Zanzibar shows how tourism spreads HIV globally

 Katie McQue
Cheap heroin – sold for as little as $3 a dose – has made its way onto the streets of Zanzibar's capital city Stone Town. Credit: Katie McQue

Soud was born with a burden that he will carry forever. He has HIV. Passed from mother to child, the virus coursed through his veins before he even took his first breath. Now a 20-year-old man, his life has been shaped by his health status.

He lives in Zanzibar, the tropical archipelago within eyesight of mainland Tanzania, and made famous by its roaring tourism trade. About 5,500 people there have HIV or AIDS, and many of these people live in shame.

Soud’s childhood was overshadowed by discrimination. ‘There was a lot of stigma at school. From teachers, as well as the students,’ he says. Now, his life focuses around his work for Zapha+, an HIV outreach NGO based just outside Stone Town, Zanzibar's capital.

‘I’d like to be a good man. To educate my society about how to care and how to protect. I have more pain from my HIV status because of the stigma. I want to stop it,’ says Soud.

Zanzibar’s azure waters and white sands draw holidaymakers from the west. The money tourism generates draws workers from all over Tanzania. Most are young and away from home for the first time. These migrant workers are some of the most susceptible to HIV infection due to the vulnerabilities of being in transit, sex tourism, gender based violence and increased drug use, several experts have told New Internationalist.

‘We try to improve acceptance, to support people with our HIV status and inform on how we can live a longer life. We talk to youth about how to prevent getting infected. That, ultimately, is our aim.’ Consolata John, the chairperson of Zapha+ says.

John estimates that 1 per cent of the people in the communities Zapha+ works with, which are on the outskirts of Stone Town, are diagnosed with HIV or AIDS.

The shame associated with the virus is a barrier to keeping healthy. People with HIV in Zanzibar are scared that they’ll be seen going to pick up their medicines or having their CD4+, which act as a co-ordinator of the immune response and are also the main targets of HIV, checked. They go to the hospital at night, as there’s less chance they’ll be seen in the dark, John added.

Soud and John both stress the importance of education and destigmatization in preventing new infections, and keeping those with HIV healthy.

Tourism is responsible for generating 10 per cent of the world’s GDP, and 1 in 11 jobs, according to the UN’s World Tourism Organization. With increasing tourism, including in Africa, there needs to be an awareness of the contributing risk factors for HIV transmission, according to the UN International Labour Organization (ILO).

‘The tourism sector engages people who are young and mobile, they’re often migrants. It’s associated with fun, pleasure. There is often easy access to sex and drugs,’ Mohammed Syed Afsar, Senior Technical Specialist of the ILO’s AIDS Programme, explained.

The intense interactions between tourists, tourism workers, and local communities combine to compound people's vulnerability to the spread of viruses, Afsar notes.

The first priority of these migrant workers is to find work, then a place to live. In many cases migrants don’t have the same access to healthcare as locals, which can make it difficult to get tested or have access to treatments, he adds.

 Katie McQue
Zanzibar, the tropical archipelago, is made famous by its roaring tourism trade. About 5,500 of its citizens have HIV or AIDS. Credit: Katie McQue

Sex tourism

Migrant workers in Zanzibar’s tourist hotspots are also sometimes drawn into trading sex for cash, John highlights.

More support is needed to educate sex workers from particularly risky practices. For instance, it’s common in Zanzibar that men buying sex request not to use a condom, if they pay more money to the sex worker, John says.

Notably, Zanzibar is a popular sex tourism destination for European women. A departure from the stereotypical sex tourist, these are commonly middle-aged women looking for a holiday romance. The transactions are nuanced. The young Tanzanian men hang around the beaches and hotels hoping to catch the eye of a tourist. A typical scenario involves the tourist being courted, given companionship and a sexual relationship, in exchange for gifts and other donations.

The ultimate aim of the Tanzanian sex worker is to become a boyfriend of the woman. If he strikes lucky, after a prolonged affair she may marry him and bring him to Europe, says John. And to forge intimacy and gain the trust of the woman, they often forgo condoms, putting the sex customer at risk.


Gender based violence

Female migrant workers are more vulnerable to gender based violence, and account for 98 per cent of those trafficked for sexual exploitation. Roles such as domestic workers and cleaning staff, generally filled by women, are risky because they are often invisible and isolated, making them more vulnerable to abuse.

