afrol News / PlusNews, 22 November - In the two years since the first voluntary counselling and testing (VCT) centre opened up in Somalia, HIV treatment, care and support has come a long way, but renewed violence threatens those gains.

"The whole of south-central Somalia, the area most in need, is a no-go area. This means that they are missing out on half-a-million US dollars [Global Fund financing]," said
Dr Fernando Morales, HIV/AIDS technical advisor for the UN Children's Fund (UNICEF) Somalia office. "Training and supervision cannot take place, as no UN and most NGO expatriates and experts cannot enter."

After 15 years without a functioning government, a transitional authority was set up in 2004 to restore law and order. But its legitimacy has been challenged by a new group, the Union of Islamic Courts, which took control of the capital, Mogadishu, in June, and has continued to extend its authority over much of southern and central Somalia.

Even before the resurgent fighting conditions were difficult for AIDS service providers. "There are not enough trained personnel in Somalia; this causes delays in programmes. We have to train lab staff, clinical staff and counsellors," Malweyi Inwani, health director for the medical charity, Merlin, said. "Setting up training courses is difficult, as we have to bring in external consultants."

Non-existent road networks and insecurity also required the air freighting of equipment, an expensive undertaking. That has now been made all the harder by a ban on flights to Somalia by neighbouring Kenya, the regional hub for humanitarian organisations.

Nevertheless there have been notable achievements in Somalia in the last few years. Financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria has allowed the expansion of HIV services; people are being trained as VCT counsellors, blood is now checked before transfusion and life-prolonging antiretrovirals are being given to 80 patients in Hargeisa, the capital of Somaliland.

A VCT centre managed by Merlin in Bosasso, capital of the northeastern self-declared autonomous region of Puntland, has been running for the past six weeks. So far, only 24 people have walked through the door - five of whom were found to be HIV-positive - but in highly conservative Somalia, that could be considered a success.

"People are reluctant to come ... there is quite a lot of stigma. Only one year ago did someone say publicly that they were HIV-positive, and they were like a hero to us," said Inwani.

The most recent survey by the United Nations World Health Organization in 2004, estimated a national HIV prevalence rate of 0.9 percent, with variations between south-central Somalia at 0.6 percent, Puntland at 0.9 percent and the self-declared republic of Somaliland, in the northwest, at 1.4 percent.

"HIV prevalence is low compared to surrounding countries, but being an Islamic country there is lots of denial. We are working to ensure that the rate stays low," Inwani said.

Morales suggests protective factors have been at work. The country's unrest since 1991 reduced mobility to high prevalence areas such as Kenya, with a 5.9 percent infection rate, while a combination of religious and cultural conservatism has also had an impact.

However, Morales said there were several risk factors, such as widespread ignorance around issues of HIV/AIDS, and gender inequality. The latest fighting has also sent nervous refugees spilling across the country's borders where, uprooted and vulnerable, they face increased risk of HIV exposure.

© afrol News / PlusNews

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