS and Islam

This article is reprinted from the website Positive Muslims of South Africa - http://www.positivemuslims.org.za/ -

published by Abdul Kayum Ahmed and Fahmeeda Miller

Who is this article for?

This article is for Muslims who are unsure about what HIV and AIDS is, and what it means for them and their families. This article will also be of value to those who deal with Muslims in a health advisory role. We hope that once you have read this article, you will have a better idea of how HIV is transmitted and how people can protect themselves from contracting the virus. People reading this should also get a better understanding of Islamic views on HIV and AIDS education. This article also considers why it is important that people deal compassionately and sensitively with those who are living with HIV or AIDS.

Is HIV a threat to Muslim communities?

Every single country in the world has been affected by HIV, including Muslim countries.

The United Nations Joint Programme on AIDS (UNAIDS) estimates that since the start of the global HIV pandemic around 29.4 million people have been infected with HIV. Although many Muslim countries claim that they have not been affected by HIV, this is not true. HIV infections have been reported in every single Muslim country. According to UNAIDS there are an estimated 300,000 people living with HIV in North Africa and the Middle East. Anyone can become infected by HIV, including Muslims.

Do Muslims need HIV and AIDS education?

Accurate information about HIV and AIDS will help to control the spread of the disease in our communities. It will also reduce the fear and discrimination against people who become HIV positive. Information will also help us to challenge any myths surrounding the disease. HIV spreads mainly through unprotected vaginal and anal sexual intercourse with an infected person. The virus is also transmitted through the sharing of needles by intravenous drug users. Therefore, HIV (the virus that causes AIDS) can affect anyone who engages in these activities, irrespective of their religion.

Islam’s view on human life and health

Human life is highly valued in Islam; it is considered a gift from Allah. In the Islamic view, Muslims are not supposed to think that it is their life with which they can do what they want. Instead, individuals have been entrusted with life by Allah. We are supposed to look after life and not abuse it. A healthy body is a gift from Allah, we are the trustees, and therefore we have no right to misuse and abuse it. Our Holy Prophet Mohammed, (peace be upon him), has stressed the importance of health at many times. He once said to his one of his companion, "O' Abbas ask Allah for health in this world and in the next." (Al-Nasa`i). And, "No supplication is more pleasing to Allah than a request for good health." (Tirmidhi). The Prophet Dawud (pbuh) said, "Health is a hidden kingdom." Our bodies are trusts from Allah that must be returned one day and we will be asked how looked after them. Therefore we should avoid any act which will harm our physical or spiritual health.

Does the concept of modesty in Islam permit us to talk about sex?

Discussing HIV and AIDS would involve discussing sexual and intimate matters. Islam has always encouraged discussions on matters which will help us protect our health and life. Modesty in Islam does not mean that we should not discuss sexual matters. Muslim men and women never felt shy to ask the Prophet (pbuh) about intimate sexual matters. The Holy Qur’an has discussed reproduction, creation, family life, menstruation and ejaculation.

The Prophet (pbuh) has said, "Blessed are the women of the Ansar (citizens of Madinah): shyness did not stand in their way for seeking knowledge about their religion." (Bukhari & Muslim). The Qur'an and hadith (words and sayings attributed to the Prophet Mohammed pbuh) have repeatedly stressed the importance of acquiring knowledge:

"Are they equal those who do, and those who do not know?"

(Qur'an 39:9). It is through knowledge that we can achieve closeness to Allah, marvel at his creative work, and appreciate the Divine rules of conduct given in the Holy Book and practised by the Holy Prophet and his companions. We should not feel embarrassed or shy when discussing or reading about HIV / AIDS. However, Islam does require people to be modest and so it is not so much the discussion of sex and sexual matters that is an issue, but how this is done. For example, in sex or Aids education, as far as possible, publications containing explicit graphic illustrations of the sexual organs should not be used.

How should Muslims act in this time of crisis?

Although Islam only approves of sex between a married couple, it should be acknowledged that this view is not held by everyone. (And acknowledging something does not necessarily mean that one agrees with it.) Muslim people living in the West and elsewhere can therefore find that society around them accepts short-term sexual relationships and sex between people of the same sex. This can lead to people behaving in a way that many Muslims find completely unacceptable. If they do behave in such a way, it is important that they know how they may be putting themselves at risk of acquiring sexually transmitted infections, or even HIV. They should know how to protect themselves from infections. The following information will help in the understanding of HIV and its transmission.

What is HIV?

HIV (Human Immunodeficiency Virus) is a virus that damages the body's defence system, stopping it from effectively fighting infections. When HIV enters the body, our defence system starts fighting the virus. Over time, our defence system becomes too weak to protect itself from many different kinds of infections. The virus lives in certain body fluids, such as blood, semen, and vaginal fluids. It is this virus which causes AIDS.

What is AIDS?

The AIDS acronym stands for Acquired Immune Deficiency Syndrome. A person has developed AIDS when they are affected by certain infections and cancers because their body's defences are weakened.

Can you tell if a person is HIV positive?

The answer is NO, by looking at someone you cannot tell if that person is HIV positive. After infection, when HIV gets into your body, for a period which may last up to ten or fifteen years, an infected person may feel healthy, and may even not know that they have the HIV virus.

How does HIV get into our bodies?

