PUNTLAND MEDICAL ASSOCIATION (PMA)

Galkayo City, Puntland State, Somalia

 Tel: 252 543 4808; Fax: 252 543 4501; Email:  somali_action@hotmail.com

 

LETTER OF APPEAL:

PREVENTION OF HIV/ AIDS SPREAD IN SOMALIA.  ACT NOW BEFORE IT’S TOO LATE!!!

 

Preamble

  

Human Immunodeficiency Virus (HIV) infection knows no borders, nationalities nor ethnic groups. Somalia is situated in a geographical hot zone as HIV/AIDS rapidly becomes pandemic. The improved security and the secession of hostilities in many parts of the country has led to the return to the repatriation of a large number of Somali refugees. Many of those returning have been exposed to HIV infection while they were living out of the country.  In Somalia, there are many other risk factors that facilitates the spread of HIV infection. According to the latest UNAIDS report, the rate of HIV infection in Somalia has risen from an estimated 0.2% in 1987 to 2% in 1997[1]. In major Somali cities, the HIV infection is spreading rapidly.

 The only effective method of combating the spread of HIV/AIDS is through education and awareness. In Somalia, raising public awareness of HIV/AIDS poses an immense yet crucial challenge. Alarming misconceptions exist – even among the well educated - that the disease is “foreign” disease that does not exist in Somalia because of the strong Muslim culture. With Sexually Transmitted Diseases (STDs) not discussed in polite conversation and HIV often portrayed as a disease of foreigners, it is not surprising that many Somalis do not think they are at risk of HIV and other STDs. This misperception can have serious consequences for Somalis and contribute to the spread of these infections. Though the rate of HIV/AIDS infection is assumed to be much lower in Somalia than in neighboring countries, studies and surveys conducted in Somaliland (the northwest region of Somalia) and Puntland (the northeast region of Somalia) indicated that the HIV/AIDS epidemic may be about to hit Somalia.

 Preventing the spread of HIV/ AIDS infections depends on influencing people to change their behavior through health education.  Efforts must be made to provide information to the public about the disease as well as the behavior conducive to its spread.  Influencing behavioral change is never been easy but the challenge is compounded by the conservative Muslim culture of Islam that makes discussions around sexual behavior taboo. Prevention efforts are key at this stage; Somalis must be educated on the risk factors for disease transmission.  Controlling the spread of disease later will be tremendously more difficult than instituting prevention efforts now.  Somalis must have access to the knowledge of a) what the disease is; b) how it is transmitted (and, in turn, how it is not); c) how likely they are to become infected; and d) what they can do to avoid infection.

 AIDS is clearly taking an immense and growing human toll. AIDS is not only a health issue. Apart from human suffering, the situation in high prevalence countries is characterized by substantial losses of trained manpower and subsequent reductions in the GNP, disruption of families and a huge social and economic burden resulting from a growing number of AIDS widows and orphans.  Increasingly, however, responding to AIDS in Somalia requires efforts going beyond the health sector in order to mitigate the social and economic consequences of the epidemic.

 STDs represent a major public health problem throughout Somalia. STDs are very important because of their complications and social stigma.  An ongoing yet unpublished study on STD prevalence in Galkayo city[2] currently indicates that 20% of people attended one of the private clinics in Galkayo suffer one or more STDs.  This figure is consistent with a recent report on STD prevalence in Somaliland, which indicated that 31% of women and 12% of men in the study had one or two STD symptoms.[3]  Yet, sexual behaviors that facilitate HIV transmission are the same as those for other STDs. HIV and other STDs share common risk behaviors and are amenable to common behavioral interventions. In addition, HIV infection and other STDs are linked by biological mechanisms. Other STDs increase both HIV infectiousness and susceptibility, yet STD prevention is not usually implemented as a significant HIV prevention strategy. Several Studies in Sub Saharan Africa on interactions between STDs and HIV particularly the Mwanza[4] finding suggest that prevention and control of STDs before or early in this epidemic will probably reduce STDs in the highly active core population and will have a major impact on the spread of HIV.  As a result, the high prevalence of STDs in Somalia will only facilitate the spread of HIV/AIDS. Therefore, as we see the scientific evidence that supports STD control as an intervention that will have enormous impact in the early phase of the HIV epidemic, we should properly consider implementing various interventions that proved to be effective on controlling the STDs. There is consensus among physicians working in Somalia that STDs are increasing among Somalis, especially women and quite possibly Somalia is on the verge of HIV/AIDS epidemic. However, timely prevention initiatives may effectively curb this epidemic. 

