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.
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.
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.
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.
“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.
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.
“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.’”
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.”
And Leigh Ann’s curiosity extends beyond her study.
