HIV & AIDS in the Afar society
HIV in Afar Region:
HIV & AIDS were apparent in the region as of the 1990’s. Initially the disease was associated with non-Afar but it became manifestly clear that the disease and transmission can and do have routes solely within the Afar society. The disease arises out of a town – context and has a town to rural transmission that is dominantly male – driven.
As of 2007, Afar Region has a 3.1% incidence of HIV compared with the national level of 3.5%. This however may well belay the real picture as many Afar communities are even without the basic health services. In the region, there are a total of 15 health institutions that offer HIV blood – serum testing and 4 places in the region where ARVs are treating people: the 2 hospitals in the region and 2 health centers. Currently only 572 people are taking anti retroviral treatment. Therefore the service has a very long way to go before it is easily accessible to the rural, pastoralist society.
There is a high prevalence of HIV among women as noted from a recent HIV testing campaign where less women than men were tested but the incidence of HIV positive was almost the same for men and women.
The traditional society:
In the first place, Afar society is one of the most traditionally controlled societies in terms of social behavior within its rural setting. Traditional law and behavior does not accept that an Afar girl/ women can be a commercial sex worker and confines girls to the bounds of their home and women to the bounds of their marriage. Again, Afar cannot involve in the sale of or consumption of alcohol. This is both the influence of Islam and the tradition.
In that polygamy is practiced and the society permits the male to marry outside of the Afar society, there is less scrutiny of male behavior. The other factor determining a dominantly male involvement in the disease transmission is the fact that Afar society is new to the influences of urbanization. Prior to 1991 (change of government), there was no Afar Regional Government and Afar were marginalized as the dry, mosquito – ridden eastern tail of 5 Ethiopian provinces starting from Eritrea south to Tigray,
Wollo, Shoa and Harague. Afar were not involved in their own affairs. Under the new government, Afar government and organization employees began to get opportunities they had not previously experienced in going to other towns/ regions for meetings, conferences and training. Then staying in a district unfamiliar to them and having support money to stay there, they became involved in the local practices of that town.
As mentioned above, Afar cannot run a business of commercial sex and neither can their females involve. However, throughout the region, trade and commerce in roadside towns and villages is almost entirely run by non-Afar (1). Moreover, the region has a number of ‘investor’ – controlled sites where the labor is highly dominantly non-Afar and the leadership is non-Afar. These include the salt – farming of Afdeera (Zone 2); the Tendaho Estate now taken over as a sugar plantation in Dubte and in Ami Bara, Zone 3 and the massive activity to construct it aside from the vast military presence in the region. The latter occupies training camps in Zone 3 and 1 as well as having some hundreds of thousands of troupes in ongoing readiness along the border between Eritrea and Ethiopia.
Traditional and modern practices affecting the spread of HIV:
While HIV is a heterosexual disease in Afar society, its spread is influenced by a number of factors as follows:
- From within traditional practice
Again, while blood transmission is necessarily very minor (2) various traditional practices involving cutting and blood – letting may cause transmission when the cutting instrument is taken from one person to the other not cleaned and while the blood of the first person is wet o the instrument. These practices include female genital mutilation (FGM) (3), delivering a mother and sharing the ‘makiita’ traditional cutting knife between 2 women delivering at the same time, marking the body for ‘beauty’, traditionally treating a person through blood – letting.
There are various issues within traditional marriage that may predispose a person to HIV transmission. Firstly, the fact that traditional ‘absuma’ marriage denies the female choice may lead to great resistance of the female to contact in marriage. Again, the fact the female has FGM and must suffer immense pain to have sexual intercourse means that the wife may well resist, fight her husband. Thereby he may well seek a more peaceful, paid for relation in the town, exposing himself to sexual disease transmission.
Moreover, a brother or a close relative is obliged to marry the widow of his deceased brother/ cousin without any recall of what disease the deceased died of. This is called ‘hiksu’ marriage and since HIV serum testing is still not wide – spread, this is one of the most highly dangerous practices.
Finally, it is not always easy for a man to get a wife in the traditional society. If he does not have an ‘absuma’ for instance, he must pay a considerable dowry for marrying a girl who is not his relative.
- From modern town influence
Afar come to towns to market animals and to purchase grain and other food/ household commodities. They may or may not have relatives in the town. The town holds different attractions varying from different food, different social life and so on. Without any real sense of money value, Afar can be trapped in towns, unaware that they are being used by shrewd merchants. They may stay longer than planned in the town, begin or already become involved in the practice of ‘kaat’ chewing, an amphetamine – type drug leaf that causes inebriation, loosing inhibitions so that the person the does what they normally would not. All market towns have sex workers in ‘buna beyts’, coffee houses – places that serve alcohol and accommodate for men to chew ‘kaat’. Thereby, the men can involve in commercial sex, particularly young unmarried boys/ men.
Finally, merchants without scrutiny have begun the market of ‘soft – porn’ in Afar town by bringing foreign videos into hotels and other screening venues. This is greatly influencing the youth as well as unaware rural people. Within towns, Afar traditional law, respect and influence is almost nil.
