More than a bad hair day

Hairdressers in the Zambian capital Lusaka have begun to think seriously about the risks they may run of contracting and transmitting HIV through their work. Recently, Judith Namoya began noticing that many women attending her backyard salon had little open sores or infected pustules on their scalps. The clients would say that these wounds were caused by the over-processing of their hair. Others said they were the result of tight and frequent plaiting, or the continuous wearing of wigs. "The suspicion was there at the back of our minds that some of our clients were hiding their heads under braids and wigs rather than beautifying themselves," Namoya told PlusNews. But it was only when a caller to a radio phone-in programme asked if it was possible to contract HIV while having a hair-cut that Namoya and her colleagues put two-and-two together. "We phoned in and asked about hairdressers," Namoya explained. "We learnt a lot about HIV transmission that day, and it occurred to us that we were exposing ourselves to risks by braiding or treating client's heads with little or no protection." Namoya believes that many HIV-positive women want to look healthy and attractive for as long as they can. "We recently had a women recovering from something we later learnt was Kaposi's sarcoma (a skin cancer common among people with AIDS), who wanted to braid the little hair that she had left. We could not refuse to do her hair, so we were as gentle as possible." Asking around, Namoya discovered that informal backyard hair and beauty salons like her own were becoming increasingly popular, and not just because they were cheaper and more convenient. Also because they were less concerned about the condition of their customers' heads. Namakau Jayateleka, on the other hand, owns an up-market hairdressing salon in Lusaka's premier shopping centre, Manda Hill. She confirmed that formal salons like hers advise clients with sore scalps and weak hair against braiding and chemical treatment. "We are extremely particular about the possibility of infection," said Jayateleka, adding that clients with weak hair or sores on their scalp are advised to seek medical treatment before having their hair done. Priscilla Janos, who owns a trendy beauty parlour in another exclusive Lusaka suburb, believes there is nothing discriminatory about turning away clients in this way. "We know about hair and the condition scalps should be in, so we give the best advice to our clients," Janos said. "And of course we have a duty to protect our staff." Janos believes that informal hairdressers were wrong to accept clients with open sores. But informal hairdressers often cannot afford to turn away clients. Therefore, some have sought creative ways of protecting themselves and their clients from the risk of infection. Most informal hairdressers cannot afford surgical gloves, which in Lusaka cost around US $2.50 a pair. So they use plastic shopping bags instead. "We just tie them to our wrists with either an elastic band or a piece of cotton," said Carol Leese, who runs a salon in her backyard. "The important thing is that our hands are covered." Reluctant to turn customers away, both Leese and Namoya advise clients with sore scalps to have a wash and set, as this does not require working with hair from the scalp. The two hairdressers also use a lot of Vaseline and creams on the assumption that any infection will then "slide off" their hands. But Mercy Banda, who is a hair braider, said that you cannot cover your hands in her line of business. Neither can your hands be too oily. "We braiders are most at risk because we have to work with the hair from the scalps using our bare hands. Because we work with combs and scissors, we are also bound to have cuts and bruises on our hands. So what do we do to protect ourselves?" Like Jayateleka, Banda would like to turn away customers who have open sores. But her boss, Merinda Bwalya, believes this would be bad for business. "Every woman who does her hair regularly will have some little sores or scabs at one point because of all the tugging and pulling and heat treatment. Short of conducting HIV tests ourselves, how are we going to know that this client is likely to infect someone?" It is not only the hairdressers who are at risk of contracting HIV from their clients, Bwalya added. Customers stand a chance of contracting HIV from infected hairdressers. Besides, to what extent do such small sores and scabs make infection possible, she asked. Dr. Beatrice Mubala told PLusNews there was a definite risk of infection. "Whenever an HIV positive person has an open wound there is a possibility of infection," she said. Hair and nails are the first things to become weak when an HIV-positive person's immune system begins to break down. The tension caused by plaiting can cause the hair to break from its roots, exposing the follicles, which then can become septic. "However, I find it unlikely that a woman with open sores would want to traumatise her hair further by braiding it." Banda disagrees. Women with sores on their scalps want to cover their heads with braids or wigs as much as any other woman who is having a bad hair day, she said. "So why should you not look good?" asked Grace Nambangi, who is HIV positive. "Having hair on your head is a great morale booster," she argued, adding that being HIV-positive does not mean that you are about to die. Similar dilemmas arise in Lusaka's male barbershops, which usually comprise of nothing more than a makeshift stall and a single set of clippers. Men today like to keep their heads shaven, said barber Mike Zulu. Apart from being fashionable, a shaven head masks the fact that you are sick and your hair is falling out, Zulu explained. "People who are recovering from an illness or who are ill, their hair starts turning weak and yellowish and looses its shine. The women fill out their head with weaves and wigs, the men shave their hair." "Every so often", Zulu cleans his clipper and wipes his clients' heads with methylated spirits in a bid to kill infection. "But it is true that people are more conscious now about HIV. More and more of my customers are insisting on either coming with their own clippers, or making sure that I clean my clippers with spirits in front of them." Alix Simambwe, the coordinator of Zambia's Network for People Living with AIDS, said his organisation has not received any complaints about discrimination at hair salons from HIV-positive people. But he admits that more could have been done to raise awareness among barbers and hairdressers about the ways in which HIV can be transmitted. "We should go into these places and educate people on transmission and how they can protect themselves and their clients, before they start discriminating against people who they perceive to have HIV," said Zulu. Basic rules of hygiene should apply to all service industries, he added, and there was no need to apply special conditions to HIV-positive people.