 Strategy to curb the spread

Emerging regional authorities, and any future government in Somalia, will have many pressing issues to deal with and a limited budget which to implement change.  It is unlikely that addressing prevention activities for HIV/AIDS (and, in turn, STDs) will rank a top priority.  Therefore:

 ü      Health professionals, international bodies and organizations must step in and advocate that regional authorities should include their priority on combating the spread of HIV/AIDS.

ü      Countrywide information gathering and surveys must be carried out.  Sentinel surveillance and KABP survey will be the most appropriate to gather comprehensive information about the HIV/AIDS status in the general population in Somalia.

ü      The high prevalence of STD must be reduced throughout the country through primary prevention including community awareness and continued health promotion.

ü      STD management through a syndromic approach should be implemented, particularly at primary care level.

ü      Local authorities have to mobilize and advocate national and international resources for STD/HIV/AIDS prevention and care.

ü      Training of health personnel in all relevant aspects of HIV/STD prevention and control, including communication skills and behavioral aspects.

ü      An HIV/AIDS task force must be created. The task force must comprise all the agencies involved in this issue, as well as regional, local authorities, religious leaders, community leaders, youth and women’s groups.

ü      In order to mobilize awareness and appropriate and timely responses in concerned sectors, the HIV/AIDS task force should bring together other agencies dealing with education, social security, agriculture, small-scale business and infrastructural development.

ü      To avoid overlaps and undeserving in some regions, all the activities and tasks must coordinated by the task force. Due to lack of cooperation and coordination between UN agencies, international and local NGO’s, local authorities, and also community members have resulted in duplication of efforts and wastage of scarce international and national resources. Therefore, we have to learn from the past experience and share information.

ü      A program of HIV and STD prevention needs to begin working at the community level specifically among women and youth groups.  We have to ensure that the local community is capable of responding to epidemics.

ü      UN agencies and International and National NGOs with the local authorities have to develop and promote national STD treatment guidelines.

ü      UNAIDS and other international agencies have developed many approaches to deal the AIDS devastation and how the local community or society can respond the HIV epidemic. These approaches need to be tailored to Somalia.

 For the past 10 years, important progress has been made towards improving STD management in order to combat the AIDS devastation in many developed and developing countries. Correct STD management is one of the few cost effective instrument with proved efficacy to reduce the transmission of HIV. Therefore, local authorities, the private sector, and donor and UN agencies need to understand the importance of establishing countrywide, appropriate, and sustainable STD services and seeks a consensus for long-term collaboration. Developing effective STD management and prevention programs will require active participation and strong leadership by both the government and the international and local agencies working in Somalia.

 The process of preventing STDs must be a collaborative one. No one agency, organization or sector can effectively do it alone; all members of the Somalia communities and the international and local organization must do their part. A successful national initiative to confront and prevent STDs/HIV/AIDS requires widespread public awareness and participation and bold national leadership from the highest levels.

 Puntland Medical Association and its members have been very active locally and internationally and we are committed to help our people wherever they are and what ever it takes. Our members have the knowledge and the expertise to combat the HIV/AIDS epidemic through not only clinical side but also prevention. PMA is willing to collaborate anyone who intent to contribute the HIV/AIDS prevention in Somalia, or any other health problem. Please feel free to contact PMA by calling 252 543 4808, by fax # 252 543 4501, or sending email to somali_action@hotmail.com.  We will be very happy to answer any question that you may have and provide you more detail information about the status of STD/HIV/AIDS in Puntland State, and Somalia in general.

 Thank you for your quick response or action.

 

Best regards,

 

Prof. Mohamed Jama Salad, MD.                                                     Abdinasir M. Abubakar, MD, MPH .     

President