Condom taboo in Zanzibar hampers fight against HIV/AIDS

Campaigns to fight HIV/AIDS often focus on the "ABC" strategy - or Abstinence, Be faithful and use Condoms. However, on the ultra-conservative, predominantly Muslim island of Zanzibar, the condom remains taboo and is rarely incorporated into public awareness messages. "We believe that advocating the use of condoms is promoting illegal sex, mainly among the youth," said Fadhil Soraga, secretary at the office of Zanzibar’s mufti, or senior Muslim scholar. "The proper campaign is A and B." While public talks or advertising campaigns about HIV/AIDS in Zanzibar may advise people to "Abstain, Be faithful," these messages carefully omit condom use as way to prevent HIV/AIDS. "We are always loud when mentioning the letters A and B, but we mumble when it comes to the C," said HIV/AIDS activist Asha Hussein. In 2003, a United Nations-supported government survey on the main islands of Unguja and Pemba found HIV/AIDS prevalence in the general population to be 0.6 percent. While the rate is relatively low compared to prevalence rates in the region - mainland Tanzania, for example, has an HIV/AIDS prevalence of 7 percent - health officials nevertheless estimate that the rate is rising. Ameir Khamis, a government epidemiology and surveillance coordinator, estimated that about 8,000 Zanzibaris were currently living with HIV/AIDS, up from 6,000 in 2002. Officials from Medicos Del Mundo (MDM), an international NGO working on HIV/AIDS in Zanzibar, said they had to be careful in their campaign against the pandemic. "We're using many ways to deliver the message to stop the spread of AIDS and other sexually transmitted diseases, but speaking about condoms in Zanzibar society is still very difficult," said Erene Casas, MDM project coordinator in Zanzibar. The European Union-supported MDM has been working to prevent the spread of HIV/AIDS, mother-to-child transmission of HIV/AIDS and sexually transmitted infections in Zanzibar since April 2002. It also organises activities to sensitise the population, especially young people, on safer sex. A moral issue "Community leaders - including religious and civic leaders - are not ready for the condom-use theory," Khamis said. A poster by the Zanzibar AIDS Commission in Stone Town, the island's main town, reads: "Our culture is the best cure for HIV/AIDS. Observe our culture and religion to stop the spread of the disease." Soraga, from the mufti's office, blamed the rise in the prevalence of HIV/AIDS on the degeneration of morality on the island. "Despite repeated religious calls and the many seminars on HIV/AIDS in Zanzibar, the number of HIV cases has been increasing because people do not want to change their behaviour," he said. "We must reform our behaviour, mainly by refraining from illegal sex." Although the government and religious institutions are reluctant to promote condoms, their use is on the rise - albeit silently - mainly among youths. Ramadhani Hassan, MDM's local coordinator, confirmed that condom "consumption" had increased. "During the film and traditional festivals in June and July, we distributed more than 90,000 condoms free of charge," he said. "The statistics show that although it is illicit to talk about condoms in Zanzibar society, their utilisation has been increasing," he added. Stigma and discrimination Stigma and discrimination were barriers to the prevention, treatment and care of HIV/AIDS patients in Zanzibar, Casas said. Many people living with the virus were reluctant to disclose their status, even when their employers encouraged them to seek out testing and counselling services. "These barriers are internalised so that people do not seek diagnostic or treatment services, or the means to protect themselves," she said. "The main causes of stigma involve incomplete knowledge, fear of death and disease, sexual norms, and lack of recognition of stigma," she said. The Zanzibar Association of People with HIV/AIDS reported that HIV-positive people on the island faced physical and social isolation from family, friends and the community. Discrimination often extended to the workplace as well and hampered access to government services. The inability of women to negotiate condom use has also proved to be a barrier to preventing the spread of the virus. Hassan noted that a lack of confidence prevented many women from demanding that their partners use condoms, placing them at great risk. A 2003 government study showed that infection rates among women were three times higher than men. Casas said stigma limited the circulation of information about the epidemic and options for care, as well as communication within couples about the risks of contracting HIV/AIDS. "I think we need to do everything possible to prevent the spread of HIV/AIDS," she said.