- HIV/AIDS awareness messages are falling on fertile ground in Dadaab refugee camp, in northeastern Kenya, where more than 140,000 Somalis who have fled insecurity in their home country have found a safe haven.
"Many people have acknowledged the facts on the ground - the awareness level of the people has changed a lot," said Shukri Santur Harun, a reproductive health and HIV/AIDS supervisor at a voluntary counselling and testing (VCT) centre in Dadaab, run by the National Council of Churches of Kenya(NCCK).
The United Nations refugee agency, UNHCR, offers prevention, treatment and care services in the camp via the NCCK. By using community education that targets women, children and religious leaders, they have been able to overcome some of the barriers raised by the conservative Somali culture to inform people of the dangers of the pandemic.
"We are well aware of the HIV/AIDS threat and do a lot of public awareness on the disease. There is a nine-person [HIV/AIDS] committee in this [section of the] camp alone, whose pivotal responsibility is to consolidate the community and health educators," said Isnino Ali, chairperson of committee in the Ifo section, one of three in Dadaab.
Among the issues tackled are male circumcision, an Islamic requirement, and female genital mutilation (FGM), practiced widely in the horn of Africa. Both types of circumcision are often carried out using a single blade on several children.
More than 90 percent of all Somali women undergo a form of FGM, in which all or part of the external genitalia are removed and the vaginal opening is stitched or narrowed, leaving an opening about the size of a matchstick to allow for the flow of urine and menstrual blood.
When circumcision or mutilation is carried out on several boys or girls at a time, without the benefit of sterilisation between procedures, the chances of infection and the risk of exposure to HIV are heightened.
Recent research has shown that unhygienic practices in eastern and southern Africa could transmit HIV, with circumcised virgins and adolescents in Kenya, Lesotho and Tanzania consistently and substantially more likely to be infected with HIV than their uncircumcised counterparts, according to the March issue of the Annals of Epidemiology journal.
"We train people who circumcise the children on cleanliness," said Maryan Ali Shireh, who works in the Dhagahaley section of Dadaab. "Besides that, we educate women on the health risks of FGM, urging them to stop it once and for all, as it has neither religious nor medical values."
Ending the practice of FGM is difficult: it is a source of income for many women in the camp, who are reluctant to relinquish their livelihood and therefore encourage families to have their daughters cut. Shireh said the women were offered alternative ways of making a living as an incentive to stop circumcising girls.
Girls in the camp were also educated about HIV/AIDS and were beginning to heed the message. "We urge the girls to refrain from sex before marriage and to acquire information on AIDS," she said, adding, "There are women who even demand HIV status disclosure from their partners before marriage."
Despite such progress, stigma and discrimination are still the biggest hurdles in fighting HIV in Dadaab. Traditionally, discussions about sex are taboo among Somalis, and HIV is still largely seen as an 'immoral' illness, so people who contract the virus are reluctant to admit their status.
"The more you conceal your status the more you suffer. The Somali people ... are afraid to be discriminated [against] by the society," said Abdi Derow Kasim, of the Dhagahaley youth group.
Although most camp residents know about the pandemic, a recent upsurge in insecurity in Somalia has increased movement across the border into Kenya. Health workers say the need for AIDS information to prevent a rise in HIV infection in the region is greater than ever.
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