Nigeria's Kaduna State Reaches Out to Women in Purdah

MAY 2009 — Binta's husband had been sick for over three years and finally became too exhausted to work. She convinced him to go to hospital for testing. During the four months he was kept in hospital, no relatives visited, "because they thought it was contagious." "It" was AIDS, and Binta's husband did not survive.

Binta, who is from Nigeria's Kaduna State, lives in purdah: she is segregated physically from men and only able to participate in limited activities outside of the home. Purdah may pose difficulties for women affected by HIV/AIDS. For example, they may not be aware of HIV, or surmise their own HIV status only when their husbands, as in Binta's case, fall sick or die. They also do not have easy access to HIV/AIDS or other healthcare services.

Binta and one of her daughters also became sick, and her daughter died. Binta's father asked her to leave the family's compound. She went to stay with her mother in Kano but didn't have the courage to tell her she was HIV-positive. Binta began taking antiretroviral medicines, regained her health, retrieved her other children, and returned to Kaduna.

However, neighbors ostracized her and her children and asked her landlord to oust the family. When one of her children was "blocked from returning home," her landlord took a stand, telling other tenants that Binta could stay in his house free of charge as long as she wanted and they could leave. Despite her landlord's support, Binta still worries about her children's education and finding enough to eat. She has not seen her father's relatives in years, and her children are no longer in school.

Support Health and Education for Development (SHED)
SHED is a community-based organization in Kaduna, the capital of Kaduna State, where the practice of purdah is widespread among Muslims. Founded in 2002 by Executive Director Aisha Ibrahim and a group of health and education professionals, SHED organizes outreach and educational activities, including helping women in purdah start support groups that provide emotional support, advocate for more access to education and reproductive health services, and disseminate basic HIV/AIDS facts and prevention messages.

Aisha refers to the "consequences of the women coming out" as community organizers and advocates for HIV prevention. She says some have accused her organization of trying to "Westernize the women…or change their faith." And some men don't want the women to come out because it would "reveal their own status."

But the men eventually have little choice, says Dr Kunle Oyedokun, a medical officer with the Nigeria's National Youth Service Corp Kaduna secretariat. "We tell them, 'You're sick, your wife is sick, get tested and get the support you need.' At some point the men's health status, the messages, and the knowledge of services overcome their reluctance."

Support for SHED from the State Action Committee and SNR
SHED has benefited from community mobilization and other training led by the Kaduna State AIDS Coordinating Agency (KADSACA), with support from the Strengthening Nigeria's Response to HIV/AIDS (SNR) program. With this assistance, SHED has successfully registered over 20 support groups.

SNR is a five-year UK Department for International Development-funded program managed by Family Health International that works to increase availability of HIV/AIDS services in local communities and fight stigma through "community drivers of change" like Aisha.

"SHED was an ideal candidate for support," says Dr Zainab Muhammad-Idris, former senior technical advisor to SNR and head of its Kaduna office, "because it reaches one of the most underserved populations in Kaduna."

Telling Their Stories
About 20 women's support group organizers and leaders agreed to meet in a conference room that SHED borrows from a neighboring organization. It's hot, transport is costly, there's no lunch, and the women have dire personal situations. Yet they compete to tell their stories and explain their motivation to lead support groups in the face of denial, abandonment, stigma, and persecution.

Many women in purdah, Aisha says, "are victims of polygamy and rampant divorce." Despite Islam's strict rules that a man should not marry more than four wives and never more than he can "deal justly with," these measures may not be followed. Divorced women who remarry may be unaware of their HIV status or may be reluctant to reveal it. In this way, stigma contributes to spreading infection.

For example, Fatimata married young and was her husband's second wife. She observed him taking what she realizes in retrospect were antiretroviral drugs, but he refused to go for testing and later divorced his "vocal wife." When she later went to the clinic for testing and saw she was the only woman in purdah, she concluded there was an urgent need for prevention, counseling, and testing messages in her community. She began support groups for women in purdah and recruited other women to lead them.

One problem SHED had was reaching women who may seldom leave their homes. They ingeniously leapfrogged this obstacle by using cell phones, particularly text messaging. "The women send each other texts like 'Come out and know your status,'" Aisha says.

— John Engels

PHOTOS: Women's support group leaders tell their stories. (John Engels/FHI)