Even more fundamental to the condition of poverty is social and political exclusion... Towards urgent Prevention of HIV Disaster in Maldives.

Using the new hope given by our government in social and political inclusion of Maldivian citizen in the country’s future will be politically reformed  environment today I want to focus on a gnawing disturbing danger that however much I ignore would not go away. For the people of my country and our people, us all I would like to put HIV into perspective. Few days ago I was talking to my friend who just came back from her home country Kenya. While she was gone to visit her family came the Red Nose day in England, and the subject of the night in the show that ran the whole night in BBC was Africa. I was quite surprised to find out all most all the videos were about my friend’s country Kenya, as one of the hardest hit. The videos showed whole villages been wiped off with the old and the adults, leaving only orphaned children. Some families comprised of four five children headed by 12 year olds. A whole bunch of 15 children been looked after by an auntie who herself was a patient. It has such a deep affect on me; I couldn’t wait for my friends return. As soon as I met her I told her what I have seen and asked her one simple question. Why? She gave me one simple answer poverty. The stories she told me to justify her answer other than one, stroke a nerve in me. Her meaning and interpretation of poverty gave me a sense of foreboding as I can relate it so much to Maldives and a possible endemic I was worried and that we need to do something to change our selves and our country in order to save ourselves..

She said specially the hardest hit with HIV is the rural areas where the mean of income is the worst. The fisherman, the states man, the business man, the shop keeper, the farmers know very well the poverty that pre veils. So the wife, the mothers, young girls out of sheer necessity for food and other needs as such give them their body in return for food and other basic favours. In return often they get HIV a warrant for death. Their eyes wide open people walk into these situation out of hunger, sheer necessity caused by poverty. Although the other explanation where the husband dies, the wife becomes a commodity and is inherited to next to kin or a relative of the husband. Often knowing that the husband has died of HIV, they still use the wife for their sexual purposes, also inheriting an HIV status does not apply to Maldives the truth of the matter is  current sexual scenery in Maldives is one that of liberal. Although in Maldives HIV has not yet resulted and is not a consequence, the sort of poverty, which has spread HIV in countries many of the social problems are of natures that we can relate to. Out of this thought also that poverty might be related to a lot of issues we have, and out of fear I went and did some research to make sure whether my friends claim are correct or not.

Of the global total of 30 million people living with HIV in 1997 some two-thirds (21 million) are in sub-Saharan Africa. Infection as true to my friends words is concentrated in the socially and economically productive groups aged 15-45, with slightly more women infected than men. There are significant differences in the ages of infection of girls and boys with infection occurring at younger ages for girls (with girls and young women in some countries outnumbering boys and young men by factors of 5 or 6 in the age range 15-20). Few people remain unaffected in indirect ways, i.e. through the illness and death of relatives and colleagues. 

Even more fundamental to the condition of poverty is social and political exclusion. So HIV-specific programmes are neglectful of the interests of the poor and are rarely if ever related to their needs, and also unfortunately are other non-HIV related programme activities such as those relating to agriculture and credit. More generally it is the absence of effective programmes aimed at sustainable livelihoods which limit the possibilities of changing the socio-economic conditions of the poor. But unless the reality of the lives of the poor are changed they will persist with behaviours which expose them to HIV infection (and all the consequences of this for themselves and their families). Two examples of this state of affairs will perhaps suffice to indicate how poverty leads to outcomes which expose the poor to HIV. Firstly, poverty especially rural poverty, and the absence of access to sustainable livelihoods, are factors in labour mobility which itself contributes to the conditions in which HIV transmission occurs. Mobile populations, which often consist of large numbers of young men and women, are isolated from traditional cultural and social networks and in the new conditions they will often engage in risky sexual behaviours, with obvious consequences in terms of HIV infection. Secondly, many of the poorest are women who often head the poorest of households in Africa. Inevitably such women will often engage in commercial sexual transactions, sometimes as CSW but more often on an occasional basis, as survival strategies for themselves and their dependents. The effects of these behaviours on HIV infection in women are only too evident, and in part account for the much higher infection rates in young women who are increasingly unable to sustain themselves by other work in either the formal or informal sectors. 

Let us start the discussion of Maldives with the following terms that I have come across in this discussion in the light of preventive measures. According to research HIV can be prevented through the three main measures of

       1. Behavioral interventions: These are interventions that aim to change individual behaviours only, without explicit or direct attempts to change the norms of the community or the target population as a whole.

       2. Social interventions: These are interventions that aim to change not only individual behaviours but also social norms or peer norms. Strategies such as community mobilization, diffusion, building networks, and structural and resource support are usually used to bring about changes in social norms and/or peer norms.

       3. Policy interventions: These are interventions that aim to change individuals' behaviour, peer, or social norms or structures through administrative or legal decisions. Examples include needle exchange programs, condom availability in public settings, and mandated HIV education in all schools in a district.

Low family income, financial stress, economic dependency, low education, lack of health and educational service, poor local job market or unemployment in the islands specially among young adults, growing up in a family  parents with low education, low current family income all hits home to the average Maldivian and one can say has become a norm of our society. These problem in the Maldives due to political exclusion and neglect has also introduced problems of drug use and other dangers of the sort such as a young adult population of vices.

