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| By: Amanda
Coggin ( View
Profile) |
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| Zanzibar (Africa's "Spice Islands") is
better known for its clove, cinnamon, and pepper than high transmission
rates of HIV and AIDS, which has devastated most of Sub-Saharan
Africa. This island, an archipelago in Tanzania off the east
coast of Africa, actually consists of a series of islands, but
is referred to by its two largest islands, Unguja and Pemba,
with a population of around a million people. |
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| Zanzibar is mostly Muslim and an island,
which may explain why there are lower transmission rates of
HIV and AIDS here. However, public health officials have also
noticed that the rate of transmission is much higher here for
the island's high risk groups than for its general population.
Zanzibar AIDS Control Programme (ZACP) and the government want
to keep the disease from bridging into the general populations,
so they are gathering information from its hidden populations,
where the behaviors are not only risky and unspoken, but also
illegal. |
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| Leigh Ann is getting her PhD in Public
Health through Tulane University and is the lone foreign researcher
on the ground with the ZACP study. We spoke over Skype (and
a ten hour time difference) to talk about her work with the
people in these high risks groups, how a government like Zanzibar's
can be a model of service when it comes to HIV/AIDS research,
and the cultural differences between those groups in Africa
compared to America. |
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| In their study, the ZACP has called in
three populations for their study: men who have sex with men
(but who don't believe themselves to be gay), injective drug
users, and female sex workers. Many men will have sex with other
men in order to make money to buy heroin or cocaine, but would
not be considered gay. The surveys consist of close-ended questions
as well as anonymous testing for HIV, Syphilis, and Hepatitis
B and C. So far they have been able to test nearly 350 people,
which is a large response for a study like this one. Leigh Ann
notes a big draw has been that many want their HIV results,
since the study tests them anonymously. ZACP wants to look at
the different conduits of transmission, while the government
wants the information to be available in a non-judgmental, yet
informative, way so that they can decide what to do with programs
and intervention in order to keep the people of Zanzibar safe. |
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| "The biggest stigma in a country like Zanzibar
is that homosexual sex acts and behaviors are stigmatized in
their culture," Leigh Ann said. "So it is harder to get homosexual
men in a Muslim culture to come in and be studied when their
lifestyle is illegal." Leigh Ann also has found that the drug
users will come in and tell her and her colleagues what they
want to hear because they get paid a nominal fee to be part
of the study. The gay men have had to be regrouped within the
study because the drug users were harassing the gay men at the
study site, which scared the gay men off. To Leigh Ann, this
was one of the biggest surprises of the study, that one group
within the study population was ostracizing the other group.
So now, the gay men and drug users come in on different days. |
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| Leigh Ann, a former Peace Corps volunteer
in Northern Thailand, had been back in Phnom Penh, Cambodia's
capital, the year before to work with an NGO since she had been
displaced from Tulane while they rebuilt after Hurricane Katrina.
What drew Leigh Ann to this particular study was its timing
and opportunity. |
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| "I liked how the Zanzibar government said,
"Within the context of our culture, we're going to allow people
to come forward and say that they are doing things that are
illegal. We're not going to remark on this or punish them because
they are our citizens, and we want them to seek care accordingly."
Leigh Ann appreciated coming into a context where the government
was willing to deal with people who were punished, severely
so, for their inclinations, but also wanted to treat them like
human beings and to give them the opportunities to find out
about their health in a format where they may not seek it out
themselves. "What they [the government] are really saying is,
'Your health is valuable and your presence is valuable. We want
to keep you around.'" |
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| That sentiment appealed to Leigh Ann as
she works with a group of local researchers there to gather
data. "My counterparts are exemplary researchers-committed,
knowledgeable, and connected to gatekeepers in these population
groups, which is vital to success in getting respondents to
trust and participate in the study." Once the respondents get
their test results, if they are HIV positive, the study connects
the participants with a resource that already exists in their
community. "There is antiretroviral therapy that they can get
on and the government covers the cost for them if they get on
it, but they [the patients] have to be at certain level of the
virus in their blood to get started on the medications." |
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| And Leigh Ann's curiosity extends beyond
her study. "We did some focus groups with men and we wanted
to know more about how they talk to their family about HIV/AIDS.
So we asked, "Who do you talk to about HIV? Where and when?"
Leigh Ann told the story of one man who is married, has four
children, and has sex with men outside his marriage. "The Koran
speaks to adultery, but his extra-marital affairs are with men,
so we asked him, 'Does your wife know this?' He said, 'No, she
doesn't.' So we asked him, 'Do you talk to her about HIV?' And
he said, 'Yes, but only if she sees it on TV, or if there is
a funeral where someone dies of HIV.' He wouldn't speak to her
about it in a personal way, because he was scared that might
open up the conversation where she might say, 'Hey, I hear you
are having sex with men.' Because what would her options be?
Divorce? Out him? Have him arrested?" |
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| The story takes an even more interesting
twist in the fact that this man works with Leigh Ann and her
colleagues on the study for about thirty hours a week. And he
is an interviewer who interviews other men, though he has not
had an interview himself. And they way they got him on board?
Some openly gay men brought him in. This peaked Leigh Ann's
curiosity even more, particularly when she found out that he
used to be a policeman. "He retired," she said. "And he was
all excited the other day when he was helping decorate for a
wedding." |
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| We went on to discuss the differences regarding
cultures, and how we had each had our fair share of attempting
to infiltrate certain cultures that we had lived among, and
how that was one of the hardest tasks at hand. |
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| "I rely a lot on my co-workers who are
local and try to identify early on those who are honest, those
who are able to look at things on a broader perspective. But
a lot of the time, I end up feeling like I can't assess everything
because it's not my culture." Though people in Zanzibar have
a pretty good idea of what's going on in their culture. "More
often than not they have seen twenty years of HIV/AIDS affecting
their community so it's hard to not have had some experience
firsthand with HIV, but there is a big difference between knowing
something is good or bad for you, and then making a choice that
is good for you. All human society does this. We know what's
not good for us, but it may not deter us from doing it." |
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| Every so often Leigh Ann will email me
a new discovery on the island or in her research. The other
day, she met someone who almost threw her research for a loop.
"One of the more-attractive-as-drag-queen-than-woman types came
into the study site today. I thought she was a drag queen because
we are only interviewing men who have sex with men right now.
When she left without an interview, I asked why, and found out
she came in to bring some of her customers. She is a lesbian
electrician who runs a gay bar where she also has a side business
working as a pimp." |
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| With me in San Francisco and Leigh Ann
in Zanzibar, it may seem like we are worlds apart, but her research
has reminded us both that the one thing we have in common is
our fascination with the people. |
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