Health Interactive with Dr Aminu Magashi  

HIV and Stigma: The Sudan experience

healthinteractive@hotmail.com

On Wednesday, 10th October 2004 , a very moving piece of information was posted at the E: Forum being man aged by Journalists against AIDS in Nigeria . It was sourced from the Agence France Presse via The Sudan News Agency (SUNA). The information is about stigmatising the disease HIV/AIDS, even as all stakeholders are making efforts to convince the doubting Thomases among us, that people living with HIV/AIDS (PLWHA) have equal right to live, be happy and secure a good job, and reproduce like others who are HIV negative.

It was reported in the news that the Sudan Government has asked a contingent of Nigerian troops in Darfur , to produce certificates proving they are not infected with the HIV virus or have undergone screening. It went further to say that the authorities would never be tolerant with regards to the safety of the people of the state. Reference was made to the group of 47 soldiers who arrived in El- Fasher, as part of the first Nigerian contingent of a reinforced African Union truce-monitoring force in the troubled region of Darfur . Sudan Health Minister Ahmed Bilal Osman reportedly said that an AIDS free policy would be applied to AU troops being deployed in the region, and the measure was PURELY PRE-CAUTIONARY (emphasis mine) and aimed at ‘ safe guarding the health of the people of Darfur’.

The minister talked about precaution, as if an ordinary handshake between the infected and non-infected person, will lead to the spread of HIV. As we all know that handshakes, hugging, sharing of utensils and eating and drinking from the same bowl and cup, respectively, will not lead to HIV. Likewise the sharing of clothes. That is why people like us are bewildered at the screening exercise being a precautionary measure. For the sake of argument, let me attempt to deduce the rationale behind the mandatory screening. It is an open secret that all over the world, when soldiers are deployed to ensure peace in trouble spots, even those that are married, have to abandon their families at home, and some may end up staying for long without coming back home. That experience may lead to a lot of legitimate or illegitimate relationships between the peacekeepers and the inhabitants of the land. In worse situations, there were many cases of reported rape and sexual assault to the inhabitants, which may lead to unwanted pregnancy and/or spread of sexually transmitted diseases of which HIV is among.

In my own understanding, that could be the reason why the minister is talking about precaution, but with all sense of judgement, I believe he is wrong, likewise the authority to mandate the production of an HIV certificate. Another question one may be tempted to ask, is ,  if some of the soldiers deployed, among them are HIV positive, how is the government of Sudan going to respond? Will the government send the soldiers packing just because they turn out to be HIV positive? If that is so, that is the worst form of discrimination and stigmatisation.  In a situation where, even if a soldier is tested HIV positive, the government is not sending him back to his country, then the exercise is irrelevant, and of course, the government needs to know that just as the inhabitants have the rights of protection against the visitors, likewise, the visitor deserves protection too. As the saying goes ‘Where somebody’s rights ends, someone’s rights begins.
Where I see the need for precaution, is the issue of sexual assault and rape, and the precaution may not necessarily be HIV screening, and infringing of rights, but to ensure that, to some extent the soldiers do not misbehave, and that could be achieved through organising a moral/social orientation to the visitors on arrival, and at same time setting up units, where inhabitants can lodge a complaint or petition. With regards to possible HIV spread from the visitors, and the inhabitants and vice versa, the approach should be to repeatedly create awareness about the disease, and sensitisation about the means of spread, and prevention and control. By this means, the inhabitants can make an informed choice whether to engage in any relationship with the visitors or not.

Where I do not see the point of stigma regarding HIV screening, is when, for example , an institution is engaging the services of someone with respect to his/her work which involves the handling of blood and other body fluids. For instance in the case of those working in laboratories and intensive care units of hospitals. The screening even in that regard, should be done with the consent of the potential employee, and the rationale should be towards protecting both the laboratory worker and the patients.

A laboratory worker who is screened and is confirmed as HIV negative, and during the course of his/her work gets the infection , needs to be compensated by the management, or to be insured against such possibility, and it is only through screening one will know who deserves to be compensated. With respect to the patient, if the laboratory worker is screened to be HIV positive, he will always be on the alert, and to use extreme precaution when taking samples of blood and other body fluids. That is why I frown at those institutions which screen administrative staff, and it is glaring that those at the head of such institutions, do not understand the concept of HIV spread, or they are deliberately stigmatising the disease.

Lastly I will like to conclude this discourse, by saying that one war that needs to be fought, is for the HIV/AIDS campaigner and implementers of projects, to change their attitude and strategy towards prevention and control of HIV/AIDS. What is often seen from them is to repeatedly say that ,  HIV/AIDS has no cure, and of course, that message is frightening. It has no cure, just like Diabetes Mellitus and Primary Hypertension, but people have been known to live with those diseases, and live a happy life. The message should be that although HIV/AIDS has no cure, one can live positively by responding to ailments appropriately, and there are available Anti Retro viral drugs, which can suppress the rate of multiplication of the virus in the system, and improve the immune status of the infected one.

HIV activists must summon the courage to publicly condemn all forms of stigma and discrimination against PLWHA, and to advocate tirelessly to the African states towards awareness creation on HIV/AIDS, and reaching out to three million people living with HIV/AIDS with Anti Retro Viral drugs by 2005 (3 by 5 policy).

Dr Magashi Is The Executive Director of Community Health and Research Initiative, Kano , Nigeria .