Maldives until recently has enjoyed one of the highest divorce rates in the world despite its smallness. Contributing to marriage break down is infidelity practises by men due to the availability of the large vice population. Any man with a job has the opportunity to go after several younger women. These women having nothing better to do except catch some employed mans eye and improve their live hood though affairs with such men regardless of the male’s marital status. It is not only these men but any available men such as visitors are seen as a commodity for financing their life style.  How many school leavers of the female population has this life style can only be determined by conducting  a research, and how many of such women end up been responsible in the divorce marriage break downs in a hundred percent Muslim country is yet to be determined. We have no right to blame these girls and sometimes boys at their cheap shots for basic necessity as we as a government fails to provide them with employment and services that can give them a proper hold. This also shows the poverty that pre-veils in our society. Today’s Maldives has formed a culture obsessed with engagement of sexual gratification using such venues created by poverty. It is a taboo to discuss it but almost every one is becoming a victim of this circumstance, even though it is a dangerous liaisons. This if Maldivian feel is a taboo to write about or a stigma that should not be discussed let the following fact indicated by United Nation make them become more open and vigilant over this issue. Maldivian vulnerability and risk factors state:

• High rates of divorce and remarriage in the Maldives create exposure to large sexual networks capable of transmitting HIV and other sexually transmitted diseases. Since HIV symptoms often do not appear for many years, people who are unaware that they are infected may infect many of their serial spouses and casual sex partners.
• The high percentage of population under 15 years of age (approx. 50%). An estimated 26,000 young people will enter the labour force in the next five years, with anticipated high rates of unemployment;
• The rise in drug use amongst young people.
•  The high number of people from the Maldives who seek medical services in neighbouring countries, with some attendant risk of infection from blood transfusions
• Maldivian is dispersed over as many as 190 islands. This dispersed population creates barriers to educating people on HIV/AIDS, distributing condoms, and treating people for STDs that increase transmission of HIV. A UN study in 2000 revealed that in the smaller islands 55 percent of the population has no radio, and 86 percent have no television in the home. Many small islands have no bookstore, and access to newspapers is irregular

Just like My friends country Kenya risk factors and vulnerability for HIV infection in Maldives indicate that the most deprived areas including the island population are mostly at risk. Furthermore it was stated that due to failure from the government side to meet the HIV patients health care needs many HIV patients from Maldives go to South Indian towns for treatment. Not only HIV patients we need to improve the health care need of the Maldivian in every way to stop the high percentage of Maldivian population who has to go to India for other medical reason. This need to be addressed to stop the flow of Maldivian patients to India due to the ultimate truth that India at the moment in the whole world has the highest number of people living with HIV/AIDS with the amount exceeding  5.1 million. We are talking about individuals infected with HIV in a country where the close “The high number of people from the Maldives who seek medical services in neighbouring countries, with some attendant risk of infection from blood transfusions” applies in the Maldives vulnerability and risk factors of HIV in Maldives.

According to research HIV can be prevented through the three main measures of behavioural intervention which all needs political commitment .Also is the thought that it is high time Maldivian practise their religion on the part, by adhering to the close of been faithful to their spouse. Where adultery is committed instead of the government’s liberal stance of allowing it ignoring the issue the government should seek to punish them according to the law.

Ziney (fornication) or illegal intercourse is one of the great offences in Islam apparently the main cause of HIV and Aids in Maldives as stated by research. In Maldives main method of infection is hetro-sexual engagement. In Islam it is an immoral deed which can lead the doer to the most evil path. Fornication can lead to moral decay, be the ruination of future descendants, devastation of family life and it will burden the government with the problems of unwanted children, inadequate care and education of neglected children and etc. In connection to that, Allah Subhanahu Wata’ala has fixed a suitable punishment for Ziney offence whereby the woman and the man guilty of illegal sexual intercourse, flog each of them with a hundred stripes. Let no pity withhold you in their case, in a punishment prescribed by Allah, if you believe in Allah and the Last Day. And let a party of the believers witness their punishment. With modernity and the change of culture under for the worse such practise of Muslim and cultural way of abiding the citizen to the right path has almost ceased and the government should really bring it back in full force, to save people from themselves.

For those Maldivian whose sexual compulsivity is not under their control, and who successfully stay above the law, for their own safety and others they should make sure they use Condom as research has confirmed that  that consistent and correct condom use reduces the chance of infection. Thus for the safety of our small population and avoid a disastrous catastrophe the quite simple solution is the use of Condom.

Finally before concluding I would like to focus on measure that can be taken at policy level at policy level there are a lot our government can do even though it all depends on the government averting its attention from the political war it is waging. At least he Ministry of Health can refrain away from political engagement at our president’s service. According to a study done by NHS the National Health Service of UK Behavioural interventions to reduce risk for HIV/AIDS are effective and should be disseminated widely by government. For Maldives this means just the way condoms are given for contraception, it should e given out for the risk group. Furthermore as drug use has become a major social problem an inherent potential danger of transmission media for HIV the same method as condoms needles should be made available in hospitals. Even when I say this the issue of religion prevails in all these factors, however the safety of the people and the problems in our society is a reality that cannot be ignored any longer, or can co-existent with religion practises in the policies. Although sexual abstinence is a desirable objective, and a religious method of sexual practises can prevent HIV we as a society has moved beyond that with our problems. More frequent and regular awareness Programs with instruction on safer sex behaviours and separate funding for drug abuse treatment programs must be put in place. Research data clearly show that such programs reduce risky drug abuse behaviour and often eliminate drug abuse.