GALKAYO, 23 October 2007 (PLUSNEWS)

Ongoing clashes coupled with a lack of central government control are crippling attempts to develop a national AIDS strategy in Somalia, where thousands have been displaced and are living in temporary shelters, with little access to basic healthcare.

Fighting continues on the border between the northeastern region of Puntland and south-central Somalia, where the town of Galkayo is located. More than 30,000 people fleeing insecurity are packed into the town; some have been displaced since the 1990s, but most have arrived since fighting in Mogadishu escalated earlier this year.

The UN Children's Fund (UNICEF) and the UN Refugee Agency (UNHCR) have a presence in the town, but they and other relief agencies have been overwhelmed by the number of people arriving every week. The local community, which already lacks sufficient food and water, healthcare and education facilities, has shouldered much of the burden of the influx.

The immediate needs of the internally displaced people (IDPs) in Galkayo are so pressing that HIV awareness raising has not been considered a priority and it shows in the high level of ignorance about the disease.

"I have only heard of HIV from some of the community meetings; I don't really understand what it is," said Khadra Osman Ali, who has been living in Galkayo for 10 years. "I know there are many here who have this disease, but I don't think I can get it."

Ali fled to Galkayo with her three children after her husband was killed in Mogadishu, the capital, and now lives in one of hundreds of wood-and-cardboard shelters scattered throughout the town. Her knowledge about the virus is similar to many others in her situation, most of whom live in shabby IDP camps.

The international medical charity, Medecins Sans Frontieres, (http://www.msf.org/msfinternational/countries/africa/somalia/index.cfm) supports the local hospital in south Galkayo, but the town has no HIV voluntary counselling and testing facility and no antiretroviral treatment services.

"We do not have treatment available for HIV patients, therefore we do not test patients, even if we suspect them of having HIV," said Karin Fischer Liddle, MSF Holland's medical coordinator in Somalia.

A very real threat With around 1 percent of its population HIV-infected, Somalia's epidemic is much smaller than that of neighbouring countries such as Kenya, which has 5 percent HIV prevalence, and Ethiopia with 3.5 percent.

However, the insecurity in Somalia has caused frequent migration between these countries, potentially exposing more people to the virus, and there are few treatment options for Somalis who find themselves infected after returning home.

"HIV is a big risk for people living in IDP settlements here. Many people have got no idea what HIV is and if they do know, there is such a stigma attached that they don't want to become isolated from their communities by going to be tested or admitting they may be infected," Malyun Osman Omar, chairperson of the Bula Ba'lay IDP camp in Galkayo, told IRIN/PlusNews.

"There is an urgent need for awareness campaigns throughout the region, but at the moment there are no resources to allow this to happen." Omar said the large Ethiopian community in Galkayo, primarily economic migrants who have come in search of work, was believed to have a much higher HIV prevalence than the local Somali population.

"The local community feel very threatened by the Ethiopian community," she commented. "But this is largely due to stigma and lack of understanding."

Knowledge and behaviour surveys conducted in Somalia by UNAIDS revealed "a serious lack of understanding and awareness of basic information on HIV". The agency noted that major work still needed to be done, especially with those most vulnerable to infection.

One such group are women who, because of the prevailing insecurity and poverty, have turned to commercial sex work, or 'survival sex', to support their families.

"Many women have fled insecurity in the south and been widowed. They have no means of making money ... they are often uneducated and therefore have no knowledge of the risks they are taking," Omar said.

"The mother-and-child healthcare facilities do provide free condoms, but the problem is that women don't know they should use them," she added. "Nobody wants to admit this is happening, but we cannot remain ignorant when people's lives are being put at risk."

Despite these hurdles, the few local and international NGOs, the Somali AIDS commission and the United Nations agencies present in the country are making some headway in fighting stigma and educating the population about the pandemic.

"We have seen positive developments in overcoming the extreme stigma attached to HIV since starting work in Galkayo 10 years ago," said MSF's Liddle. "Three years ago it was impossible to even bring condoms in."

More importantly, religious leaders are starting to speak more candidly about AIDS. Abdulkadir Ali Ghelle is chair of a local NGO responsible for teaching Islamic scholars about HIV/AIDS. "It has taken time to convince the mosques to understand the importance of this training but, at the moment, with so few resources available to us and no central government, it is the most powerful tool we have."

His organisation is also lobbying for HIV to be discussed in classrooms, but health workers in Somalia say ultimately it will be impossible to create and implement a successful HIV prevention, treatment and care programme while current levels of insecurity continue.