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Sickle-cell disorder killing 100,000 infants a year
Related to country: Nigeria
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

At least 100,000 infants die from the sickle-cell genetic disorder in Nigeria every year, and the country still has the highest incidence of the illness in Africa.

“From available statistics, 100,000 infants die from sickle-cell disease in Nigeria annually, making it the number one sickle-cell endemic country in Africa,” Sadiq Wali, president of the Nigeria Sickle-cell Foundation, told IRIN.

“Based on World Health Organization [WHO] indices, Nigeria accounts for 75 percent of infant sickle-cell cases in Africa and almost 80 percent of infant deaths from the disease in the continent”, Wali said.

According to the WHO, 200,000 infants are born with sickle-cell in Africa every year, with Nigeria accounting for about three-quarters of these births. Sixty percent of the 200,000 will die as infants.

Sickle-cell disease is an incurable genetic disorder widespread in sub-Saharan Africa and among descendents of Africans worldwide. Sufferers have no visible symptoms, but periodically experience severe pain and are also highly prone to anaemia because the blood cells break down after only 10-20 days, rather than the usual four months.

A person can only inherit sickle-cell disorder if both parents are carriers of the genetic trait, and then there is a one in four chance of giving birth to an affected child. WHO says that in some parts of sub-Saharan Africa, up to 2 percent of children are born with the condition. For more on this see Africa: Little help for those who suffer from blood disorder.

“This genetic disorder alone accounts for 8 percent of infant mortality in Nigeria which calls for urgent attention”, Wali said.

Around four million Nigerians are estimated to suffer from the disease, while 25 million others carry the genes which they pass to their offspring.

Link with malaria?

According to the WHO, sickle-cell is particularly prevalent in areas of high malarial transmission.

“The mutant sickle-cell gene confers a survival advantage against malaria which explains the prevalence of the disease in Nigeria where malaria is endemic,” explained Ibrahim Musa, a Nigerian medical expert based at Kano general hospital.

Carriers of sickle-cell are less prone to being infected with malaria, which attacks red blood cells. However, those with sickle-cell disease are more vulnerable to malaria because of their weakened health, experts say.

Although sickle-cell in infants is curable through bone marrow transplants, lack of expertise and the high cost of the operation makes preventive measures the best option, medical experts say.

“This is why we advocate genetic counselling by intending couples before marriage to determine the status of their genes”, Nigeria Sickle-cell Foundation’s Wali said.

“People should go for a genetic test in the same way they determine their HIV status before marriage as the most effective way to protect their children and curtail the disease”, he said.

Sickle-cell contributes to 9 percent of deaths in children under five in West Africa, and up to 16 percent in some countries. Sickle-cell has a heavy impact on children: malaria is the leading killer of under-fives in Africa.

August 21, 2008 | 8:28 AM Comments  0 comments
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Underground sex in the conservative north
Related to country: Nigeria
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Idris is a pimp and makes no bones about it. Because of the way the sex industry works in Nigeria's northern city of Kano, he and the women he pimps have a co-dependant relationship – they exploit each other.

Kano's history dates back 1,400 years as an iron-working centre that adopted Islam in the 14th century and grew on the back of the trans-Saharan caravan trade.

Outside the old city walls is a quarter known as the sabon gari, where "foreigners" traditionally lived, segregated from the Hausa-speaking indigenous population. With sharia law applicable in Kano, it is in the bars and hotels of the sabon gari - where Islamic jurisprudence does not reach - that Idris does his business.

He works with a group of Hausa-speaking women from all over the north who live in a dingy, nameless hole-in-the-wall hotel, whose anonymity seems deliberate. Quarrelsome, poor, with some clearly on something narcotic, these are women at the edge of society.

As they prepared for the evening, applying henna to their hands and feet, cleaning their rooms, getting stoned, Idris explained that his role was to guide the "big fish" to the establishment, and sometimes act as muscle. He gets tipped by the women, maybe gets fed if they feel sorry for him, or he has a girlfriend among them, but the money they make is theirs alone.

It is not that much. They pay N450 (US$4) a night for the rooms and share blocked toilets downstairs, having to burn incense to cover the smell, and charge around N300 (US$2.60) for sex – an amount whispered out of earshot of Idris and the other pimps. While a "big fish" in the capital, Abuja, or the commercial metropolis, Lagos, might shell out N150,000 (US$1,300), here a serious score would be N15,000 (US$130) – and it doesn't happen often.

