The crisis of HIV stigma in Puntland, Somalia, reveals the intersection of public health challenges and deeply entrenched societal attitudes. Despite efforts to expand access to antiretroviral therapy (ART), stigma continues to discourage individuals from seeking or maintaining treatment, jeopardizing their health and undermining broader public health goals.

Scope of the Problem

In Puntland, only 646 individuals are receiving ART, representing a small fraction of the HIV-positive population. While urban centers like Garowe, Bosaso, and Galkayo provide relatively better access to treatment, rural areas remain grossly underserved due to:

Healthcare disparities: Limited infrastructure in smaller towns like Qardho and Badhan restricts access to essential services.

Cultural stigma: Societal discrimination forces many to avoid testing and treatment for fear of ostracization.

This stigma drives poor treatment adherence, leaving individuals vulnerable to opportunistic infections and advancing illness. The ripple effects of untreated HIV extend to increased transmission rates, perpetuating the epidemic.

The challenges in Puntland mirror broader trends across Somalia, where HIV-related stigma is deeply rooted in cultural misconceptions and religious beliefs. According to a 2017 stigma index, Somalis often exhibit a strong reluctance to engage with HIV-positive individuals, exacerbating feelings of isolation among patients.

For women and girls, the situation is particularly dire:

Gender inequality: Limited access to education and healthcare disproportionately exposes women to infection and reduces their ability to seek treatment.

Intersectional vulnerabilities: Marginalized groups face compounded stigma due to poverty, gender, and geographic remoteness.

The abandonment of ART by hundreds of individuals has dire consequences:

For individuals: Without consistent treatment, HIV progresses to AIDS, leading to severe health complications and death.

For public health: Poor treatment adherence increases viral loads, raising the likelihood of transmission.

Economic costs: Untreated HIV places an additional burden on already limited healthcare systems in Puntland.

Furthermore, stigma prevents open dialogue about prevention and testing, perpetuating ignorance and misinformation.

The Puntland AIDS Commission (PAC) has taken several steps to address the crisis, including:

Engaging community leaders: Religious figures and elders are instrumental in shaping societal attitudes. Partnering with these influencers helps counter stigma from within the community.

Civil society involvement: Non-governmental organizations and community-based groups are critical in raising awareness and providing support to patients.

National strategies: Somalia’s National Strategic Plans aim to reduce transmission and improve healthcare accessibility, but their impact remains limited in regions like Puntland due to resource constraints.

Key obstacles must be addressed to mitigate the crisis:

Infrastructure gaps: Investment in rural healthcare facilities is essential to ensure equitable access to treatment.

Education and awareness: Comprehensive public education campaigns are needed to dispel myths and promote acceptance of HIV-positive individuals.

Support for marginalized groups: Targeted interventions for women and rural communities can address their unique vulnerabilities.

Policy and funding: Stronger government commitment and international support are critical to sustaining public health initiatives.

Puntland’s experience underscores a critical global lesson: combating HIV requires more than medical interventions. Without addressing the societal factors that drive stigma, treatment efforts will fall short. This crisis also serves as a reminder that public health systems must integrate community engagement, education, and structural reforms to achieve long-term success.

The challenges in Puntland also reflect broader issues in low-prevalence, resource-limited settings. While Somalia’s HIV prevalence is relatively low (0.55%), the crisis demonstrates how stigma can amplify the impact of even a modest epidemic.

The HIV treatment crisis in Puntland highlights the devastating consequences of societal stigma and healthcare inequities. Addressing this issue will require a multi-faceted approach combining medical access, education, and cultural transformation. While progress has been made through partnerships with local leaders and civil society, much more is needed to ensure that those living with HIV can access life-saving treatment without fear or discrimination.

