Stigma impedes HIV treatment in Somalia

Mogadishu, Somalia – In a small dark room in Mogadishu’s Banaadir Hospital, a group of patients sits quietly on wooden chairs waiting to collect their monthly medication ration.

They’re all HIV positive. The medicine they are given is anti-retroviral (ARV) drugs.

The female patients wear a face veil while the men cover their mouths with scarves and mostly look down, dodging eye contact. They all avoid answering their phones when at the hospital, as they don’t want someone in the room or nearby to recognise their voices.

In Somalia having AIDS or being HIV positive means doing everything in one’s power to stay invisible. The identity of HIV/AIDS patients at Banaadir Hospital is kept secret. Nurses call the patients using identity numbers instead of names.

The number of HIV-positive patients in Somalia is unknown [AP]

A father of five children, Abdirahman – whose surname was not used to protect his identity – said he contracted HIV from his previous wife who passed away in 2001. He has good reason for wanting to stay anonymous.

“I was naïve and told my neighbours I’m HIV positive when I was first diagnosed, expecting they will sympathise with me,” said Abdirahman, shaking his head in regret.

“Hours later, all my neighbours moved out and my children were kicked out from the local school because their father is HIV positive.”

Soft-spoken with a greying goatee, Abdirahman, 43, looks older than his age. He found out he had the virus after going to the hospital for tuberculosis treatment.

Sitting opposite him is 25-year-old mother-of-five Rahma. She contracted HIV when dentists at her local clinic used unsterilised equipment to remove a bad tooth. She was diagnosed HIV-positive 11 months ago and is still coming to terms with her condition.

“I’m still in shock of why this happened to me and why they did this to me,” Rahma said, tears filling her eyes. “I only told my husband and we agreed we won’t tell no one else, even our parents. If we tell our families they will abandon us and our children.”

Aggresive awareness campaign

Somalia’s health system has been destroyed by the civil war that’s raged for more than 20 years. The capital Mogadishu has many hospitals – both private and those funded by international organisations – but until recently none offered free treatment to HIV-positive patients.

Patients in Mogadishu used to go to Merca, a town more than 90 kilometres away, to seek treatment. Most couldn’t afford the fares for the journey. Recently a local organisation, South Central Relief Network (SCRN), opened its first office in Mogadishu’s Banadir Hospital to cater specifically to HIV/AIDs patients. Currently it provides free treatment to 132 patients who are HIV positive.

“The number of people with HIV in Somalia is increasing,” said Mohamed Siad, head counselor at SCRN. “We now receive between five to seven new patients a day. They are referred to us from the hospital.”

The exact number of people living with HIV/AIDS in Somalia is unknown.

According to the Somali government, one percent of the country’s estimated nine million population is HIV positive. In 2011, UNAIDS estimated the number of people living with HIV in Somalia to be 35,000.

The number of patients coming to SCRN in their Mogadishu clinic is increasing, thanks in part to an aggressive awareness campaign.

“We have placed advertisements on TV and local FM radio stations to raise awareness, to tell people they don’t have to suffer in silence,” said Mohamed, who himself is HIV positive.

But the awareness campaign is not without its challenges.

“Some TV channels and radio stations refused to accept our ads for fear of been stigmatised,” said Mohamed.

Most of those coming to the HIV/AIDS clinic in Mogadishu are too poor to buy the medication elsewhere.

Those who can afford to travel abroad for treatment usually do so, in order to keep their condition private.

“People come to us to do blood tests. They then call to ask for the result,” explained Omar Abdi of the Fathu Rahma Laboratory and Pharmacy. “If they’re positive they never come back but go to Kenya for treatment.”

Private hospitals and pharmacies in Mogadishu avoid stocking HIV/AIDs medication.

“We are a private hospital and if those patients not suffering from HIV or AIDS found out we treat people with AIDS or HIV in our hospital, they will all discharge themselves and we won’t have any patients and we won’t have any business after that,” said Dr Abdulkadir Sheikh of Hanano Hospital.

“We are a private hospital and to treat HIV positive or AIDs patients will be economic suicide.”

Stigma of AIDS

In Somalia, HIV/AIDS is associated with promiscuity and in conservative Muslim society, it’s proving difficult to convince many to come out and seek treatment.

“Because of our religion and people wanting to protect their family name, no one wants to have the community thinking they go around sleeping with everyone, especially prostitutes,” Mohamed said.

The new internationally recognised government, which took office in September last year, has encouraged patients to get treatment despite the social stigma attached.

“We offer training to hospital staff, we also do the same for the community to increase their knowledge of HIV/AIDS,” said Sadia Abdisamad, HIV/AIDs National Program Manager at the department of health.

“We have put billboards in the city, placed ads on radios. Our focus is to increase awareness to try and stop the spread of the disease, and to make people come out and seek treatment without fear of been stigmatised,” she said.

Despite such attempts by the government and local organisations, it may be a long time before the stigma and fear associated with HIV/AIDs in Somalia is overcome.

“Somalis are more scared of HIV than bombs, so fearful they will not accept to be in the same building as someone with HIV,” said Abdirahman.

Now, all he wants is to be left alone in peace to look after his five children. “I’m very weak and in the final years of my life, I want to be left alone to raise my kids without harassment,” he said.

Follow Hamza Mohamed on Twitter: @Hamza_Africa