Development & Aid, Headlines, Poverty & SDGs

HEALTH-SENEGAL: Cardinals and Khalifs Unite Against AIDS

Mercedes Sayagues*

DAKAR, Jul 8 2004 (IPS) - Traffic stops around the Old Mosque in the Senegalese capital. Thousands fill the streets, and when the muezzin calls, they kneel, bow and pray in perfect unison.
     The sermon is about the earthly problem of how to avoid contracting HIV, and helping people who have the virus. On Sunday, Catholics will hear a similar message.

It’s 13:30 in the Senegalese capital, Dakar, on Friday. Traffic stops around the Old Mosque. The sound of babouches shuffling on the pavement replaces hooting. Thousands fill the streets.

When the muezzin calls, they kneel, bow and pray in perfect unison. It is a moment of intense collective spirituality – and a chance to ponder the more earthly problem of AIDS. The sermon dwells on how to avoid contracting HIV, and the fact that people who are infected with the virus must be helped, not shunned.

On Sunday, Catholics will hear a similar message during Mass.

This partnership between religion and public health has been one of the pillars of Senegal’s anti-AIDS strategy. And, its success is beyond dispute – a point worth noting as delegates from around the world prepare for the Fifteenth International AIDS Conference, to be held in Bangkok from Jul. 11 to 16.

HIV prevalence in Senegal remains low, at 1.4 percent of the 10-million-strong population. This amounts to some 80,000 HIV-positive people.


Although Senegal shares some of the problems common to West Africa such as poverty, it has managed to pull off what other nations in sub-Saharan Africa have not: implement rapid response and prevention programmes for AIDS.

While many of the continent’s leaders under-stated the significance of the pandemic for years, or responded to it apathetically, Senegal’s government swung into action as soon as the first six cases of AIDS were diagnosed in 1986. A team of respected scientists and doctors persuaded the then president, Abdou Diouf, that this might be the country’s only opportunity to contain the spread of HIV.

By the end of 1986, a national AIDS body was working to guarantee a safe blood supply, measure the spread of the epidemic, expand existing programmes for control and treatment of sexually transmitted diseases – and reach out to sex workers. These persons must be registered and have regular medical check-ups, where they are provided with information about AIDS, and free condoms.

But AIDS officials soon realized that the health sector could not win this battle alone. Religious leaders, non-governmental organizations (NGOs)and community groups had to do their part.

With its network of thousands of mosques which enjoy high attendance for Friday prayers, Islam’s potential to encourage prevention and solidarity was huge.

A rich variety of religious organizations, sports and cultural clubs, women’s groups, village and neighborhood associations was thus tasked with AIDS prevention nationwide.

“The AIDS response was built on the lively and complex local human architecture,” says Gary Engelberg, Director of Africa Consultants International – a Dakar-based NGO that focuses on cultural and health-related activities.

This contrasted sharply with the way in which religious leaders reacted to AIDS in other countries.

The first instinct of many was to associate the spread of HIV with loose morals, condemn those infected – and oppose AIDS awareness initiatives like condom distribution in schools. This was done because of fears that it might encourage promiscuity amongst pupils.

In Senegal, government and religious leaders reached a tacit agreement. Clerics would preach abstinence and fidelity but would not oppose condom campaigns. In turn, condom promotion would be “soft” and stress responsible sexuality.

“Each actor has an area of responsibility and we complement each other,” says Bamar Gueye, National Coordinator of the Islamic NGO, Jamra.

Senegal is a deeply religious country. Ninety-four percent of citizens are Muslim, and four percent Catholic. Muslims networks or “confreries” are very strong, while the Catholic Church’s influence derives from the many schools and clinics it runs, as well as its dynamic youth movement.

“We needed to work with religious leaders to succeed,” says Ibra Ndoye, Executive Secretary of the National Council for the Fight against AIDS (CNLS), and a key architect of the response since 1986.

In briefings with Islamic leaders, health officials explained the disease and why preaching that AIDS was a divine punishment for sin would increase stigma and discrimination.