The success of these efforts will depend on sustained investment, political will, and community involvement, offering a path forward for Puntland and other regions grappling with similar

Somaliland is emerging as a beacon of potential, rich in untapped resources and poised for a transformative future. With its strategic location, stable governance, and a wealth of natural assets, this region is quickly becoming an attractive destination for foreign investors. As President Abdirahman Mohamed Abdullahi Irro leads the charge for Somaliland’s recognition on the global stage, the time is ripe for international investors, particularly from dynamic economies like USA, to engage with this promising territory.

Somaliland’s landscape is dotted with significant reserves of oil and various minerals, including gypsum, limestone, salt, and iron ore. The promise of these natural resources presents a unique opportunity to catalyze economic growth and job creation. By investing in sustainable extraction technologies, foreign investors can not only harness these resources but also contribute to the development of local economies, laying the groundwork for a prosperous future.

Situated along the Gulf of Aden, Somaliland enjoys a prime geographic advantage, serving as a natural hub for trade that connects Africa with the Middle East and beyond. This strategic position makes it an ideal location for logistics and commerce, further enhancing its appeal to potential investors. Coupled with a youthful population eager to adapt and innovate, Somaliland offers a workforce that is primed to meet the demands of various sectors, including technology and agriculture.

To effectively attract foreign investment, Somaliland must embrace the power of storytelling—crafting a narrative that resonates with prospective investors. This story should highlight the region’s vision for growth, showcasing local entrepreneurs who have thrived against all odds. By sharing these success stories, Somaliland can illustrate its resilience and potential, inviting investors to join in its journey.

The cultural richness of Somaliland is another key facet of this narrative. The warmth and hospitality of its people are a vital part of the experience, making the region an inviting place for businesses to establish roots and foster meaningful connections. As Somaliland strives for international recognition, it is crucial to underline the political stability and governance structures that have allowed it to maintain peace and security, making it a more attractive locale for investment.

To further bolster interest from global investors, Somaliland could benefit from the establishment of a dedicated investment promotion agency—a one-stop shop to provide tailored support and information about investment opportunities. This initiative could include the development of a robust digital presence through social media and targeted outreach, ensuring the narrative of Somaliland’s potential reaches audiences far and wide.

Hosting international investment forums presents another avenue for engagement, inviting business leaders from around the world, especially from tech sector, to explore opportunities firsthand. Networking events can facilitate connections that ignite collaborations and encourage dialogue about Somaliland’s investment potential.

In particular, the tech industry stands poised to thrive in Somaliland. Companies in fields like agritech, health tech, and fintech can find fertile ground for innovation and growth. By providing customized incentives, such as tax breaks and partnership models with local businesses, Somaliland can create an inviting atmosphere for investment.

A collaboration with international organizations can further lend credibility to Somaliland’s efforts. Partnerships with influential entities such as the World Bank or the African Development Bank can enhance visibility and provide a sense of security for potential investors, showcasing a commitment to sustainable practices and innovation.

At its core, the story of Somaliland is one of resilience and opportunity. As President Irro’s government embarks on this new chapter, global investors—especially those from UK, and EU—are invited to discover the vast resources and investment opportunities that await. This is more than just a financial decision; it is a chance to forge connections with a community eager for growth, innovation, and partnership.

As the world turns its gaze toward Somaliland,  join in unlocking the full potential of this extraordinary region. Together, investors and Somaliland can build a promising future, establish a unique narrative of success, and elevate Somaliland on the global stage as a vibrant hub for investment and development. Now is the time to be part of this transformative journey.

A recent study has highlighted a disturbing connection between smoking and the prevalence of harmful bacteria in the mouth, underscoring the health risks tobacco poses beyond lung cancer and respiratory disease. According to findings by researchers examining the oral health of 128 participants in a previous vascular and metabolic health study, smokers demonstrated higher concentrations of harmful bacteria like Fusobacterium, Campylobacter, and Tannerella forsythia, which can exacerbate gum disease and potentially heighten the risk of cardiovascular disease due to their inflammation-inducing properties.

