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

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."