“After training, we realized we should not stigmatize sex workers or people with AIDS,” recalls Gueye.

In 1988, Jamra signed an agreement with government concerning the Muslim response to AIDS. Staff from the NGO and health officials started to visit imams, khalifs and traditional authorities to discuss the epidemic. Slowly, the perception these leaders had of HIV/AIDS changed.

In 1991, top Islamic leaders heard their first account from an HIV-positive person of what it meant to have contracted the virus.

In 1992, a “community train” staffed by volunteers conducted AIDS prevention nationwide.

In 1995, Jamra published a guide on AIDS in French and Arabic, which gives factual information about HIV/AIDS and explains how living according to Islamic principles can prevent its spread.

The guide advises against female circumcision, wife inheritance, premarital sex, anal sex and sex during menstruation. Use of condoms within marriage is allowed. By the late 1990s, many imams were supporting a grassroots campaign to stop female genital mutilation.

Today, the Society of Women against AIDS in Africa (an NGO headquartered in Dakar) reports that rural imams support their promotion of the female condom among married couples. The imams ruled that a wife has the right to protect herself from infection.

The involvement of the Catholic Church was slower, partly because Cardinal Hyacinthe Thiandoum (who died in May) was deeply opposed to condom promotion.

But in 1991, a group of young Catholics began promoting AIDS awareness in schools. These efforts resulted in SIDA Service, an NGO that specializes in AIDS prevention, voluntary testing and counseling (VCT) – and in care and treatment of HIV-positive persons.

Its founders set out to change the Catholic hierarchy’s attitude, visiting each bishop and archbishop in the country from 1992 to 1993. “It wasn’t easy, but we were known for our religious commitment so the bishops listened,” says Paul Sagna, Executive Director of SIDA Service.

Their efforts crystallized in a conference, ‘AIDS and Religion: the Responses of Christian churches’, held in Jan. 1996.

Today, each of the seven dioceses has a SIDA Service committee with several “antennes’ (outreach points) in the community. The activities of these committees include prevention, testing, counseling and care of people who have contracted HIV.

SIDA Service started the first free VCT facility in Dakar in 2000 and now runs eight of the dozen VCT facilities in all regions.

To avoid stigmatisation of its clients, SIDA Service in Dakar renamed itself the Cardinal Hyacinthe Thiandoum Centre for Health Promotion (Centre de Promotion de la Sante Cardinale Hyacinthe Thiandoum).

Fittingly, in November 1997, Dakar also hosted the First International Conference on AIDS and Religion, sponsored by the Jointed United Nations Programme on HIV/AIDS (UNAIDS) and the European Union.

The partnership advanced further in May 1999 with the launch of the Alliance of Religious Leaders and Medical Experts Against AIDS (Alliance des Religieux et Experts Medicaux Contre le SIDA) comprising Jamra, the Association of Imams of Senegal, SIDA Service and CNLS. The Alliance conducts AIDS prevention and training and organizes national and international conferences.

As various researchers have noted, certain aspects of Senegalese culture have assisted the country to contain the spread of HIV. These include conservative attitudes towards sex, low levels of alcohol consumption and universal male circumcision (which affords men a degree of protection from HIV).

However, there’s no denying that roping religious leaders into this battle was of great importance.

Today, the virtues of a partnership between religious and public health institutions have become part of conventional wisdom. Sixteen years ago, however, this was a groundbreaking approach to fighting AIDS – and sadly, still a rarity in other African states.

(* Mercedes Sayagues is currently doing a best practice study on AIDS policies in Senegal for the South African Institute of International Affairs, at the University of the Witwatersrand in Johannesburg.)

 
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Africa, Development & Aid, Headlines, Health

HEALTH-SENEGAL: Cardinals and Khalifs Unite Against AIDS

Mercedes Sayagues*

DAKAR, Jul 8 2004 (IPS) - It’s 13:30 in the Senegalese capital, Dakar, on Friday. Traffic stops around the Old Mosque. The sound of babouches shuffling on the pavement replaces hooting. Thousands fill the streets.
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