APDA’s history of response to HIV & AIDS:
In 1999, driven by the stark reality of rapid – growing commercial sex in towns under the influence of the military presence (4), APDA began taking up the issue of HIV transmission and its affect on the pastoralist community. The organization trained Afar men and women as HIV scouts, sending them into the most affected villages, markets and town areas to raise awareness, teach and counsel people toward safe sexual practice.
In the process, the organization developed a variety of IEC material including locally produced films depicting how HIV is transmitted from the town to the rural area and how ‘kaat’ chewing is involved in this process, a series of 4 posters that tell the story of town to rural transmission, the need for HIV blood serum testing and how the community needs to respond and assist those affected by AIDS. Again booklets in Afar were published and cassettes made of songs and traditional poetry directing community response to HIV & AIDS.
APDA also trained a core group of 15 Afar people as HIV counselors assisting in rural areas periphery to towns. These people facilitated Afar to go to one of the 15 government outlets that provide HIV serum testing.
Leading all this, APDA formed its own music and drama group that have developed an ever – increasing repertoire of songs, traditional poetry ‘kasow’ and dramas that lead to awareness and community response.
APDA has also worked with and supported various youth groups and clubs in the community that they evolve their own response. In the process, the organization constructed 2 youth centers: one in Logya and the other in Hayyu for recreation, learning, discussion and so on.
Again, using what is described as the ‘community conversation’ method, APDA facilitated one woreda to develop traditional response to town practices pertaining to HIV transmission. This also actually led the woreda to stop the practice of FGM.
Finally and over all, APDA has deliberately made HIV response part of its entireprogram. All the organizations’ community development workers (currently 236 community teachers, 202 community health workers, 139 women extension workers, 450 traditional birth attendants) are trained in community HIV response and as part of their work, carry the message to the community. In each community meeting, workshop and training, the issue of how the community can respond to HIV & AIDS is raised.
In the process, APDA has learnt and is learning much regarding the most affective way to facilitate community response leading toward both safe sexual practice and assisting those affected by HIV & AIDS within the community. The best strategies and practices that APDA has evolved in this are listed as follows:
- Being an organization that focuses on HIV & AIDS as a central Afar development issue. This then leads APDA to have a wealth of exemplary people and families through its membership since response starts at the individual level.
- Locally produced films are excellent as the community immediately identifies with the issue. Through this means, APDA has been able to breach the issue of condom use, how ‘kaat’ chewing predisposes to unsafe sexual practice and how Afar females are victim to the process. APDA takes the films to the community with a generator – powered film – projector and is thus able to show an audience of over 1,000 people the films at one session.
- The rural community greatly appreciates and involves in music and drama performance. They enjoy both traditional and modern Afar music as well as their own medium of message – passing through the traditional poetry of ‘kasow’. Again, this organization group goes to the community with generator – powered musical instruments and speakers. This greatly helps to popularize the message.
- It is essential to have Afar as HIV counselors – both females and males. Non-Afar are not able to satisfactorily facilitate the person to a right response without being recognized as being within the cultural and religious framework of the society.
- Youth group influence for vulnerable youth is instrumental to develop safe practices.
- Campaigning against harmful practices is essential to lowering the risk of HIV in the Afar society: both stopping FGM an giving women rights in traditional marriage.
- Community conversations as a method fits well to Afar society in that the society has traditional association leaders ‘fi’amat ‘abba’ whose role in the community is to police social practice. Utilizing this system, the community can develop regulations on how Afar should behave and respond in the town including how they should be have in response to ‘kaat’ chewing.
- Probably the most important strategy is to work to lower ‘kaat’ consumption. This therefore is both a urban and rural activity.
- Creating space for Islamic leadership to influence the community is important.
The way forward:
In order to strengthen and better affect community control on the HIV & AIDS endemic, APDA would like to
- Develop the situation where APDA members are exemplary having annual HIV testing. This then would require an internal fund to respond to individual case – need supporting the person and the family.
- Set up deliberate HIV response work in Afdeera, Assayita and Buure in northern Eli Daar – all districts known for their high HIV transmission – rate.
- Gain community radio to be the motor of community response
- Continually mobilize the community on HIV & AIDS through the musical band and drama group.
- Further develop the ‘community conversations’ initiative so that traditional leadership can provoke agreed community response.
(1) There has been a slight increase in Afar commercial activity in the past 5 years but it remains minuscule compared to the non-Afar ownership of commercial activity.
(2) For the HIV virus to transmit from one person to another through blood, wet infected blood must come into contact with the now –infected person’s blood. Blood on a razor blade, cutting knife or the like once dried, the virus dies.
(3) However, it must be considered even less likely that a child is infected with HIV.
(4) Ethiopia and Eritrea fought a border war from 1998 to 2000 that was not concluded. Some hundreds of thousands of military remain in various parts of the Afar Region in training camps as well as on the northern border with Eritrea.