Fighting A Curse in Ghana
Before they can treat HIV, health authorities have to figure out who has it
ACCRA, Ghana – When Clement Azigwe Banwinwo’s wife fell mysteriously ill and died two years ago, he assumed what many Ghanaians would have – that she’d been cursed. Witchcraft, known as du-du, is often invoked in rural Ghana as the cause of illness. People in these regions tend to seek treatment from traditional healers, or du-du men, rather than from clinics. If Banwinwo had seen a doctor, he probably would have learned that his wife was dying of AIDS. And he might have saved her life.
As part of an aggressive new campaign to identify and treat HIV sufferers, authorities aim to identify at least a third of HIV-infected people by 2010 (from less than a tenth 2003). Since many Ghanaians only seek medical attention if they are sick, the campaign is taking place on the job, and in the streets.
Banwinwo’s employer, the Newmont Mining Company, offered free educational briefings and HIV tests to all of its employees. But Banwinwo was one of only 40 of Newmont’s 360 employees to get tested. Most probably feared the stigma, and had some misconceptions about HIV, according to Naomi Tettey, a Newmont communications officer who led the information sessions.
Some 2 percent of Ghanaians, or nearly 400,000 people, are believed to be HIV-positive, and health authorities agree that encouraging more people to find out about that is the key to fighting the epidemic. Yet as the Newmont case demonstrates, even showing up on someone’s doorstep with a testing kit isn’t enough.
Deborah Kwablah of Family Health International (FHI), an NGO that recently carried out the first large mobile testing campaign in Ghana, argues that the stigma and ignorance surrounding HIV are still widespread, and that education campaigns are necessary for mobile testing to succeed.
“We go in a week beforehand to educate the community,” she said. “We let them know there is treatment for HIV, that HIV is no longer a death sentence, but a chronic disease. Without education, no one shows up at all.”
Much of this mobile testing work is carried out by NGOs like FHI. The West African AIDS Foundation (WAAF), an Accra-based NGO, has been able to reach Accra’s reclusive Muslim communities by working closely with local imams, and by recruiting peer educators. Eric Essiam, a local activist based in Accra’s Muslim neighborhoods, believes pre-test education is key.
“When you come to them and you are a Christian, they ignore you,” said Essiam. “You have to gain their trust through the imams.”
Essiam found that many Accra Muslims thought HIV could be spread by mosquitoes or public toilets, or that it was untreatable. Young people were tough to reach, since their parents were often wary of sexually explicit discussions. Eventually, with the support of the imams, Essiam won them over. WAAF tested about 800 people in four weekends.
Hope for All Foundation workers focused on befriending prostitutes, and recruited them to encourage other prostitutes to get tested. Some 40 percent of Ghanaian sex workers are believed to be HIV positive. Executive Director Mary Addison-Fynn organized the testing of 2,035 mostly sex workers over several months.
Sex workers are hard to reach because of their odd hours, she said.
“Sometimes girls work until 4 a.m., and they need to sleep during the day,” she said. “Leaving for the clinic is not their top priority, even if they are educated. But if we take it to their doorstep, they do it.”
Authorities think that some 25 percent of gay men are HIV postive – but they are one of the toughest groups to reach. Homosexuality is illegal, and violence against gay men is widespread. According to Mac-Darling Cobinah, founder of the Center for Popular Education and Human Rights Organization (CEPERG), most gay men don’t even identify themselves as homosexuals, and have wives or girlfriends in order to mask their sexual identities. A CEPERG survey found that 95% of men who have sex with men also have sex with women. Since HIV campaigns generated by the Ghanaian government only acknowledge heterosexual sex, he frequently encounters misconceptions how AIDS is contracted.
“People here think that sex between a man and a man can’t take place,” he said. “So if you see that women are being shown on TV carrying HIV, they think if I have sex with men, then I am safe.”
When Banwinwo’s test came back positive, he was shocked. He had not led a promiscuous life, he said, and had not suspected wthat his ife had had AIDS. Sussie Akrobotu, the social worker who counseled him, was pleased that he left with the intention of carrying out her advice, since patients who test positive often react by denying in at first.
“Some people will tell you, ‘I don’t believe the test. I have to go to another place to do the testing again,’” she said.
It’s her job to call people up and encourage them to seek treatment. She was especially proud of one case that ended well. A few months after a man stormed out in denial, she received an unidentified call on her cell phone. She soon realized who it was.
“He said, ‘I want to come to your clinic, when can I come?’ I said, ‘Come. When you get to our neighborhood, give me a call.’ I went down to the junction to wait for him. Now he is on medication, and he’s doing fine.”
Ghana has mounted a major campaign to find out who is infected with HIV.
A volunteer talks with a sex worker at a club in Tarkwa, a mining town in Ghana's Ashanti region.
A volunteer talks with the boyfriend of a sex worker outside a club in Tarkwa, a mining town in Ghana's Ashanti region.
All photos by Alex Cotton