Prevention of mother-to-child HIV transmission starts

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".