The study adds to mounting evidence from the World Health Organization (WHO), which reports that smoking-related complications claim an estimated 8 million lives annually. Despite these risks, an estimated 1.3 billion people worldwide continue to use tobacco, with a large majority residing in low- to middle-income countries. Furthermore, smoking has been linked not only to lung disease but also to oral health disorders, where it disrupts the oral microbiome—a critical, balanced community of microorganisms that aids digestion, regulates immunity, and maintains health in the mouth.

The findings indicate that tobacco’s toxic chemicals, including nicotine, tar, and ammonia, create a breeding ground for harmful bacteria by reducing oxygen levels, altering pH, and hindering saliva production. Saliva plays an essential role in the mouth, not only aiding in digestion but also combating germs through antibacterial properties. A dry mouth, common among smokers, allows harmful bacteria to thrive, tipping the balance against beneficial microorganisms.

Nicotine further compounds this disruption. It fosters the growth of P. gingivalis, a bacterium known for its ability to bind to tooth surfaces and proliferate in dental biofilms—complex bacterial colonies that form plaque. If unchecked, these biofilms contribute to periodontitis and tooth decay, impacting both oral and systemic health.

Research suggests that the overgrowth of bacteria in smokers’ mouths may lead to slow healing, chronic inflammation, and even antibiotic resistance, increasing susceptibility to broader health issues such as cardiovascular disease and oral cancer. Streptococcus mutans, another bacterium, typically exists in balance within a healthy mouth but, under the conditions created by smoking, can contribute to dental biofilms and lead to tooth decay and, in some cases, cancer.

The study also suggests caution for those who view vaping as a safer alternative. Although e-cigarettes do not contain tobacco, early evidence indicates they may similarly disrupt the oral microbiome. Harmful bacteria like Fusobacterium and Bacteroidales, known to contribute to gum disease, are reportedly more prevalent in individuals who vape. While research on vaping’s impact on oral health is still emerging, preliminary findings cast doubt on its safety as a smoking substitute.

However, the study brings a hopeful message: quitting smoking can restore the oral microbiome’s natural balance over time, reducing the risk of gum disease and improving saliva production. Health experts advocate for ongoing public health campaigns, especially aimed at younger populations, to promote awareness of these risks.

Somalia, a country beset by protracted conflict, environmental crises, and economic instability, faces a hidden yet formidable challenge: a rising mental health epidemic. The impact of these crises, coupled with the scarcity of mental health services, has left many Somalis grappling with psychological distress in silence, as explained by Alberto Macin, the mental health activity manager for Médecins Sans Frontières (MSF) in the region. His work sheds light on the reality that Somalia’s health crisis extends far beyond the visible and requires urgent, coordinated action.

Macin, who has worked on mental health initiatives in some of the world’s most challenging regions, underscores that mental health needs in Somalia are inextricably linked to wider socio-political and economic conditions. His team’s interactions with residents in Galkayo and Baidoa districts illustrate the spectrum of mental health challenges Somalis face: individuals recount displacement due to climate crises, trauma from sexual violence, and the burden of caring for family members afflicted with severe mental illness without sufficient resources.

According to the World Health Organization (WHO), the prevalence of mental disorders in conflict zones stands at approximately 13%, with both mild and moderate cases of depression, anxiety, PTSD, and bipolar disorder frequently documented. Yet, the stigma around mental health, compounded by limited access to clinical support, prevents many from seeking help. Vulnerable groups, especially women, children, and the elderly, remain disproportionately affected. The breakdown of traditional community support networks further exacerbates feelings of isolation, stress, and despair among displaced populations who now reside in overcrowded camps with little privacy or security.

The mental health needs MSF encounters in Somalia range from psychosomatic complaints to severe conditions like psychosis and substance abuse. However, the overwhelming distress stemming from trauma and ongoing insecurity often leads to the development of new conditions, including PTSD and acute stress reactions. While the humanitarian response to Somalia’s crisis focuses on critical needs like food, shelter, and basic health care, mental health remains under-prioritized. Consequently, the psychological toll of these hardships risks growing unchecked, with limited pathways to recovery for those affected.