Forced sex further increases the risk of HIV transmission to women due to tears and lacerations, which gives the virus more opportunity to enter the woman’s bloodstream, causing infection.

AIDS is the leading cause of death among females aged between 15 and 44 worldwide, according to UN Women. Women who have experienced violence are up to three times more likely to be infected with HIV than those who have not.

Women fearing violence often do not feel they have the power to request the use of a condom or refuse unwanted sex. They are also more likely to choose not to be tested or receive treatment. Women are often afraid to ask for money or permission from their husbands to attend HIV/AIDS facilities. Between 16 per cent and 86 per cent of women, across different developing countries, who are aware they have HIV choose not to disclose their status to their partners for fear of violence or abandonment, according to the World Health Organization. This hastens the clinical progression from HIV to AIDS.

Zapha+ reads comic books to small children with HIV to teach them about the virus, and the importance of good nutrition.
Zapha+ reads comic books to small children with HIV to teach them about the virus, and the importance of good nutrition. Credit: Katie McQue

Drug corridor from East to West

Drug use is another HIV risk factor. Zanzibar, for instance, sits on a major corridor for drugs being trafficked from Asia to the West. Consequently, cheap heroin – sold for as little as $3 a dose – has made its way onto the streets of Stone Town. Some estimates place Zanzibar’s heroin use rate as high as 7 per cent among the general population.

HIV rates among intravenous drug users in Zanzibar are thought to be up to 30 times higher than the rest of the population, according to the UN Office on Drugs and Crime .

The use of drugs that are not administered by injection, such as cocaine or marijuana, also fuel HIV transmission, Consolata John adds. ‘People have to get money to buy it. They will sell sex to be able to buy drugs,’ she explains. ‘It’s common for young people, both male and female, to sell sex to earn money. Once they see white people they know that they are likely to be tourists and have money.’

 Katie McQue
There needs to be an awareness in the tourism sector of the contributing risk factors for HIV transmission. Credit: Katie McQue

HIV: What can be done?

Things can be done to control HIV infections among workers in tourism, particularly with the support of employers.

There are many proactive steps business leaders in tourism can take to protect their employees’ health, says Afsar. Uganda’s hotel sector, which employs 450,000 workers, provides an example. The workers are mostly young migrants. In 2008 a study discovered the HIV prevalence rate in the hotel sector was 10.3 per cent, much higher than the national average of 6.9 per cent.

In response to this, the ILO launched a Uganda Hotel Owners Association (UHOA) programme to help increase knowledge and understanding about HIV prevention among workers in the hotel sector. This initiative also encourages hotel workers to undertake testing without fear of being stigmatized or discriminated. HIV positive workers are assured of support and continued employment.

To incentivize hotels to honour these approaches, their provision of HIV care to their workers is now a factor that contributes to the star rating given to hotels in Uganda.

‘If you respect human rights of people, you succeed in your public health response. Discriminating laws and attitudes need to change. People will not take the test if they associate HIV with discrimination and fear they will lose their job,’ says Afsar.

Great strides have been made in the global effort to combat HIV. By mid-2016, 18.2 million people living with HIV were receiving antiretroviral therapy (ART) globally, according to the WHO. And, for the first time, there are 5 million people with HIV aged over 50-years-old, showing that treatment is working. ARTs also reduce the amount of virus particles (viral load) circulating in a patient’s blood, lowering their chance of transmitting HIV to others.

It’s important to note that AIDS is not over, however, and continues to be a major public health issue, Afsar stresses.

There were approximately 36.7 million people living with HIV at the end of 2015 across the world. Of those the majority, 25.6 million people, live in Sub-Saharan Africa. In 2015 alone, there were 2.1 million new infections and 1.1 million people died of HIV related causes globally. Worryingly, 40 per cent of people living with HIV do not know their status and 7,500 people in Africa are infected each week, according to the ILO.

Treatments need to be readily available in order for medical systems to get HIV under control. Through international and domestic funding, including the Global AIDS Fund, more than 18 million people in the world are receiving HIV medication.

Western nations slashing AID budgets can be disastrous in controlling HIV. U.S. President Donald Trump’s administration has recently proposed a budget that would cut U.S. funding for global health programmes including efforts focusing on HIV/AIDS, tuberculosis and malaria, by about one quarter, to about $6.5 billion for 2018.

