Tanzanian AIDS Clinic Offers Frayed Lifeline

DAR ES SALAAM, Tanzania (WOMENSENEWS)–When women sitting in an HIV support group circle here were asked how many believed they were infected by their husbands, 11 of the 15 raised their hands.

Gathered at WAMATA, Tanzania’s oldest clinic for people with HIV, they were attending a support group dominated by women. Mothers cradled young babies and children darted around the edges of the group telling stories and seeking strength from one another.

"I had given up but this group has given me hope," said 48-year-old Ashura Mohammed, who was diagnosed with HIV in 2001.

After her brother learned he was HIV-positive she had herself tested and the bad news turned her life upside down, she said.

When her husband died in 2000 she suspected he might have been HIV-positive but when she confirmed her suspicions her brother’s family, with whom she had been living, threw her out of the house.

AIDS carries a heavy social stigma here, particularly for women. When they test positive, women are often considered to have done something wrong, cheated on their husbands or engaged in prostitution, when more often they are infected by their partners who bring the virus home.

Now Ashura Mohammed’s six children are living with friends because the small house she shares with another HIV-positive woman cannot accommodate them.

U.N. AIDS Summit

Last week the United Nations held a three-day meeting in New York to renew the world’s commitment to fighting the disease. The international organization said the effort would cost $22 billion a year by 2008, with half going to prevention efforts and one-quarter to prevention and care. Two-thirds of young women in sub-Saharan Africa still do not know how HIV is transmitted, the U.N. reported.

WAMATA, founded in 1989 by Theresa Kaijage, a U.S.-trained professor and social worker, represents both the promise and shortcomings of the response to the disease in sub-Saharan Africa and especially in Tanzania, where women are among the most at-risk groups for infection.

According to the Tanzania National Commission for AIDS, women between 22 and 29 years old are most likely to be infected. The East African nation of 37 million has 1.4 million HIV-infected adults, according to the U.N.

"Cultural norms, beliefs and practices that subjugate subordinate women are important determinants," the Tanzania AIDS Commission says on its Web site.

In addition to obligatory sex in marriage, obstacles to divorce and polygamy, the commission notes that female circumcision–which a study published in the British journal Lancet this week found increases the chance of death for mother or infant between 20 percent and 50 percent–is common practice among many tribes.

Economics also play a crucial role, according to officials at the country’s Health Ministry and international organizations working in the country. Many men leave depressed rural areas for jobs in cities such as Dar es Salaam where they engage in unprotected sex with prostitutes and then carry the infection home to their wives.

Medication Supply Line Broken

Until last year WAMATA provided patients with anti-retroviral drugs, which create multiple obstacles to viral reproduction and have proven highly effective in attacking HIV.

But Kaijage, who spoke with Women’s eNews in an interview at the clinic, says her group lost touch with the nongovernmental organization, AIDSETI, that had been supplying the drugs. She asked a U.S. friend to check on what was happening and discovered that the group’s Washington offices had been vacated. Now the clinic must refer patients to other clinics.

AIDSETI did not respond to a request for comment.

Kaijage says many patients travel for hours by bus or foot to reach the center. Sending them off to another clinic, often even farther away from their homes, is a barrier some cannot overcome. Kaijage says a one-stop service and treatment point is needed in Tanzania for people with HIV-AIDS, which was one of her goals for WAMATA.

Ordinarily daily life in Tanzania, where the vast majority of the population lives on less than $2 a day, is difficult enough, but living with HIV and the resulting social stigma can seem nearly impossible, especially for women.

Five of the 11 women who believed they were infected by their husbands or partners said they were later blamed by them for bringing the infection into the marriage.

In a society where those infected with HIV are still isolated, many women put off being tested for the disease lest their family and friends shun them.

But at WAMATA those living with HIV can find solace and companionship as well as medical treatment for various ailments, including malaria and dysentery, and psychological support and counseling. There are several support groups including one for friends and family of those living with HIV and a group for people taking anti-retrovirals.

Support Group to Discuss Diagnosis

Kaijage, a native of Tanzania, first noticed the spread of HIV in her country when she returned from earning her master’s degree in social work at the University of Pittsburgh in the 1980s.

"At that time there was a silence policy," she told Women’s eNews. "No one was saying anything. So I realized that I needed to start a support group that would break that silence and create a therapeutic facility where they could discuss their diagnosis."

The first support group mushroomed as dozens of patients flocked to weekly meetings at her small office at the National Institute for Social Work, a Tanzanian university.

Before long she began renting space and WAMATA was born.

Today the organization treats about 700 regular patients. Since its doors opened in 1990, the facility has seen more than 7,000 patients, offering testing, treatment and referrals in addition to social support services. WAMATA was able to move into a space it owns in 1997.

While WAMATA, has helped thousands, Kaijage says erratic funding from nongovernmental groups and international donors limits what the organization can do, leaving a dangerous gap in a country where the national health budget is only $10 per person per year.

"We beg, steal and borrow from whoever can give us," Kaijage said, with a vibrant laugh that filled the small clinic office and then subsided as she looked away and grew more somber. "Nothing is consistent, it’s very hard."

Damaso Reyes is photographer and print journalist who has covered stories in Rwanda, Iraq, Indonesia, Kosovo and much of the United States. His photographs are featured in the monograph "Black: A Celebration of a Culture" and "Innocents Lost: When Child Soldiers go to War." More of his work can be viewed online at http://www.damaso.com/.