MSF’s efforts to address this gap include integrating mental health services within its broader health programs, collaborating with the Ministry of Health (MoH) to provide psychological support, and running group activities aimed at promoting healthy coping mechanisms. Since the beginning of 2024, MSF has conducted nearly 5,000 mental health consultations and has reached over 38,000 people through group activities, community training sessions, and psychological first aid. Despite these initiatives, the scope of the problem is immense, and current resources are insufficient to meet the demand for mental health services across the country.

Beyond the immediate support that MSF and other agencies provide, Macin emphasizes the need for a sustainable and community-driven approach. Building mental health capacity within Somali communities could alleviate the demand for clinical specialists, who are scarce. Empowering communities to offer peer support and reestablishing traditional support systems could help fill the gaps. Encouragingly, community self-help groups can provide a sense of normalcy, fostering resilience among individuals and reducing the overall impact of psychological trauma.

For those in the early stages of trauma, access to psychological first aid—offered by trained volunteers, teachers, and health staff—can provide essential relief. By equipping community members with basic skills to support individuals in crisis, the response can be scaled to reach larger groups. This grassroots approach not only strengthens community ties but also helps alleviate the psychological burden of Somali families.

Despite the resilience demonstrated by many Somalis, the absence of widespread mental health support risks perpetuating a cycle of suffering. Macin’s appeal calls for mental health to be fully integrated into humanitarian efforts, encompassing both immediate relief and long-term care. He advocates for comprehensive strategies that address basic needs like food and shelter alongside psychological first aid and a clear referral system to mental health services.

Somalia’s future stability hinges not only on rebuilding its infrastructure but on healing the minds and lives of its people. As the international community and local authorities grapple with these pressing needs, prioritizing mental health within the humanitarian response is essential. The lives of millions hang in the balance, and failure to act could leave a generation struggling with the scars of trauma and loss.

The World Health Organization (WHO) has commended Rwanda’s robust response to the ongoing Marburg virus outbreak, which has so far resulted in 62 confirmed cases and 15 deaths. Speaking in the Rwandan capital, Kigali, WHO Director-General Tedros Adhanom Ghebreyesus emphasized the importance of sustained vigilance, even as the number of new cases has slowed. Rwanda has recorded no new infections in the past six days, with 44 people recovering from the virus.

“We are encouraged by the fact that no new cases have emerged in recent days, but we must remember that we are dealing with one of the world’s deadliest viruses,” Tedros said during a press conference. “Enhanced surveillance, contact tracing, and infection control measures must continue at full scale until the outbreak is declared officially over.”

Marburg virus, a highly infectious pathogen similar to Ebola, has a fatality rate of up to 88%. The virus causes hemorrhagic fever, with symptoms including severe bleeding and organ failure. However, the mortality rate in the current Rwandan outbreak has been notably lower, at 24%, largely due to the country’s swift and effective response.

Tedros visited a treatment center over the weekend, where he praised the medical staff for saving the lives of two critically ill patients who had suffered multiple organ failure. “These patients were successfully intubated, placed on life support, and have since been extubated and are now recovering,” he noted. This marks the first time patients with Marburg virus have been successfully extubated in Africa, a significant milestone in the treatment of the disease.

While there are no approved vaccines or antiviral treatments for Marburg, potential therapies, including blood products and immune treatments, are currently being evaluated. Earlier this month, Rwanda also initiated a vaccination trial in a bid to curb the outbreak.

Tedros cautioned that an official declaration that the outbreak is over can only be made after 42 days—equivalent to two incubation periods—without any new confirmed cases. He reiterated that continued vigilance is critical, stressing that the nature of the virus leaves no room for complacency.

The Marburg virus is transmitted to humans via fruit bats and can spread between humans through direct contact with bodily fluids or contaminated surfaces. With Rwanda making strides in containing the outbreak, the country’s efforts are being closely watched as a potential model for managing future outbreaks of similar diseases.

