Almost two years after appointing a national HIV/AIDS commission, the self-declared republic of Somaliland, in northwestern Somalia, has slowly begun rolling out antiretroviral (ARV) drugs.
The ARV programme, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, started in 2005 with 30 participants; it now provides medicines, supplemental food and counselling services to 300 HIV-positive people in Hargeisa, the Somaliland capital.
"Besides an improvement in my health, the best thing about the ARVs is that they have allowed me to keep working and earning money for my family," said Rahma Hirsi, an ARV recipient and mother of three.
Relief workers attribute the success of the ARV programme to the relative stability of Somaliland compared with south-central Somalia, which continues to be racked by conflict, displacing large numbers of people.
Need for vigilance
Somaliland's position makes it a destination of choice for a constant flow of displaced persons from south-central Somalia, as well as a transit point for migrants from east and central Africa attempting to reach the Gulf States, putting the region at a higher risk of HIV.
According to UNAIDS, Somalia's national HIV prevalence rate is 0.9 percent, significantly lower than its East African neighbours, but in Somaliland the infection level is slightly higher at 1.4 percent.
Regional experts attribute this to a number of factors, including increased border traffic with neighbouring, higher-prevalence Ethiopia, as well as an emerging commercial port at Berbera, on the Red Sea, where UNAIDS estimated the prevalence rate at 2.3 percent.
Activists have criticised the Somaliland government's failure to finalise a national HIV/AIDS policy covering HIV awareness, treatment and care, which has been in draft form for two and a half years.
"The parliament has not seen HIV/AIDS as a priority, and the fact that we have no national policy is proof of this," Mustafe Farah Migane, project coordinator at the Somaliland HIV/AIDS Network (SAHAN), a Hargeisa-based non-governmental organisation (NGO), told IRIN/PlusNews.
According to the executive director of the Somaliland National AIDS Commission, Mohamed Hussein Osman, a comprehensive HIV/AIDS policy was read by the executive cabinet recently and will be tabled in parliament "in a few weeks".
Stigma against HIV-positive people and their families is widespread, and Somali cultural conservatism means discussion about sex is taboo. "There is still this perception that HIV is something that is contracted only through illegal sex," Migane said. "In other words, if you say that you are HIV-positive, you are saying that you had sex outside marriage."
According to UNAIDS, there is "a serious lack of understanding and awareness of basic information on HIV within Somali populations".
SAHAN has led a series of workshops for women, young people and influential religious leaders. UNAIDS, in partnership with the AIDS commissions of Somalia's three regions - Somaliland in the northwest, Puntland in the northeast and south-central Somalia - is also involved in educating people across the country about HIV.
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