Trump’s budget proposal envisions cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) programme, a cornerstone of U.S. global health assistance, which supports HIV/AIDS treatment, testing and counselling for millions of people worldwide. Under the new budget, PEPFAR funding would be $5 billion per year compared to about $6 billion annually now, the U.S. State Department has said.

Cuts to HIV programmes can mean that some patients, especially in poorer countries, will not have access to medication as their governments rely on international funding to afford to provide medicines.

‘Donors need to support the issue,’ says Afsar. ‘Any slow-down in funding can be disastrous.’


Exclusive: Inside Diego Garcia, America’s highly secretive military base

An aerial view of Diego Garcia island, part of the Chagos Archipelago in the Central Indian Ocean (22 November 2013). by U.S. Navy photo/Released

When Danilo* tore open his first pay slip at his new job, the amount staring back at him was just six dollars. This was his pay for a whole month working as a warehouse caretaker.

It was 2007, and Danilo had begun his two-year contract on the secretive US military base known as Diego Garcia, located on a small island in the Indian Ocean.

This paltry salary was because of hiring costs he was made to pay to his new employer upon starting his job for the US military and the remittance he was required by contract to send to his family in the Philippines.

‘Six dollars was all I got to spend before my next payday. Dang!’ he says. ‘Who would be happy with that?’

Things did not improve throughout his years on Diego Garcia. Five years later his total annual earnings for 2012 stood near to USD$2,200, according to pay-slips seen by the New Internationalist. In 2015, his monthly earnings were around $450 per month, for working a minimum of nine hours per day, six days per week. This works out at about $2 per hour.

Diego Garcia
Image obtained by New Internationalist.

Diego Garcia’s non-military staff are almost exclusively from the Philippines. This is because they can be hired for much lower wages than employees from other countries, since jobs in the Philippines are scarce, several workers have said.

Jobs on offer on Diego Garcia include positions as cleaners, warehouse caretakers, and construction workers that spend long days working in the 40-degree heat of the tropical island.

Cheap labour practices on Diego Garcia have spanned decades, and with knowledge and complicity of the US government, documents passed to the New Internationalist reveal.

Over the past two years the New Internationalist has interviewed 11 current and former workers about pay and conditions on the island. They spoke on the condition of their anonymity due to fear of repercussions.

Image obtained by New Internationalist.

Some of the workers have told New Internationalist they believe that the contract hiring organization exclusively hires Filipinos because they come from a poor country and will accept lower salaries.

Most workers are hired through a contract firm, Centerra Parsons LLC. This is a limited liability company, created for contracting work on the base. Centerra Parsons specifically recruits Filipino workers. Those interviewed have said Centerra Parsons and the US Department of Defense capitalizes on their desperation by paying salaries that are low, even by standards in the Philippines.

Working overtime can be unlimited. Desperate for money to send home, says Arvin*, an engineer, often risks his health to work 12 hour days, 7 days per week, for periods of several months at a time. Having worked on Diego Garcia for 8 years, he has been promoted twice. His salary is now $2.50 per hour – which is considered high compared with some of his colleagues.

The Diego Garcia Island is part of the UK-owned Chagos Islands in the Indian Ocean from where the British Army forcefully evicted the indigenous Chagossian population in the 1960s, before leasing it to the United States. It has since hosted America’s largest overseas airbase. Because of its notoriety, the base is shrouded in secrecy.

Guided-missile submarine USS Florida pulls into Diego Garcia 7 January 2016. Navy photo by Mass Communication Specialist 3rd Class Zachary A. Kreitzer/Released.

Only military employees are allowed to set foot there and no journalist has been allowed to visit Diego Garcia since the establishment of the base. The UK announced in November that it is planning to extend the US’s lease for the island for a further 20 years, up until 2036.

Meanwhile, Diego Garcia’s refugees have been left in poverty and uncompensated. Their fight to return to their motherland continues to this day.

The UK also ruled in October 2016 that Chagossian refugees would not be allowed to return home. This was the latest blow in the refugees’ four-decade long fight to go back to the Island.

The island has allegedly served host to the CIA’s post-9/11 secret rendition program, where terror suspects were held and tortured. Former UK foreign secretaries Jack Straw and David Miliband have both denied these allegations, yet a US Senate Intelligence report has stated that suspected terrorists were detained there.

Diego Garcia's Public Works Department hosts its first Construction Contractor's Forum 26 February 2014.

Some 1,000 US Military personnel and almost 2,500 contract workers are based on the Island.

