In Somalia, diagnosing AIDS can be risky

JOWHAR, Somalia -- There may be no harder place in the world to fight AIDS than Somalia.

For the United Nations and Western charities, some areas are off-limits because it is so risky. But even in places where they operate, the basic task of testing someone for the virus is widely considered too dangerous.

''If we tell someone that they are HIV positive, they might take revenge," said Josef Prior Tio, general coordinator for Doctors Without Borders in this central Somali town and in Mogadishu, the capital.

''You could get killed," said Halima Hasan Osmani, a supervisor at a Doctors Without Borders clinic that specializes in care for pregnant mothers but does not test for HIV. A nearby hospital does offer tests, but the Doctors Without Borders staff will not ask whether a patient knows his or her status.

Faiza Narbeth, a Somali native and consultant to the UN Development Program's HIV/AIDS initiative, explained the problem by telling a story she had heard earlier this month at an educational HIV/AIDS seminar. She said that one participant told the group about a birth attendant who had tested a pregnant woman in the southern city of Kismayo, learned that the woman was HIV positive, and then gave the result to the woman and her husband.

''The participant in the seminar told us that the husband accused the birth attendant of infecting his wife," Narbeth said. ''The birth attendant was hidden by the community and had to flee from Kismayo. But the husband found her and shot her dead. These stories are commonplace."

Somalia's HIV prevalence rate is estimated at 0.9 percent of the population, according to a World Health Organization survey in 2004 of pregnant women in antenatal clinics. But no comprehensive studies have been done in the country, which has been without a central government for 15 years. If accurate, that rate would be one of the lowest in Africa.

In Somalia, the UN's focus is simply to educate people about the dangers of HIV and how to prevent transmission. But the widely accepted ''ABC" prevention method -- abstinence, being faithful to one partner, and consistent use of condoms -- is hotly contested here.

At Narbeth's 30-person seminar, some vehemently opposed condom use, saying it encourages promiscuity, which is against the tenets of Islam.

''We agreed to disagree," Narbeth said. ''It raises the problem of how do you fight against the spread of the disease. We are at the beginning, beginning, beginning stage, where everything is based on fear."

John Donnelly can be reached at donnelly@globe.com.