"There is a religious/cultural dimension; they are outcasts from their families and find succour in drugs: ruffies [Rohypnol, a date-rape drug], Benzedrine [an amphetamine], cough syrup," explained Salamatu Da'u, behaviour change communication coordinator in Kano of the Society for Family Health (SFH), a Nigerian AIDS service organisation that had just begun working at the hotel.

The way you change a car is the way you change a wife in Kano.
Kano, Nigeria's second largest city, has an HIV prevalence rate of 3.4 percent - just below the national average of 4.4 percent - but among brothel-based sex workers it hits 49.1 percent. In a six-state behavioural survey by the federal ministry of health, Kano's brothel-based sex workers were the least able to correctly identify ways of preventing HIV transmission, and the least likely to use condoms with their customers.

The stories of the women working out of the brothel in the sabon gari were almost identical: divorced, or running away before being forced into marriage, hoping one day to find somebody to settle down with. "I come from a religious family and I know what I am doing is a sin, but I pray every day for God to create an opportunity for me to leave this business; not just me, but all the girls," said Fatima Danjuma*.

Married young

In the north, the pressure on girls to get married begins almost as soon as they start menstruating, said Da'u. "Ï grew up with it. The idea is sold to you from six or eight; it's a way of life. The girls see it as a rite of passage: 'soon I'll be on my own', independent, grown up." But the sacrifice is education, and the chance of real independence that it can deliver.

According to the Population Council, an international reproductive health organisation, 45 percent of girls in northern Nigeria are married by the age of 15, and 73 percent by age 18. The "vast majority" of child marriages are arranged by families, to husbands 12 years older than their wives on average.

"Men made the vast majority of decisions in the household, regarding not only major life issues such as large purchases, but also more mundane matters such as daily purchases and meals. Sexual debut was often unwanted and traumatic for these young brides," the Population Council's website noted.

The vulnerability of the girls is magnified by the high divorce rate in Kano, a commercial city where a new bride can be a status symbol for a man. "A girl can be married at 12 and divorced at 18, with children to support," said Da'u. "The way you change a car is the way you change a wife in Kano. You give birth to a few children and you can find yourself divorced for the slightest excuse."

That creates a class of young women who are likely to have limited schooling, possibly living at home again - with all the tension that entails after running their own household - and expected to earn an income. Typically, this means petty trading on the streets, selling food, cosmetics or small items, while waiting for suitors; but it can also shade into sex work, in a region where condom use is exceptionally low.

"The north is a very traditional place; to make inroads you must work with traditional religious leaders," said Kene Eruchalu, SFH's national head of behaviour change communication. "What we don't have yet is many traditional leaders coming out to promote condoms. A number of them have come to terms with the fact that people are having sex, and we're thankful that we've had some kind of silent support which hasn't opposed the intervention."

Sheikh Zachery Adam says he is "deeply involved in the fight against HIV/AIDS" and, through a local association that meets one a month, supports the use of condoms for men who cannot abstain from sex or remain faithful to their wives. "I don't jump to conclusions, only God will judge who goes to hell or heaven," he told IRIN/PlusNews.

Kamalu Ibrahim, head of the local Koranic school, politely waited until the sheikh had left the room before offering his opinion. "Islamic laws are rigid, no matter the situation. There can be no sexual intercourse unless you are married; [rather than using condoms] the only solution [to sexual urges] is to marry young."

* Not her real name

August 18, 2008 | 5:17 AM Comments  0 comments
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Mind your language - a short guide to HIV/AIDS slang
Related to country: South Africa
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

HIV has hit our lives, our families, our economies; it also shapes the way we talk. IRIN/PlusNews looks at how the virus and its impact translates into everyday speech from the streets of Lagos to the townships of Johannesburg, and finds that despite the billions of dollars spent on positive communication strategies, the word on the street remains decidedly negative.

In Zimbabwe's Shona language, spoken by about 80 percent of the population, slang is called chibhende. According to Dr Robert Muponde, a senior lecturer in English studies at South Africa's University of the Witwatersrand, the expression speaks volumes about how HIV is understood and accommodated.

"Chibhende means speaking obliquely of something, in order not to blow its cover, or in order to speak about it more comfortably," he told IRIN/PlusNews.