Stationed on the Island base, Arvin remains distant from his family. He has a daughter aged 7 and a son that is 10-years-old. He hasn’t seen them since April 2016 and won’t until April 2018, which is when his work contract ends. To block the pain of this separation he drinks – almost every night. A 12-pack of Miller Light costs nine dollars on the duty-free military base. Sometimes he finishes all 12 cans in one sitting.

‘The hangovers are bad. My supervisor gets angry. We drink lots because we’re homesick. I have no choice, in my situation,' he says. ‘I cannot see my kids grow up.’

A lot of workers drink to cope, says Danilo. ‘When you are too drunk because of being homesick, it is either you end up in a brawl or on a bed with a dude. That’s the reality on Diego Garcia,’ he adds.

Personnel assigned to U.S. Navy Support Facility Diego Garcia commemorate the holidays with caroling at the base chapel, 18 December 2013.
U.S. Navy photo by Mass Communication Specialist 3rd Class Caine Storino/Released

Nimuel*, 28, earns $400 per month working as a domestic helper on the base. He sends most of this home to support his girlfriend and infant son. When asked about the last time he saw his baby, his reply is: ‘Only on Facebook’.

Some Filipino workers are employed directly by the US Navy, and they have seen their wages slashed in cost-saving efforts by the military. Schemes have included indexing salaries to the volatile Philippine peso that resulted in a net decrease of 44 per cent, according to calculations by the US Navy.

In one leaked document a Naval Commander writes that the cut is inconsequential because the ‘employees reportedly believe they are not permitted to form a union.’

New Internationalist has also seen a contract imposing a wage reduction that a female worker was made to sign before she was allowed to leave the island to tend to a personal issue in the Philippines. Other workers have been threatened with being fired if they did not sign contracts that required them to take a pay cut, Navy documents show.

Knowledge of the situation has travelled as high as the House of Representatives, who absolves the United States of responsibility to these workers. A letter dated 2001 states ‘The US Navy, who hires Filipino Third Country Nationals [non-US workers employed overseas], does not have to comply with US Labor standard salary and compensation laws.’

Members of the US Navy have long been shocked when they learn the salaries of their Filipino colleagues. James Patrick, a Commanding Officer of Diego Garcia in the early 2000’s, was compelled to write in a Department of Defense cable that the pay policy is an ‘injustice’, especially considering the employees are living and working in a US dollar-based economy.

‘This situation is seriously affecting TCN [overseas worker] morale, will significantly lower their standard of living,’ Patrick continued in the cable.

When employees arrive on Diego Garcia they have the option to surrender their passports to their employers, New Internationalist understands.

‘Having your passport with you was a risk, in case you lose it or try to do something stupid,’ said Cristanto*, a former worker. ‘In case you have an opportunity to fly away without permission.’

If somebody does want to break their contract to go home early, there can be fines involved, one former US military veteran who was stationed on Diego Garcia says. He met and fell in love with a woman working on the base. For her to leave with him to get married when his tour on the island finished he had to pay a penalty of about USD $3200 to her employer, the United Seamen’s Service. Only then was she allowed to have her documents back.

This situation was typical at the time, he noted.

The US Department of Defense did not respond to the New Internationalist’s request for a comment on the pay issues for Filipinos on Diego Garcia.

Centerra Parsons told the New Internationalist that: ‘Our employees’ base salaries start at the mandated minimum of $400 monthly and progressively increase based upon position category and responsibilities.’

Centerra Parsons also conceded that it deliberately sources low-cost labour.

‘There are lower-cost labour sources available from other Asian and African countries, but we have chosen to hire from the Philippines because of the wealth of skills, abilities and tremendous first-hand knowledge they bring from years of supporting the island community,’ it added.

Diego Garcia
Firefighters assigned to G4S/Parsons Pacific on Diego Garcia escort a simulated victim of a natural disaster during Exercise Reliant Gale 1 May 2014. US Pacific Fleet

Work on the island is not always safe. Two former employees told the New Internationalist about accidents and industrial-related deaths occurring over recent years.

The UK’s Foreign & Commonwealth Office, who are responsible for recording deaths on Diego Garcia provided the New Internationalist with a list of five industrial fatalities that have occurred since 2000, it includes a death caused by ‘extensive head and face crush injuries’. The list, however, is incomplete. When the New Internationalist pointed out to the FCO that it knew of at least one death that had not been included on the list, the FCO acknowledged the omission and that there had also been delays in recording some deaths.

