SOMALI HIV HOT-SPOT MAPPING: EXPLORING

HIV VULNERABILITY AMONG POPULATIONS AT

INCREASED RISK OF INFECTION (2008)
BACKGROUND
Somalla lacks sLraLeglc lnformauon for an eecuve
and evldence-based response Lo Lhe Plv epldemlc.
Slnce no epldemlologlcal sLudy has been conducLed
ln Somalla on Plv rlsk behavlours and populauons
aL rlsk, llule ls known abouL Lhe dynamlcs of
Lransacuonal sex, and lLs lmpllcauons on Plv
vulnerablllLy and lnfecuon sLaLus of populauons
aL lncreased rlsk. 1hls hoL-spoL mapplng ls Lhe rsL
sLudy Largeung aL-rlsk populauons across Somalla,
and was conducLed from 2007-2008 ln parLnershlp
wlLh Lhe Somall AluS Commlsslons.
OBJECTIVES
- Explore Plv vulnerablllLy among populauons aL
lncreased rlsk ln relauon Lo Lransacuonal sex,
- Idennfy eecuve, culLurally approprlaLe meLhods
of collecung Plv and sexual behavlor daLa,
- Establish an evldence base for developmenL of
Lhe rsL Somall Plv lnLegraLed 8lologlcal and
8ehavloural Survelllance (l88S) survey among
populauons aL lncreased rlsk ln 2008.
METHODOLOGY
1hls was Lhe rsL sLudy Lo explore Plv vulnerablllLy
among key populauons aL rlsk of Plv lnfecuon ln
Lhe Somall conLexL. 1hree hundred and y (330)
paruclpanLs (143 females and 207 males) were re-
crulLed Lhrough snowball sampllng among lemale
Sex Workers (lSW), and key lnformanL lnLervlews
wlLh clvll socleLy and non-governmenLal organl-
zauons, as well as wlLh unlformed servlces, khaL
sellers, Lea sellers, Lruck drlvers and pharmaclsLs.
- 8eporLs of assaulL, lll LreaLmenL, rape and refusal Lo
pay were common and lemale Sex Workers (lSW)
suered from threats and v|o|anons by Lhelr auackers.
1hls oen resulLed ln ln[ury Lo Lhelr person and damage Lo
properLy, reduclng Lhelr ablllLy Lo work, leadlng Lo a loss of
lncome, whlle also needlng Lo cover medlcal cosLs and loss
of properLy,
- lSW reporLed hlgh levels of moblllLy before and aer Lhelr
regular engagemenL ln Lransacuonal sex. Many le home
aL a young age aer becomlng a slngle/double orphan,
or experlenclng conlcL and domesuc vlolence. LnLry lnLo
sex work was oen referred Lo as a means of survlval,


SOMALIA
RESEARCH BRIEF
29people
living with HIV and AIDS
were interviewed
1nL C8ILC1IVL WAS 1C LS1A8LISn
INICkMA1ICN 1nA1 CCN1kI8U1LS
1CWAkDS DLVLLCING AN LVIDLNCL-
INICkMLD kLSCNSL 1C nIV AND AIDS
AMCNG VULNLkA8LL CULA1ICNS.
RESULTS
QUOTE from focus group discussion:
[ 1he rsL ume l Lraded sex ] l was 12 years
old ... my faLher and moLher had dled . l dldn'L
have anyone Lo Lake care of me, and [dldn'L] have
anyLhlng Lo eaL or dress ln. 8elng a sex worker was
Lhe only cholce.
- lSW aged 23

- 1he ma[orlLy of lSW had never been LesLed for Plv and
dld noL know Lhelr sLaLus. 1he maln barrler Lo Lesung was
a lack of rlsk percepuon. Many lSW dld noL know where
Lhey could geL LesLed and many doubLed Lhe condenual-
lLy of Lhe vC1 servlces. 1he mlnorlLy who soughL Lo know
Lhelr sLaLus were mouvaLed by lllness amongsL frlend lSW,
nLAL1n MIGkAN1S IN nLAL1n CCMMUNI1ILS
International Organization for Migration
IOM Somalia Oce
Tel: +254 20 444 4174
Email: MHDSomalia@iom.int
www.nairobi.iom.int
A8lL 2012
WI1n 1nANkS 1C CUk
Ak1NLkS:
RECOMMENDATIONS
1. An eecuve nauonal response Lo Plv ln Somalla
needs to address both |nd|v|dua| and structura|
vu|nerab|||ty Lo Plv among sex workers and Lhelr
cllenLs,
2. Integrated prevennon, treatment and care speclcally
Largeung populauons aL lncreased rlsk oughL Lo be a
prlorlLy,

3. lnLervenuons oughL Lo lnclude peer educauon,
condom dlsLrlbuuon, vC1, access Lo A81 and should
address sexua| and gender-based v|o|ence,
4. 1argeted and ev|dence-|nformed responses are
requlred Lo meeL Lhe speclal needs of sLreeL chlldren,

3. Lnsure LhaL lSWs have access to comprehens|ve nIV
serv|ces LhaL emphaslze Sexual and 8eproducuve
PealLh (S8P) and rlghLs.
CCNCLUSICN
1hls sLudy makes clear LhaL Lhe genera| popu|anon
approach to nIV prevennon |n Soma||a has fa||en
short of reach|ng sex workers and the|r c||ents.
lL also demonsLraLes LhaL Plv research among
sex workers and Lhelr cllenLs can be conducted
|n a cha||eng|ng env|ronment characLerlzed by
slgnlcanL culLural and rellglous sensluvlues, ln
addluon Lo conslderable populauon movemenL.
Mob|||ty |n Soma||a lncludes porous borders wlLh
counLrles LhaL have hlgher Plv prevalence (u[lbouu,
LLhlopla, kenya), and Lhe presence of hlgh-rlsk moblle
populauons assoclaLed wlLh oLher Plv epldemlcs
ln Lhe reglon (Lruck drlvers and Lhe mlllLary).
kLSUL1S (cont.)
- lSW were more llkely Lo reporL exchanglng sex
for gls or favors raLher Lhan money, as was Lhe
case for Somallland and SouLh-CenLral. Survlval
sex was more promlnenL due Lo populauon
movemenLs,
- 1hough almosL all mlgranL lSW had heard
of Plv, knowledge around prevenuon
and Lransmlsslon ls mlxed, wlLh many
mlsconcepuons sull presenL,
- 78 sex cllenLs aged 17-34 were lnLervlewed.
1he mosL common sex cllenLs were Lruck
drlvers, seafarers, porL workers, unlformed
servlces, buslnessmen, Lraders and
unemployed men.
sexually acquired
from husband to wife
The most commonly reported
mode of HIV transmission was
78
sex clients
aged 17-34 were lnLervlewed. 1he most common clients
were Lruck drlvers, seafarers, porL workers, unlformed servlces,
buslnessmen, Lraders and unemployed men.