Issue No. 721

Stigma and HIV in Somalia
 

Last week, the Banaadir regional administration announced it had arrested 35 workers in Mogadishu for carrying infectious diseases in the capital, including Hepatitis and HIV/AIDS. Of that number, four HIV-positive foreign nationals working menial jobs were subsequently deported to 'prevent the spread of the disease.' The apparent criminality of carrying these diseases, with some unaware of their condition, was not explained by the administration. Somalia is far from the only country that has archaically and without logic deported individuals living with HIV, with Algeria, Egypt, and Saudi Arabia, among several others, known to do so as well.

What is notable is the sustained lower rates of HIV/AIDS in Somalia when compared to its neighbours, particularly Kenya. Somalia has long enjoyed one of the lowest HIV infection rates in Africa, even as the continent accounts for 65% of the global HIV-positive population and 62% of all new HIV cases worldwide. However, with the government's collapse in the 1990s and subsequent decades of conflict, gathering accurate medical statistics and the ability to diagnose diseases in Somalia has proven extremely difficult. One 2023 UNAIDS report estimated that only 8,200 people in Somalia were living with HIV, a proportion far below the global average of 1.2% and Sub-Saharan Africa's 9% average. The accuracy of this number is questionable when examining other data sets, including a UNAIDS testing of prisoners, that suggests the actual proportion may be closer to 0.4% or higher. Even 0.4% is extraordinarily low, however, considering that 70% of Somalia's population lives below the poverty line, less than 30% have access to healthcare, and communities lack knowledge about practising safe sex. These factors, and particularly the conflict-HIV nexus, would lead one to expect far higher rates.

The comparatively low rates of HIV in Somalia, even acknowledging that most medical statistics in Somalia should be taken with a pinch of salt, can be partially attributed to the isolated nature of the country in the past 30 years. Patterns of transmission of HIV in Africa have routinely fallen along major trucking roads due to the prevalence of prostitution. There has been massive and sustained internal displacement in Somalia over the years from climate disasters and armed conflict, but these patterns, as well as the nomadic nature of pastoralist communities, have not resulted in widespread HIV infections. Yet other sexually transmitted diseases, such as chlamydia and syphilis, remain more prevalent in large parts of the country.

The stigmatisation of HIV and extramarital sex has resulted in the underreporting and active discrimination of those living with the disease. Within this context, religious and cultural norms have typically portrayed HIV-positive individuals as symbols of moral failure, with the virus being unfairly associated with sexual immorality or relations with foreigners. Moreover, the prevalence of Female Genital Mutilation (FGM) in Somali society, around 98% of women are believed to have undergone infibulation– the most extreme type, further makes women and girls more vulnerable to infection.

Open-minded approaches to HIV are often equated with moral corruption, making the open reporting of infections or seeking healthcare for HIV-related issues far more complicated. TV and radio channels have been known to refuse to air HIV awareness campaigns, while those living with the disease are often evicted from their homes by landlords. These cultural perceptions of HIV in Somalia are likely to have contributed to the recent arrests and deportations of infected individuals, as well as the broader challenges in effectively managing the virus within the country, even with the comparatively low levels. For many Somalis, HIV is viewed as a disease that has been ‘imported’ from outside the country, and that is not endemic to a Muslim society.

With violence and conflict still so widespread across the country, women remain vulnerable to rape and sexual violence from a host of armed actors, further raising their risk of HIV infection. Equitable access to post-exposure prophylaxis and other HIV drugs remains a major issue, with the country's healthcare system highly fragmented. While several clinics in Banaadir provide HIV support, those outside of Mogadishu are forced to deal with a far more patchwork health system that may not include HIV therapy. There are still fewer functional hospitals, fewer medical personnel and equipment, as well as drugs and financial resources to help support those living with HIV to suppress the disease.

These cultural and structural barriers severely undermine early HIV diagnosis, reporting, and treatment in Somalia, creating significant challenges in effectively managing the preventable virus. While the country has comparatively low rates of HIV, those living with it experience enormous discrimination from the conservative elements of Somali society. Awareness-raising of the importance of safe sex and the realities of living with HIV in 2024, as well as early testing, timely reporting, monitoring and management, are critical to preventing new cases and supporting those living with HIV. Overall, implementing a 'do-no-harm' approach for the Somali context will be far more effective at tackling HIV in the long term than the current sporadic system in place today.

By the Somali Wire team