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HIV/AIDS programs adjust to changing culture in Cameroon 

Cameroon is one of the most diverse African nations: it boasts over 16 million people, three major religions, and 24 major African languages with hundreds of dialects. In a country as diverse as Cameroon, there are many distinctive cultural traditions. Unfortunately, some of these traditions may be exacerbating the spread of HIV. "In certain regions of Cameroon, tradition dictates that when a man marries a woman, it is accepted that he have sexual relations with his wife's younger sisters. In certain other areas, a woman may be required to marry her former husband's brother after her husband's death," says SWAA Clinic Doctor Siewe Dissi Pulcherie. With practices such as these, the likelihood of HIV transmission increases for all, especially if few people are getting tested or using protection. SWAA has set up offices and culturally specific HIV programs in five regions in Cameroon to best reach these diverse cultural audiences. They recognize that some cultural behaviors may threaten the health of the entire nation. "In this setting, everyone is vulnerable," says Chantal Bellet-Edimo, the Program Officer for the center.

At the SWAA main office in Douala, staff work to provide over 800 people living with HIV who have little means to support themselves with a functional clinic and community center. Many clients who visit the center are poor, unemployed, and female. Many are single mothers or widows.

While there is stigmatization in the community against people living with HIV, many of the clients are ready to speak out about their status. One woman named Njoya declared, "I will not hide my status from the people around me in my community. If I get a job, I will not hide it there either. Because people will always talk. For me, it is just a question of talking to people and helping them to understand HIV. People who see me now see that I have gotten better and healthier. Let them talk about that." For many of the clients who visit the center, breaking the cycle of ignorance about HIV has become a personal mission. They talk and educate their friends, neighbors, and co-workers. In the long run, these conversations will change the culture in Cameroon to become more accepting of people living with HIV.

But with a climbing HIV rate in Cameroon that is already in the vicinity of 12%, outreach from the patients themselves is clearly not enough. The center is currently expanding its mission to perform outreach to targeted groups in the community. SWAA's newest project aims to teach young people in high school about the realities of sex. Sex education in the public school system is often folded into a general health class. The young people in the pilot project have demonstrated to the teacher how this cursory knowledge is inadequate. "One child asked whether it is true that if sperm touches your head, you become crazy," says Ms. Bellet-Edimo, who is overseeing the program. The goal of the class is to challenge these types of misunderstandings by teaching young people about the biology of sexual organs, the psychological changes of puberty, and even gender roles in the media.

Ms. Bellet-Edimo explains that the reason SWAA created this program was to respond to a shift in culture that caused these issues not to be discussed in the home. "Today, we see a great need to talk to young people. In traditional culture and society, talking about sex was seen as the responsibility of the parents and whole community. While traditional culture dealt with this responsibility very well, today people are no longer in the village. In a society of workers, it seems that parents cannot find the time to talk to their kids or that they no longer know how to bring up the subject." SWAA hopes that a comprehensive sex education curriculum will soon be a requirement in the public school system. But they also bemoan that this involves pushing for change in a public school system that is already strapped for funding.

SWAA has found it important to engage in preventive education efforts among young people because culture in Cameroon is changing rapidly. Part of the reason is an influx of western cultural ideas among young people. Ten years ago, it was very rare to see unmarried pregnant young women. "Today it is a big problem. Now, it is normal to see young single mothers. The men seem to be skipping out on their responsibilities," says Dr. Siewe Dissi Pulcherie. The women of SWAA recognize that finding a solution to these troubles will be challenging. As mentioned earlier, women are severely underrepresented in a government built on the interests of men. SWAA is calling for more representation in the government so that women's interests can be equally represented. But seeing change will take time and patience.

Chantal Bellet-Edimo sees a solution: "Non-governmental organizations have to take action; we have to organize and unite to fight the system together. However, the challenge is that here in Central Africa, there is a lot of fragmentation among non-governmental organizations." When asked why, she exclaims, "Maybe it is because in the jungle it is difficult to see through the trees. You may never know what is right next to you."

