HIV/AIDS among Pastoralists & Refugees in North-East Africa: A Neglected Problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. 

This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001-2014. 

Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. 

Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. 

This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.

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By:  Serbessa MK1, Mariam DH1, Kassa A2, Alwan F3, Kloos H4.

• 1 School of Public Health, College of Health Sciences , Addis Ababa University.
• 2 IGAD Regional HIV/AIDS Partnership Program-Programme Facilitation Office (IRAPP-PFO) , Kampala , Uganda.
• 3 Intergovernmental Authority for Development (IGAD) Secretariat , Djibouti.
• 4 Department of Epidemiology and Biostatistics , University of California , San Francisco , USA. 

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Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis

OBJECTIVES:

To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen.

METHODS:

Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five.

RESULTS:

We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan.

CONCLUSION:

National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.

Full article at: 

By:  Chaabna K1,2, Kouyoumjian SP1, Abu-Raddad LJ1,2,3.

• 1Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
• 2Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America.
• 3College of Public Health, Hamad bin Khalifa University, Doha, Qatar.

PLoS One. 2016 Feb 22;11(2):e0149966. doi: 10.1371/journal.pone.0149966. eCollection 2016.

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Countries with Highest Prevalence of Female Genital Mutilation, 2004-15

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Qualitative Interviews with Non-National Tuberculosis Patients in Cairo, Egypt: Understanding the Financial & Social Cost of Treatment Adherence

Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. 

In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative data. Analysis was based on thematic analysis that aimed to identify recurrent themes and codes from the narratives. 

The study identified a number of factors that influence TB treatment adherence. Uncertain financial status due to limited or no employment was frequently discussed in interviews, which resulted in fear of not being able to support family, loss of pride, dependence on family and friends, fear of losing housing, food insecurity and limited food options. Respondents also feared infecting other household members and longed for opportunities to discuss their illness and treatment experiences with other individuals but their social networks were often limited. TB-related stigma was driven by shame and blame of infection. Respondents also believed stigma was based on their foreign origin. Stigma manifested in distancing and exclusion in various ways, resulting in isolation, psychological distress and reluctance to disclose TB status to others. Poverty-related factors and social context with a special focus on stigma should be considered when developing strategies for supporting long-term treatment courses for non-national patients in Cairo and other similar urban settings.

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By:  Lohiniva AL1, Mokhtar A2, Azer A3, Elmoghazy E4, Kamal E5, Benkirane M1, Dueger E1,6.

• 1Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No 3, Cairo, Egypt.
• 2National Tuberculosis Program, Ministry of Health in Egypt, Cairo, Egypt.
• 3United Nations High Commissioner for Refugees, 7th District, Egypt.
• 4Cairo Association Against Smoking, Tuberculosis and Lung diseases, Cairo, Egypt.
• 5Refugee Egypt, Cairo, Egypt.
• 6Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 

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