Taboos, denial and shortage of data hinder fight against AIDS

The battle against HIV/AIDS has begun in the Islamic Republic of Mauritania. But social taboos surrounding the discussion of sex, widespread denial that the disease exists in this deeply conservative country and an absence of accurate data, combine to make progress difficult. Koumba, her head wrapped in a bright yellow scarf, is well aware of the reality of AIDS and the difficulty of seeking help and sympathy. The slim 29-year-old woman is poor, frightened and already has to live with the disease. Her husband and two-year-old son are also infected with the HI virus, but no-one else in their family knows. “We can’t talk about it. The stigma of AIDS is a serious problem," she told IRIN in a back room of Mauritania's only AIDS treatment centre in the capital Nouakchott, so as not to be overheard. "We could never tell anyone that we are HIV-positive, not even my mother. We would be rejected,” she said. In fact Koumba is not even the real name of this young woman who has already lost a four-year-old daughter two years ago. She is not certain, but she thinks that she too had AIDS. “People here don’t understand AIDS, talk of it scares them," Koumba said. "They think they can catch it just by sharing some food with me, talking with me or standing close to me,” she explained over copious glasses of strong sweet green tea. Djibril Sy the President of SOS-Educator Peers, a voluntary group that works to increase awareness of a whole range of sensitive issues among young Mauritanians, said the reluctance to discuss HIV stems from a closed attitude to sex. “Talking of sex is relatively taboo and so by association, talking about AIDS is taboo also,” Sy said. “Publicly everyone says there is no sex before marriage or outside of marriage – but of course not everyone respects that.” Since transmission of AIDS is associated with infidelity or promiscuous behaviour, most Mauritanians refuse to accept that AIDS is a real problem in their country, Sy said. “Mauritanians think that AIDS is an illness that affects other people, it is very difficult to get people to accept that AIDS is their concern too,” continued Sy who recently led a series of AIDS awareness classes for university students. The caravan of hope Volunteers from SOS-Educator Peers also appear on The Caravan of Hope, a truck equipped with a sound system and video unit that combines music and entertainment with AIDS sensitisation. The truck, which serves as a stage in open air gatherings, is operated by Nedwa, a local NGO specialising in public education with youth groups and illiterate populations. It was bought for Nedwa by the US-based Christian charity World Vision and tours the country to spread the AIDS awareness message. Last week it was belting out music and warnings about AIDS at a junior league football tournament in the Ksar Stadium in the capital Nouakchott. “AIDS is a dangerous illness,” agreed 11-year-old Khaleed, who had turned out with friends to enjoy the fun. “But it is not here, it is something they have in other places,” the boy added as he flitted his eyes between a football match under way on one side and the AIDS roadshow on the other. Soya Watt, one of the SOS-Educator Peers speaking at the roadshow was unperturbed by Khaleed’s words. “It takes time for the message to get through,” she admitted. But before long she was back on stage having another go at hammering her message home through the giant sound system: “Dispel the myths! AIDS does exist in Mauritania - among school children too!” she shouted into her microphone. A lack of reliable data While sensitisation is a problem, AIDs workers are also concerned that they have no idea how many families and individuals may be struggling silently with the virus since the government has never carried out a national sentinel survey of HIV prevalence. Based on limited HIV testing at 13 antenatal clinics in 2003, UNAIDS estimates that 0.6 percent of the population are HIV positive, but health workers on the ground say that the figure could be higher. Professor Baidy Lo, Director of the National Hygiene Centre (CNH), which is responsible for the establishment of sentinel testing nationwide, told IRIN that the programme should be fully up and running by the end of March. By then, eight ante-natal clinics across the country will systematically conduct voluntary AIDS testing on all the pregnant women who come in for consultations. “We have two sentinel sites already operational in Nouakchott. We have plans for one more there and five in the interior of the country,” he said. All eight sites were initially scheduled to be operational before the end of 2004, but administrative problems hindered the establishment of those in Mauritania's desert interior. AIDS workers doubt the government's capacity to carry out a proper nationwide sentinel survey before the end of the year, but when it is finally produced, it is expected to throw more light on apparent regional disparities already identified by CNH. “Studies so far indicate that there is a higher infection rate at border towns and notably in the northern port city of Nouadhibou, where more than 1 percent of those tested in antenatal clinics were HIV positive,” said Lo. Sensitisation in the interior is difficult in a country nearly twice the size of France with a scattered population of three million and a sparse network of roads. Doctors in the interior can't diagnose AIDS “AIDS is a new illness here and many doctors and nurses, especially in the interior, don’t know how to diagnose it,” said Abderrahmane Ould Mouhamedoune, the head doctor at Mauritania’s only testing and treatment centre, which is operated by the French Red Cross in Nouakchott. The centre is now working to train doctors and nurses across the country in HIV diagnosis so that patients can be referred to it for treatment. Koumba is one of 72 Nouakchott residents already receiving anti-retroviral (ARV) treatment, counselling and nutritional advice at the centre. She and her husband came for testing after suffering months of unexplained illnesses. The ARV treatment has improved Koumba's health to the point where she is able to hold down a cleaning job that brings in vital money so she and her family can eat well and stay healthy. “That’s our objective, to enable people with HIV across the country to live a normal life,” said Doctor Ould Mouhamedoune. “Many people feel they have to be locked away waiting for death, but there is no reason for them to stay at home in shame,” he said.