Taiwan has pledged a total of $24 million to support critical sectors in Somaliland, further solidifying ties between the two diplomatically unrecognized states. Of this amount, $22 million will go towards the reconstruction of Hargeisa General Hospital, a vital healthcare facility in Somaliland’s capital, while an additional $2 million will be directed to bolstering the nation’s electoral process ahead of upcoming elections.

The agreement to revamp Hargeisa General Hospital was formalized on Friday with Somaliland’s Minister of Health and Taiwan’s Representative signing the accord. The investment will focus on modernizing healthcare infrastructure, improving the quality of medical services, and expanding access to healthcare for residents in Hargeisa and its surrounding areas.

Alongside this healthcare initiative, Taiwan’s $2 million electoral support package aims to reinforce democratic governance in Somaliland. The funding will aid in election preparations, emphasizing transparency, voter education, and logistical arrangements.

In a statement, Taiwan’s Representative Office in Hargeisa underscored the values underpinning the partnership between the two territories: “Democracy is a language we share, and freedom is a common goal that unites us. Freedom and democracy are the core principles that connect Somaliland and Taiwan to the global community.” This shared commitment to democratic principles has been central to the burgeoning relationship between Taiwan and Somaliland, which began in August 2020 when the two entities formalized diplomatic ties.

Both Taiwan and Somaliland face significant challenges to their international legitimacy. Taiwan has been governed independently from China since 1949 but is still claimed by Beijing, which opposes any formal recognition of the island’s sovereignty. Similarly, Somaliland declared back its 1960 independence from Somalia in 1991 but has yet to be officially recognized by any country or major international organization. Their diplomatic relationship has therefore attracted notable geopolitical attention, especially as China and Somalia have condemned the partnership, citing concerns about territorial integrity.

Despite the criticism, Taiwan has steadily worked to enhance Somaliland’s key economic sectors, focusing on agriculture, fisheries, and small-scale industries that are essential to the country’s economic stability. This latest round of healthcare and electoral support is part of Taiwan’s broader strategic effort to build alliances in regions where Chinese influence is expanding, particularly in Africa.

As Taiwan deepens its ties with Somaliland, both entities hope to enhance their standing in the international arena, leveraging their partnership to strengthen domestic institutions and promote democratic ideals. The projects funded through Taiwan’s investments will not only improve healthcare and democracy in Somaliland but may also signal the potential for further collaboration in other areas crucial to both nations’ development.

Sex workers in Kamituga face health risks and stigma as mpox spreads through the mining hub, threatening livelihoods.

Sex workers in Kamituga, eastern Congo, are at the center of an mpox outbreak, grappling with health risks, stigma, and economic hardship. With around 40,000 sex workers in this mining hub, the majority of mpox cases are contracted through sexual contact, exacerbating vulnerabilities. Despite the outbreak, many sex workers continue working due to economic necessity, while facing stigma from clients and the wider community. The lack of vaccines and condoms, along with social and legal barriers, hinders efforts to control the virus’s spread. Health officials push for intervention, but the response remains limited.

The outbreak in Kamituga highlights broader systemic issues, such as poverty, the precarious situation of women, and the sex industry’s entanglement with mining economies. As sex work remains the primary income source for many women, particularly single mothers, stopping the spread of mpox without providing economic alternatives remains a challenge.

Health officials warn that without targeted support for sex workers, the virus could extend further into Congo and the region.

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At 86, Edna Adan Ismail stands as a living testament to the power of resilience, courage, and determination. A nurse, midwife, and advocate for women’s health and human rights, she has spent decades breaking barriers and shattering cultural taboos—particularly those surrounding female genital mutilation (FGM). She became the recipient of the prestigious Templeton Prize, a recognition of her lifelong commitment to transforming the lives of women and girls in Somaliland and across Africa.