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Women enlist the religious community to fight HIV/AIDS in Northern Nigeria 

While Northern Nigeria is populated by diverse ethnic groups, it has become a strongly religious area in the past twenty years with the institution of Muslim sharia law. While not all women here are religious or follow these religious traditions, a large number of them live in purdah or seclusion in the home. As explained earlier, women in purdah have been historically hard to reach with education or services. Zainab Ahmad Suleiman, the Chairperson for SWAA Nigeria in Kano, explains, "Women in this setting do not always feel empowered to negotiate terms of sex with their husbands. Sometimes men do not even disclose their HIV status even if they are married and have concubines. They believe it is their right as the head of the family to do as they please."

While SWAA operates a visiting center in Kano, it is a small office on the second floor of an office building. Most of the care and services SWAA offers are performed by a mobile testing and counseling unit. The system of home-based care for people living with HIV/AIDS is appropriate in a culture where women may feel uncomfortable leaving their homes. "We have six permanent counseling people doing home-based education for the families of people living with HIV. For the sake of confidentiality, our counselors often come to visit their clients with a crate of eggs, as if they are just a friend coming for a visit," explains Zainab Ahmad Suleiman. The counselors' visit is geared for multiple purposes. They are certified by the local health center to bring the client's monthly allotment of anti-retroviral medications, and they also provide psychological and nutritional counseling on an as-needed basis. The counselor also acts as a connection to the Association for Positive Living, a 100-member strong association for people living with HIV in Kano. SWAA Nigeria is the only stand-alone organization in Kano State that provides comprehensive HIV treatment to people who have tested positive.

Outreach is an important mandate for SWAA Nigeria. In fact, public awareness about HIV/AIDS is a relatively new initiative for Nigerians. Before 1996, the official government policy on AIDS was that there was no policy. There was widespread misinformation about AIDS and a general denial of its existence. This made for a very difficult environment to operate HIV programs. The tide turned ten years ago when the famous Nigerian composer and musician Fela Kuti died. His brother spoke out soon after his death and admitted that the national musical icon had died of AIDS. After this, the government could no longer ignore that the pandemic was affecting Nigerians. According to Zainab Ahmad Nagee, the State Secretary for SWAA Nigeria in Kano State, "Before Fela's death, HIV was represented in a skull and terror fashion. But ever since the government admitted HIV existed, even the religious leaders have come on board to fight the disease." Today, the situation is slowly improving. There is now a general acceptance of the existence of AIDS among the general public. But public services are not yet set up to address the complex needs of people living with HIV. The state budget allotted for HIV/AIDS programs seems to get pocketed by corrupt politicians every year.

Faith-based and non-governmental groups such as SWAA are stepping up to the challenge. Today, SWAA operates various public awareness programs to increase the knowledge of HIV/AIDS among targeted groups. In addition to regular radio jingles and call-in talk shows featuring people living with AIDS, outreach is also being performed to schoolchildren. Morality is carefully folded into these messages, as it is of prime importance not to alienate the religious community. Zubaida Ahmad Nagee, the State Secretary for SWAA Nigeria, explains, "We do not talk about condoms in schools. Talking about sex with young people is a taboo." Instead, outreach workers talk to children about fidelity and abstinence.

But even while talking about sex is a taboo and HIV counselors hide their identity during home visits to people living with HIV, SWAA Nigeria staff insist that the Muslim community here in Northern Nigeria is responding capably to the impact of the pandemic. Ms. Ahmad Suleiman explains that compared to the Christian south of Nigeria, "the stigmatization [against people living with HIV] is less noticeable here. The community and the family unit tend to be very supportive and accepting. To encourage acceptance from the family unit, we have made it a requirement for our positive clients to visit the center with a family member. This way, we can ensure that they are well taken care of since most of the care for HIV-positive persons occurs in the home."

The categorical involvement of the religious community is also important for SWAA Nigeria, which works with the local faith-based hospital to reach its clients. "We have a referral system set up with the local Muslim hospital. At this hospital, there is no preaching. The religious people who work and volunteer there simply want to get patients AIDS relief. They also want to help us to build our capacity because they recognize that we are providing the community a crucial service," says Ms. Ahmed Suleiman.

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