Fighting AIDS in a war zone

Aid agencies working in a climate of heightened insecurity in Somalia have been forced to come up with inventive ways to keep their HIV programmes, and their staff, alive following the recent kidnappings of several foreign and local aid workers.

"The security situation has deteriorated, and there is very limited access for United Nations and partner agencies to provide humanitarian support," said Ulrike Gilbert, an HIV specialist with UNICEF (the UN Children's Fund) in Somalia, the principal recipient of Somalia's HIV grants from the Global Fund to fight AIDS, Tuberculosis and Malaria.

"We have had to build the capacity of our local partners - local NGOs who work on the ground and live within communities in insecure areas - because even our Somali national staff have no access to many areas now."

HIV prevalence in Somalia is low - just under one percent - but knowledge about the pandemic and access to HIV services is also low. According to UNAIDS, only five percent of the population has been tested for HIV, and only four percent of young women aged between 15 and 24 have accurate knowledge about the virus.

UNICEF and its partners have started several HIV programmes, including a woman-to-woman peer education programme, encouraging religious leaders to discuss the disease more openly, and providing voluntary counselling and testing (VCT) and antiretroviral (ARV) therapy at six sites across the country.

"Some of these organisations are doing amazing work, continuing to provide awareness and other services amid shelling and insecurity," Gilbert told IRIN/PlusNews.

One such group is the Coalition of Grassroots Women's Organisations (COGWO), an umbrella agency working in five areas of south-central Somalia, where fighting between Ethiopian-backed Somali forces and insurgents has forced up to one million people to flee their homes, and resulted in the deaths of an estimated 6,500 civilians since 2007.

"We run the woman-to-woman HIV/AIDS programme, using 24 facilitators to sensitise women about HIV," said a spokesperson for COGWO, who asked not to be named. "We hold assemblies where women talk about HIV-related issues, we counsel people living with HIV, refer people for VCT and go house-to-house doing education."

Flying under the radar

These activities all involve interacting with people in their communities. "It's dangerous; we have to keep a very low profile in order to avoid being harassed by the militias," she said. "We don't go to the frontline: the areas where the TFG [Transitional Federal Government], the Ethiopian troops and the insurgents are fighting.

It's dangerous; we have to keep a low profile in order to avoid being harassed by the militias

"We are also careful about what time we carry out activities," she added. "In the morning, before the khat [a mild stimulant widely chewed in the Horn of Africa] arrives in the market, the militias are alert and can harass our staff about what they are doing, and whether they have the authority to do it. But in the afternoon, when most of them have gone to chew the khat, we can move around more freely."

To avoid possible persecution, the COGWO staff do not mention the HIV component of their work and simply tell the militias they are holding meetings for women.

The spokesperson told IRIN/PlusNews it was possible to keep educating people, but the continued insecurity could be both dangerous and disruptive to activities. "Recent shelling in Beletweyne [330km north of the capital, Mogadishu] displaced some of our facilitators and peer educators, so their work had to stop."

Getting sick people to hospitals was also extremely difficult. The only site in south-central Somalia with VCT services and ARV treatment is in Merka, 100km south of Mogadishu, said the COGWO official. "The road between Merka and Mogadishu is not safe."

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