Ismail’s journey is not just one of personal triumph, but of creating systemic change in a region historically plagued by instability and gender inequality. As Somaliland’s first trained nurse and midwife, and later as its first foreign minister, Ismail has dedicated her life to the fight against FGM and the advancement of maternal health. Today, her proudest achievement is the Edna Adan Maternity Hospital, which she founded in 2002 to address the health crisis left in the wake of the Somali civil war. The hospital is now a beacon of hope in Somaliland, training hundreds of healthcare workers and providing life-saving maternal and child healthcare services.

A Battle Against FGM

For Ismail, the battle against FGM is deeply personal. Having suffered the practice herself, she has fought tirelessly to ensure that no more girls endure the same trauma. “I’m a midwife, and my job is to deliver babies in a safe way,” she explains. “I fight [FGM] because all the girls in my country are subjected to it, and because anybody who has any compassion for human values and the rights of the girls should be fighting it.”

Female genital mutilation, often performed in secret, is recognized globally as a violation of human rights and a form of gender-based violence. Yet, it remains a widespread practice, affecting over 200 million women and girls, according to the World Health Organization. The physical and emotional scars left by FGM are lifelong, increasing the risk of complications during childbirth and posing severe health risks.

But Ismail has seen progress. In the 45 years she has been involved in advocacy, discussions about FGM have gone from unspoken to mainstream. “In my culture, and I’m sure in many African countries, girls are brought up to be ‘respectful,’” she says. “We didn’t talk about a part of the body that is considered to be indecent to speak about… But nowadays, discussions are being held about FGM on the radio, in schools, even in places of worship.”

For Ismail, the breaking of these taboos is a victory in itself, but there is still much work to be done. Her relentless advocacy, however, continues to raise awareness and challenge deep-seated cultural norms, making it increasingly difficult for the practice to remain hidden.

A Legacy of Healthcare and Empowerment

Ismail’s dedication to maternal health is just as profound. When she returned to Somaliland in 1997, the country was in shambles after years of civil war. There were only 18 qualified nurses serving a region the size of England and Wales, and no formal training institutions. Driven by her father’s example—himself a pioneering doctor in Somaliland—Ismail decided to take on the challenge of rebuilding the country’s healthcare infrastructure.

“When I came back, we had 18 qualified nurses. Today, Somaliland has over 1,000 midwives and eight training schools,” she says proudly. Thanks to her efforts, maternal mortality in Somaliland has steadily, if slowly, decreased, and the country now boasts over 15 hospitals, 200 maternal-child health centers, and private clinics. The Edna Adan Maternity Hospital has become the foundation of this transformation, serving as both a medical facility and a training institution.

In a country where healthcare was once practically non-existent, the changes have been monumental. Somaliland’s healthcare workforce has not only grown but has also started attracting medical professionals from abroad. Ismail’s hospital, and the university that grew alongside it, have become pillars of Somaliland’s recovery, ensuring that women receive the care they need while fostering the next generation of health workers.

Inspiring Future Generations

Throughout her career, Ismail has broken numerous glass ceilings. She was Somalia’s first lady, Somaliland’s first foreign minister, and one of the first women in her region to receive a formal education. But her impact reaches far beyond titles and accolades.

“I wish to be remembered as an experimental animal,” Ismail says, with her characteristic humility. “In the experiment of teaching a girl to read and write, to become a nurse and a midwife, to hold community and national responsibility… And the experiment was a success.”

Her life is a story of perseverance and possibility, a living example of how education, determination, and a deep sense of responsibility can change lives and inspire others. By paving the way for women in healthcare and leadership, Ismail has become a role model for girls across Africa, proving that no cultural or societal barrier is insurmountable.

Edna Adan Ismail’s work is not yet done. As she continues to raise awareness about FGM, advocate for women’s rights, and build healthcare infrastructure, her legacy grows. For the girls and women whose lives she has touched, she is not just a healthcare provider or an advocate—she is hope personified. In a world that often dismisses the contributions of women, particularly in places like Somaliland, Ismail’s example is proof that change is not only possible—it is inevitable when driven by a force as unyielding as hers.

Her dream is simple, yet profound: to ensure that the doors she has opened remain open for future generations of women, so they, too, can change the world.