SIERRA LEONE: Enlisting chiefs in the fight against HIV/AIDS

Koidu, 24 August 2006 (PlusNews) - In Sierra Leone, where poverty is endemic and the overwhelming majority are illiterate, the paramount chief is an elected leader and the main conduit through which information is channelled and circulated. The National AIDS Secretariat (NAS) hopes to harness this influence in the fight against HIV/AIDS.

"We believe that with an issue like HIV/AIDS the chief can help enormously, particularly in the area of stigma and education," said Abdul-Rahman Sessay, deputy director of the NAS in the capital, Freetown. The chieftaincy system is entrenched in Sierra Leone's culture and society.

"Whenever someone is diagnosed with HIV/AIDS, the first thing they do is retire to their village where there's huge stigma about the disease, but where the chief has authority. If we can involve the chiefs in the national response to HIV/AIDS and educate them, they in turn can educate their people, and change attitudes and beliefs about the virus," he said.

The queue of people waiting for the attention of Paramount Chief D.C. Sahr Fengai Korgbende, of Gbense Chiefdom, snakes down the crumbling stairway of his three-storey house in Koidu, capital of Sierra Leone's diamond-rich eastern province.
"The role of a paramount chief is of the utmost importance; he is a chief among chiefs. My decision is final. I know my chiefdom and my subjects and, as I have a lot of knowledge and experience, people trust my opinion."

A 2005 sero prevalence survey put the national HIV infection rate at a relatively low 1.5 percent compared to eastern or southern Africa, but there are fears that all the conditions for an escalation are in place.

Sierra Leone's 10-year civil war displaced over half a million people. In areas like Koidu, where mining has attracted large numbers of migrant workers and a thriving commercial sex industry, HIV prevalence is already thought to be considerably higher than the national average.

There is an urgent need to step up the national HIV/AIDS campaign, but the war destroyed much of the basic infrastructure and many villages in rural provinces still lack electricity and running water. In these isolated areas, the chiefs can provide a vital link with the outside world.

While the NAS hopes to capitalise on the chiefs' influence, there are concerns among some HIV/AIDS workers that many of the deep-rooted cultural practices they uphold, such as polygamy, wife inheritance and female genital mutilation, work against combating the disease.

"As far as I can see it's a crazy idea to involve the chiefs if you want to disseminate this kind of sensitive but vital information," said Evette Magbity of Freetown's HIV/AIDS Care and Support Association (HACSA). "Yes, it's our custom to use the heads of the community to get the listening ears of the people, but most of our figureheads are not good examples in this case - how can we have a leader who has at least five wives talking about faithfulness in public?"

However, Dr Yvonne Harding, Sierra Leone director of Marie Stopes, an international reproductive health organisation, is adamant that without the chiefs, basic health information would not reach people, and educating them about the risks of HIV/AIDS would be almost impossible.

"Once you get the chief engaged, things seem to work," she said from her Freetown office. "If managed properly, using the chief to get the message across could work effectively."

Harding believes it is not vital that chiefs practice what they preach. "There are doctors who smoke but tell their patients not to, so why not polygamous chiefs advising fidelity or using a condom?"

Abdul-Rahman Sessay of NAS points out that 'Abstain, Be faithful, Use a Condom' - the 'ABC' approach to combating HIV - has not yielded results in much of the world. He argues that in the long term, interventions that tie in with and complement local culture will be more effective than those that go against tradition.

"Take, for example, wife inheritance: if we say, 'Don't do that', we will be in conflict with the bulk of the population. So what we are actually saying is, 'If you want to inherit your brother's wife, fine, but you must both take an HIV/AIDS test before you have a sexual relationship and, if it proves negative, go ahead and get married but remain within your sexual circle'."

While there is widespread agreement that involving paramount chiefs in the national HIV/AIDS campaign will make messages more acceptable to a greater number of people, there are also concerns that the policy assumes a degree of knowledge among chiefs that often does not exist.

Chief Korgbende admits he's never actually seen or heard of someone who has HIV/AIDS. "According to what the government is doing, people do know it [HIV/AIDS] is there. Even when you listen to the radio, [South African President] Thabo Mbeki says this HIV/AIDS business is to do with poverty. But really, if we were going to have this explosion of HIV/AIDS here, it would have happened years ago."

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