HIV can be transmitted in the following ways:

* Unprotected sex between a man and a woman, or between two men.
* By sharing unsterilised needles, syringes, and other injecting equipment.
* By blood transfusion with HIV infected blood or blood products, e.g. plasma or Factor 8.
* Through organ transplants that are infected with HIV.
* Through artificial insemination with HIV infected semen.
* From an infected mother to her baby (either in the womb, during labour, or through breast-feeding).

Rates of transmission from mother to baby are 14-25% in developed countries, and 29-40% in developing nations.

Islam absolutely does not approve of sexual relations outside marriage. However, if someone does so anyway, they still should use a condom in order to avoid the exchange of body fluids which may be infected. This advice is important for the protection of their wife or husband.

Is blood transfusion safe?

Blood transfusion services check all blood for HIV, so it is usually safe to receive blood. However, because there is a short period of time after infection when HIV might not be detected (called a window period), you should not donate blood if you have had unprotected sex.

Can you get HIV through everyday contact from someone who has the virus?

HIV cannot be passed on through everyday contact. HIV cannot be passed on by touching, shaking hands, kissing, using toilet seats, sharing cups, cutlery, crockery, towels, coughing, sneezing, insect bites, or swimming pools.

How can you protect yourself from HIV?

We know that HIV is mainly transmitted through unprotected sex with an infected person. The most important means of protection is obviously abstinence from sex and to remain faithful to your partner in marriage and not to have any sex before or outside such a relationship. However, one does not always know the full history of sexual activity of one's partner in marriage and this is why it is important for all individuals to also go for HIV tests before they engage in marital sex. Besides staying away from sex altogether or faithfulness in a relationship, which is the most important measure, using condoms is the only way to reduce the risk of HIV and other sexually transmitted infections. If used correctly, condoms are up to 99% effective. Injecting drug users should not share needles and syringes. Pregnant women should have an HIV test, and if they are HIV positive, seek medical advice on ways of reducing the risk of infection between mother and child.

How should Muslims behave towards people who are living with HIV or AIDS?

There are many Muslims who are affected by AIDS. These people are someone’s son or daughter, brother or sister: they are part of the Muslim community. We cannot shun people living with HIV or AIDS. Any person with AIDS should be given attention, care, love and affection, so the person can lead his/her life with dignity. We also have no right to judge or condemn people. It is up to the Almighty to forgive or punish. AIDS and HIV is all around us, inside our Masjids and in many of our homes. It does not help to ask if someone is innocent or guilty in this. All of us know that alcohol is prohibited in Islam (and all of us know of some Muslims who do drink); All of us know that sex outside marriage is not allowed in Islam, but all of us also know our own lives and history bit better than outsiders. Suppose a Muslim arrives at the scene of a motor car accident and he or she notices that a number of people are badly injured. Is our first concern how it happened or to get help? Do we go around and point fingers at the guilty driver and then say, "Well he caused it," and then just move on? Do we go around and smell the breath of the injured and when we find that they smell of alcohol, do we say, "Alcohol is haram; they should not have taken it and they asked for it"? No, as Muslims we know the Prophet Muhammad (pbuh) said:

"Have compassion towards those who are on earth and the One who is beyond will have compassion towards you." Islam is a religion that is full of compassion, love and mercy. The Prophet Muhammad (pbuh) reminded Muslims that: "You will not enter into paradise until you believe, and you will not believe until you love one another." In another Hadith, it has been said, "Allah shows compassion only to those of his servants who are compassionate." Love and compassion are the qualities of a good Muslim, and people with AIDS cannot be denied these powerful emotions. Visiting and caring for the sick is another good deed that is highly recommended by the Prophet (pbuh).

"Whoever visits a sick person is walking along the high road to heaven." (Bukhari) "A visit to a sick person is only complete when you have put your hand on his forehead and asked him how he is." (Tirmidhi). People with AIDS need our compassion, our love, and our affection, so do not be afraid to embrace them or touch them.

The Prophet (pbuh) also said, "If you enter the house of a sick person, then only speak good words, for truly the angels will confirm what you say, and they will open up the way of heaven to him," (Nasa'i).

There are many more sayings from the messenger of Allah about showing love and compassion to people in ill health. Therefore, we must remember what is expected from us by Allah.

HIV, AIDS and ISLAM

Islam is a religion that is very close to human nature. It appreciates the powerful sexual desires that humans have. Therefore it encourages that these desires be fulfilled, and advocates and encourages marriage, so that through marriage sexual desires can be fulfilled. Like other heavenly religions, Islam provides us with a moral code for sexual enjoyment. Islam also prohibits the use of substances which may impair the senses. Therefore the use of narcotics such as heroin and alcohol is strictly prohibited. However, we must recognise that people engage in sexual activities before marriage, and there are also people having extra-marital sex. Islam means the submission or surrender of one’s will to Allah, and therefore it follows that a Muslim should not be involved in any act that is prohibited by Islam.

Nevertheless, we need to be realistic and must face the fact that not all of us follow our religion fully. Sexual practices that may not be allowed by our religion do nevertheless exist. Therefore, there is the need to accept reality and develop HIV and AIDS educational programmes for all our communities. These programmes must emphasise Islamic moral values, but should also inform people about methods of protection from this life threatening illness. Some Muslims may think that HIV and AIDS are not issues for the community. The reality is that HIV and AIDS are major issues in many Muslim countries. It is therefore becoming extremely important that we accept that we are equally vulnerable to HIV and AIDS. Given the increase in HIV infection globally, it is more important than ever that we discuss HIV and AIDS openly.