In Zimbabwe, HIV is often spoken about as a thief (matsotsi). If you are HIV-positive, people might say you've been mugged, or Akarohwa nematsotsi in Shona, Muponde said. The phrase gives an idea of how the virus is perceived – as a sneak attack – but it also creates a space for discussion that otherwise might not exist.

"Sex is difficult to handle in a shy language like Shona," Muponde said. "Slang gives the unspeakable street value by making it look accessible and banal."

Felicity Horne, who studies AIDS and language at the University of South Africa, agreed, saying that while many communities struggled to break the silence about HIV and AIDS formally, informal or slang terms for the epidemic were proliferating and were beginning to construct a response to the pandemic.

"Language can neither be separated from our thoughts and feelings, nor from the social context in which it is used," she said. "Words and images create different conceptual realities of the phenomenon."

Organisations like SAfAIDS, a southern African HIV/AIDS information dissemination service based in Zimbabwe, argue that the slang used to describe the virus – which is almost uniformly negative – reinforces the stigma and fatalism that has proved so difficult to erase over the past 25 years of advocacy.

August 15, 2008 | 6:38 AM Comments  1 comments
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Gays hesitate at the closet door
Related to country: Nigeria
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

There is no explicit gay scene in Nigeria, but in the Ibiza bar in the capital, Abuja, the action on the packed dance floor seems a little more exclusively guy-on-guy, a little bit raunchier than may be considered "normal".

According to Oliver Okem*, a smart and trendily bespectacled AIDS activist, when the mood and the music is right, he and his friends can strut their stuff at Ibiza, Excelsior, or a couple of other gay-tolerant clubs in Abuja. Sometimes, though, it becomes advisable to "straighten up; rough-looking guys can stare at you, wondering what's up, and maybe whispering among themselves".

Being gay in Nigeria is hard: homosexual sex is illegal, but there is also the sanction contained in a rising tide of religious fundamentalism, and with cultural traditions that generally abhor same-sex coupling.

In a country - especially in the south - where marriage and children are seen as sacred, there is the added pressure from parents who expect their offspring to settle down and deliver grandchildren. Being gay means becoming invisible and, as a result of that secrecy, much more vulnerable to HIV/AIDS.

A behavioural surveillance survey by the ministry of health in 2007 found that, after sex workers, men who have sex with men (MSM) were the group most at-risk of HIV infection, with a prevalence rate of 13.4 percent – three times the national average of 4.4 percent. There was considerable variation in three cities surveyed, but in the commercial capital, Lagos, prevalence hit 25 percent.

The circumstances of MSM vulnerability are not unique to Nigeria. As in the rest of the world, some MSM do not regard themselves as gay and are in heterosexual relationships, making it difficult for orthodox AIDS campaigning to reach them.

"A lot of stigma is associated with the moral aspect [of homosexuality]. It drives people into the closet – they don't want to come out, which means they can't access [AIDS] services," said one senior HIV researcher, who asked not to be named as he did not have clearance to talk to the media.

Okem said it was a little more complicated. "The vast majority of MSM believe you cannot contract STIs [sexually transmitted infections] from anal sex. In Nigeria we don't talk about anal sex, and all the [AIDS] interventions are targeted at heterosexuals and vaginal sex. The perception of gay people not using condoms is not because we don't want to, but because we are not well informed."

The internet, with social networking websites like Facebook, and the more discreet clubs provide enough opportunities to hook up. "Very few relationships are formed, most of it is about the sex or the benefits," said Okem.

"The majority of 'passive' [recipient] gay men have accepted their sexuality ... some 'actives' may have done it once or twice and liked it – but wouldn't agree they are gay. There is a financial exchange then, but more usually it is actives that take money for sex."

Getting organised

Gays and lesbians are beginning to organise: at least 10 groups have been formed in Nigeria and are pressing for better representation in the AIDS response, which the government seems ready to grant. Alliance Rights Nigeria, one of the oldest, was set up in 1999 in response to the toll of AIDS deaths among MSM, who were "dying in ignorance", said the group's executive director, Ifeanyi Orazulike.

Unlike Okem, who has not told his parents or ruled out getting married, Orazulike is open about his sexuality and feels attitudes are beginning to change. "People are coming to the realisation that there are gays in Nigeria," he told IRIN/PlusNews. "There is a level of toleration."

