GUINEA-BISSAU: Traditional beliefs hinder PMTCT

Bissau, 28 January 2008 (PlusNews) - A pig, half a sack of rice, black corn and five litres of sugarcane brandy are the ingredients a traditional healer in the West African country of Guinea-Bissau uses to perform a ritual many believe will prevent a woman who has given birth from getting HIV.

If the ritual, known as tarbessadu, is not carried out, some say the mother will be struck by a disease, and she will pass it on to her male partner.

Dilma (not her real name), 27, knows only too well how strongly people believe in this ritual. She is HIV positive and has tried, unsuccessfully, to get her husband to seek help at the local hospital. He refuses because in his view there is only one cause for his sickness: the fact that the tarbessadu ritual was never performed on his wife.

"He's there [at home], lying in bed. Before he would use an umbrella as a walking stick, but now he can't even walk, he's really bad. When night falls he cries a lot and can barely sleep," she told IRIN/PlusNews.

Women to blame

Ali Hizazi, a psychologist with the Céu e Terra (Sky and Earth) project, an Italian non-governmental organisation working with pregnant HIV-positive women, noted that these rituals carry so much weight because HIV is still relatively unknown in Guinea-Bissau.

The country's HIV prevalence rate is estimated at four percent. "People don't accept AIDS as a disease, so they attribute it to something women failed to do, or did wrong, and for which they are being punished," Hizazi said.

Women often actually believed they were to blame for bringing the virus into their families. "Blame is internalised because the man just doesn't accept this responsibility. He thinks that the woman's promiscuity is what has led him to be punished by God by becoming infected," he commented.

A 2006 survey of HIV/AIDS knowledge, attitudes and behaviour found that a third of the population believed AIDS depended on the will of God. According to Hizazi, the tarbessadu is practiced most by the Balanta ethnic group, which makes up 20 percent of Guinea Bissau's 1.4 million inhabitants.

Problems preventing vertical transmission

Cultural issues and gender inequality also exert an influence. The 2006 survey revealed that most Guineans would end a relationship if their partner were HIV positive - hence many pregnant women's fear of being tested for HIV.

Nevertheless, data from the National Secretariat for the Fight Against AIDS (SNLS) shows that 75 percent of the 4,124 pregnant women who received information on testing during prenatal checkups in the first half of 2007 agreed to be tested for the virus.

The test results were positive for 217 of these women, but only 42 percent of their partners agreed to be tested.

Many mothers either become desperate, turn to alternative medicine, or simply fail to comprehend the gravity of the situation.

To make matters worse, there are only two healthcare facilities offering prevention of mother-to-child transmission (PMTCT) services in the country. SNLS president Paulo Mendes acknowledged that this is a problem.

"It's hard for us to plan prophylactic treatment against mother-to-child transmission in a regular manner, due to the hardships we face in terms of human, financial and material resources. This is the hard truth," he said.

Lack of follow up

Closely monitoring the mother and child for up to 18 months after the infant is born is also difficult. Between 2002 and 2006, Céu e Terra only managed to monitor about 800 infants, less than half the babies born to HIV-positive mothers during this period.

"Many mothers either become desperate, turn to alternative medicine, or simply fail to comprehend the gravity of the situation," said Oscar Basisio, president of Céu e Terra. "The fact is that more than half of them did not continue treatment."

For many Guineans the tarbessadu is still the best method of prevention. Isabel (not her real name), of the Mandjak ethnic group, was not familiar with the ritual, although she had married a Balanta. "At the time I wasn't aware of this ceremony. He never told me anything about it," she recalled.

She had her first child in 1994, and both she and the baby were healthy. In 2003, she discovered she was HIV positive and in her second marriage underwent the tarbessadu in the presence of her husband and older child.

"Sometimes I get to thinking that I'm HIV positive because I took so long to undergo the ritual," she admitted. "But then I just banish these thoughts from my head."

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Theme (s): Care/Treatment - PlusNews, Gender - PlusNews, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]