Mauritania: Low HIV prevalence, widespread AIDS stigma

In the wooden shanty town of Elmina on the outskirts of Mauritania's capital, Nouakchott, AIDS educators do not let religious or cultural conservatism get in their way.
A wooden dummy of a penis fitted with a condom is used to instruct people about the dangers of unprotected sex - perhaps a somewhat unexpected sight in a country which is almost entirely Muslim, and where frank discussions about sex have tended to be taboo.
”When doing this awareness creation we carry with us the dummy of the penis, and after the demonstration we distribute the condoms which we get,” says Aichetou Gueye, chairperson of the Union of Co-operatives on Economic Development, a group which informs people about the pandemic.

Peer educators are used to ensure that those addressed feel some affinity with their instructors, which doubtless ensures that information is communicated more effectively.

”If we find a house with old women, we take an old lady to carry out the talk. If it is one with young girls we use a young person to do the training,” Gueye told IPS. The condoms issued to those who attend the classes are donated by non-governmental organisations (NGOs).

But, it's not only women who have to confront the wooden penis.

”We target the men as well, because HIV/AIDS affects both women and men. We tell them it is better to use a condom for protection (as) we all know that it works,” notes Gueye. In addition, educators give information on how to care for people who are ill with AIDS-related diseases.

HIV prevalence in Mauritania is low - less than one percent, according to government statistics.

However, activists such as Gueye believe that concerted AIDS awareness efforts are still necessary - not least because a stigma attaches to the syndrome in this north-west African country. This can be seen in the low numbers of people who make use of the free service at HIV testing and counseling centres.

”People are afraid of visiting these centres...They are still not open about it since they fear being shunned by the community in the event that they are found infected,” says Gueye, adding that this has prompted women to be more vocal about the dangers of AIDS.

”Women have taken the lead because we know that everywhere, it is them who are affected most by the disease,” she notes. Women make up about 51 percent of Mauritania's 2.5 million strong population.

Government, also acknowledging the stigmatisation of HIV, says it has involved religious leaders in the battle to get people to talk openly about AIDS.

”We have got in touch with Imams (religious leaders) to help in sensitising the local populations on all aspects of the disease, including the negative impact of stigma,” Koita Bamarian, director general of the human rights department, told IPS.

”We have also created a committee that is based within the health ministry to scale up the fight against HIV/AIDS. This the team does in consultation with local and international non-governmental organisations operating in the country.”

For those who find they have contracted HIV, there is hope in the form of anti-retroviral (ARV) treatment. Government says that, with the help of NGOs, public health facilities across the country have been supplied with the life-prolonging anti-AIDS drugs.

”We want the sick people to take advantage of this, in line with the '3 by 5' initiative,” says Bamarian. This programme, launched in 2003 by the World Health Organisation, seeks to provide three million AIDS sufferers in the developing world with free ARV therapy by 2005.

The extent to which traditional practices promote the spread of HIV is also receiving attention in Mauritania - particularly the practice of female genital mutilation.

This involves the removal of part of, or all female genitalia - notably the clitoris, and the labia minora and labia majora, which are folds of skin surrounding the urethral and vaginal openings.

Crude, unsterilised instruments are sometimes used to carry out the procedure on various girls and women - something which can cause the AIDS virus to be passed from one to another.

According to Aissata Kane, formerly the first female cabinet minister in Mauritania and now chairperson of a Francophone group of women's associations, the country has one of the highest mutilation rates in Africa.

In the Soninke ethnic group, for example, up to 98 percent of girls and women are reportedly subjected to female genital mutilation - also known as female circumcision. Amongst Fulanis, the rate is put at 72 percent, while almost 30 percent of Wolof girls and women are circumcised.

”We have never had laws against this practice, but now we want the government to end it completely,” says Kane. ”This can be done through tough policies and laws addressing all those involved in carrying out the procedure.”

Many of those who are responsible for circumcisions depend on the practice for their livelihood, however. As a result, efforts are underway to find alternative income-generating activities for these persons, such as clothes making and dying.

In addition, activists are trying to educate parents about the fact that observing the tradition of female circumcision may cost daughters their lives.

Other norms and traditions pertaining to women also require attention, says Ishmael Noko, secretary general of the Lutheran World Federation - a church grouping which claims to represent about 66 million Christians.

During events this week marking the thirtieth anniversary of the federation's activities in Mauritania, Noko warned against the tendency to frown on women who try to voice their opinions on how sex should take place.

Across Africa, women who suspect their partners may be HIV-positive still find themselves coerced into having sex without a condom. Men often claim that use of the prophylactic decreases their pleasure during intercourse, or take issue with their partners over the lack of trust that is implied by the request that a condom be used.

”Allowing women to have a say on sexual matters will precipitate a different environment where a disease forced on someone does not arise,” Noko told IPS in Nouakchott. ”If we do not do this, then we are undermining ourselves and we can forget about winning the HIV/AIDS war.”

These words were echoed by Maye mint Haidy, chairperson of the National Association for Women's Support and Protection of Children in Mauritania.

”It is the men who have an upper hand when it comes to discussing sex. If the woman cannot talk about sex, how will she tell her spouse to use condom?” she asked.

by Joyce Mulama (END/2005)