In the Muslim north there has historically been a cultural acceptance of "Dan Daudu" – men who live as women – despite the contradiction to traditional Islamic teaching. But even in the south, with its avowedly macho outlook on life, Orazulike said he had never been confronted with anti-gay aggression. That could be a testament both to his discretion, and to the innocent incredulity with which many Nigerians regard homosexuality.

"We don't intend to rub people's faces in it, otherwise they are forced to react; just live your life," Orazulike explained. That approach is likely to guide Nigeria's AIDS response to the gay and lesbian community, where a little tact may be required to avoid the attention of the national assembly and some of the more conservative elements in government.

"There will be no specific intervention response that targets this group," said the researcher, who works for a major funding agency. "It will be a package to address the most at-risk groups, and we'll reach them that way, but not as a population cohort themselves."

* Not his real name

August 15, 2008 | 6:30 AM Comments  0 comments
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AIDS spending breaks records, but needs more focus
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

GLOBAL: AIDS spending breaks records, but needs more focus
Anti-poverty activists say more money needs to be spent at the grass roots level
NAIROBI, 8 July 2008 (PlusNews) - HIV/AIDS funding to low- and middle-income countries reached a record level in 2007, according to a new report by UNAIDS.

AIDS spending by the G8 group of wealthy nations, the European Commission and other donors hit US$ 6.6 billion last year, up from US$ 5.6 billion in 2006. However, despite the largesse, UNAIDS said a US$8.1 billion gap in funding for essential HIV/AIDS programmes remained.

The United States was the largest grant-giver, providing 20 percent of resources in 2007, followed by the United Kingdom. Some non-G8 nations also provided significant assistance, including the Netherlands, Sweden, Australia and Ireland.

The report comes as the G8 - made up of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States - reiterated a commitment they made at the 2005 summit in Gleneagles, Scotland, to spend US$60 billion to fight disease in Africa; the repeated commitment added a five-year timeline to the initiative.

At the G8 summit this week in Hokkaido, Japan, leaders also announced that they would provide 100 million insecticide-treated mosquito nets by 2010 to control the spread of malaria on the African continent, and would work towards increasing the health workforce in countries experiencing a critical shortfall in health staff.

"The G8 will take concrete steps to work toward improving the link between HIV/AIDS activities and sexual and reproductive health and voluntary family planning programmes, to improve access to health care, including preventing mother-to-child transmission, and to achieve the MDGs [United Nations Millennium Development Goals] by adopting a multisectoral approach and by fostering community involvement and participation," a statement from the G8 said.

The announcement of the funding comes as a relief to organisations working to combat disease and poverty in Africa; several press reports had hinted that a draft communiqué scheduled to be released by the G8 would omit HIV/AIDS targets.

However, some organisations felt the commitments still fell short of expectations, with the anti-poverty NGO, ActionAid, describing the summit's statement on Africa as "as a mixture of recycled promises and failed remedies".

And although they welcomed the five-year timeframe for the disbursement of the $60 billion for health, "there is still no indication of who will pay up and exactly when".

"The proposals for strengthening health services are also seen by ActionAid as flawed, unless more is done to stem the exodus of skilled staff from African countries," a press statement said.

Getting the funding to where it's needed

"Training more health workers is pointless if the brain drain continues," said ActionAid Malawi's food security specialist. "There are more Malawian doctors in the city of Manchester than in the whole of Malawi."

"It's good progress that they will provide the promised levels of funding," Leonard Okello, head of ActionAid's international HIV/AIDS team, told IRIN/PlusNews. "However, we hope they will fulfil these pledges, because one of the big problems with health funding is lots of money promised and only part of it ever being paid."

"The G8 and other leaders of the developed world usually work on a political timetable, so their funding is suited to when they arrive and exit office, not around the needs of the people they are targeting," he added.

"The other problem with HIV/AIDS funding is that it rarely reaches the people who need it most, who are at the community level," Okello said. "Research shows that in Africa, more than 70 percent of the work in the HIV field is done by community-based organisations, but only 11 percent of the funding goes to them."

"In addition, the organisations the money goes to have to meet strict standards - usually only large international organisations without a good idea of the landscape in which they are working can meet the criteria, so the money winds up being spent where it is not needed," he added.

He noted that large sums of money were spent at luxury hotels in high level meetings - money that could be better used if it were channelled directly to the community.

"It's no wonder that despite all the funding, the response is still lagging behind the epidemic," Okello said.

August 15, 2008 | 6:21 AM Comments  0 comments
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