Siyaasadda Xakamaynta HIV-AIDS-ka Somaliland

1.1. Background
The scale and impact of the global HIV/AIDS epidemic is devastating, constituting a formidable challenge to human life, dignity and the enjoyment of human rights, undermining social and economic development. The consequences of inaction and complacency in Somaliland can have equally devastating implications. Low prevalence rates, if left unchecked rapidly transforms into high rates of infection with consequent social and economic costs. Through strong political, religious and community leadership, Somaliland must intervene early to prevent HIV/AIDS from totally taking off in the general population. Worldwide, governments are in the frontline of the fight against HIV/AIDS. International development partners are central in the provision of technical and financial support and civil society and the private sector play a vital role. However, the final responsibility for leading and coordinating national efforts to prevent and control HIV/AIDS and mitigating its impact rests with governments. HIV/AIDS is a political priority for the Government of Somaliland (GOS).
1.2. National Response
In 2003, the government Somaliland established the HIV/AIDS National Technical Committee (NTC) under the tutelage of an Inter-ministerial Committee (IMC) chaired by then vice president. Under the auspices of the HIV/ AIDS Inter-Ministerial Committee (IMC), the HIV/AIDS National Technical Committee (NTC), Predecessor of SOLNAC), has developed the HIV/AIDS Action Plan for Somaliland 2004 – 2005. Two years later, the president of Somaliland established a government regulating body with the Decree No, 88 of 28 June 2005, Somaliland National HIV/AIDS Commission that will plan and coordinate multi-sectorial efforts to curb the spread of the pandemic in the country. The commission would also design strategies for providing effective drugs to those living with HIV/AIDS and to lead a concerted campaign to reduce the spread of HIV transmission, mitigate its impact on the infected or affected people raise awareness in the community about the risk behaviors and methods of prevention. The established commission comprises Steering Committees of 6 ministries with secretariat of Executive Director and 4 Department Directors with stakeholder engagement of) nongovernmental organizations, civil society groups, the religious sector and the HIV-positive community, will chair the National AIDS Commission. It will have a full-time secretariat headed by an executive secretary. Later on, 2014, the Somaliland parliament passed the establishment act of Somaliland National AIDS Commission (SOLNAC), Headed by the president as chairman and Advisory committee which comprises 7 members designated by the SOLNAC ACT2014. Its membership includes representation from the Ministry of health, ministry of education, ministry of justice, ministry of religion, ministry of labor and social affairs, ministry of youth and sports. As well as an Executive Directory lead by an executive director and four directors.
1.3. HIV/AIDS context in Somaliland
A community-based survey on Knowledge, Attitude, Believes and Practices (KASP) conducted in 1999 was the first referable survey to reveal HIV prevalence in Somaliland and its outlook in a conservative and less aware community. In that survey, Somaliland had prevalence rate of 0.9% in general population, 4.6% in TB patients, 47% in a limited number of voluntary tested female sex workers, 0.8% among ANC women, 1.8% in patients with other STIs. In 2007 – 2008, an ANC survey conducted in Somaliland manifested HIV prevalence of 1.7% and among patients with other STIs the result was 6.3%. The total prevalence in the general population revealed to be above 1% with geographical variations and demographic factor dependent pattern of distribution. In the subsequent years, the concerted and coordinated efforts by multi-sectoral partners and stakeholders of Somaliland government spearheaded by SOLNAC, international organizations and local/community engagement, the prevalence rate of HIV started to persistently decline as the ANC surveys conducted in 2010 and 2014 was 1.3% and 0.72% respectively. Look at the figure below.

The country has adopted the UNAIDS 90-90-90. This method is rather ambitious but achievable targets towards a new narrative on HIV. These targets are: (i) By 2020, 90 percent of all people living with HIV will know their HIV status; (ii) By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and (iii) By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression. By June 2019, all the three targets were not being near achievement with a need to redirect efforts in order to get closer on track. In the Somali context, the HIV/AIDS epidemic is characterized as geographically heterogeneous prevalence based on antenatal care (ANC) sentinel surveillance over the years where Somaliland has relatively higher prevalence.

Figure: Median HIV prevalence rates among ANC attendees in Somaliland 2004 - 2018

The prevalence level has demonstrated a consistent level of decline in Somaliland. The 2018 CNC surveillance considered many more sites than the previous year and it also provides a more generalizable picture of the whole population.The total number of documented PLHIV is 1916 people in Somaliland with only average 6% of ART coverage; 8% and 4% of adults and children living with HIV respectively although Somaliland has taken the ‘test and treat model’.