The pay policy for Diego Garcia directly conflicts with US Department of Defense guidelines, says American lawyer Michael O’Hara, of Michael A. O’Hara, PLLC in Kentucky.

Guidelines state foreign national employees will be based on the prevailing wage rates and compensation practices (for comparable work in comparable industries) in the country concerned, which should refer to the UK.

‘They are discriminating based on the national origin of the workers,’ O’Hara says.

‘Diego Garcia is part of the UK. Rather, they’re compensated in comparison with the Philippines,’ says O’Hara. ‘Diego Garcia is not surrounded by the Philippines’s economy. It is also in the middle of nowhere, 12,000km from the nearest landmass. While workers are sending some money back to the Philippines, they are still living in the host country’s economy and they deserve to be paid as that.’

*Names changed to protect identity of those interviewed.

UK Supreme Court highlights right of Chagos refugees to return home


Olivier Bancoult, a refugee from Diego Garcia, and leader of the Chagos Refugees Group (centre) holding a flag of three horizontal stripes. The first is orange, representing the sun, the second is black to signify their grief, and the third is blue for the sea they long for. by Katie McQue

Bernard Nourrice has been desperate to go home for 50 years. He is from Diego Garcia, a small UK-owned island in the Indian Ocean. The UK government expelled him, his family and all other inhabitants from there in the 1960’s.

Bernard and his fellow refugees have fought the British government for decades for the right to return to their motherland. Failed court cases, and tangled in the bureaucratic red tape imposed by the UK government means they’ve had little success.

But now progress may be possible. The British Supreme Court has called for a review on the 50-year government ban on the Chagos refugees from returning to their homeland.

The statements, which came as a surprise, were delivered in a 29 June ruling that upholds the current government ban on the refugees’ return. However, judges highlighted that a fresh study published in 2015 could provide the arguments strong enough to support their resettlement.

‘This ruling has given me great courage that there is an open door now. We do have the hope that things will be brighter,’ says Bernard.

Bernard Nourrice, from Diego Garcia. The UK expelled him, his family and all other inhabitants in the 1960’s.

Katie McQue

The British government removed the people of the UK-owned Chagos Archipelago with the purpose of allowing the US to build an airbase on the largest island, Diego Garcia. It has been host to the US’s largest overseas military base ever since. Diego Garcia’s location makes it strategically advantageous for the US military for reaching destinations in the Middle East. It has also been reported that the base participated in the US’s infamous CIA rendition programme.

These people, the Chagossians, have languished in poverty for decades. After the UK military left them on the shores of neighboring islands Mauritius and the Seychelles, they were left to fend for themselves.

When the financial crisis descended in 2008, and after a tough fight for UK passports, many of the refugees came to the UK, looking for a better life.

The British government removed the people of the UK-owned Chagos Archipelago with the purpose of allowing the US to build an airbase

The UK – made up of England, Scotland, Wales and Northern Ireland – which made the Chagossians homeless, has not made financial provisions to enable them to begin their new lives with a degree of some comfort, they say. Many work long hours in minimum wages jobs, struggling to pay their rent. Their elderly relatives spend most time indoors, unsure how to navigate their new surroundings and the chillier climate.

Diego Garcia in the Chagos Archipelago is host to the US’s largest overseas military base. The island's location makes it strategically advantageous for the US military for reaching destinations in the Middle East. It has also been reported that the base participated in the US’s CIA rendition programme.

Poverty is squeezing this community to the point where some are choosing to leave.

For Ginette Charles, a refugee from Diego Garcia, life in the UK was a non-starter. She didn’t have money to take the bus to work. Instead she would set off on foot at 5.30 each morning before starting a long shift as a cleaner at a library. Her salary, stretched, barely covered her rent. She hadn’t visited the dentist in years, fearful of what the bill may be. And when her son finished school, she was not able to support him through further education.

At this point she decided that she and her family must leave for the Seychelles. A British citizen, who just couldn’t afford to live in the UK.

‘By coming here, I think we made a mistake. When we came we had to struggle to find our own way, without any help from the government. So it was very, very hard. It is unfair [that the government didn’t help] because we have been uprooted. We were happy on the island,’ she says.

For their protests, the Chagossians unite under a flag of three horizontal stripes. The first is orange, representing the sun, the second is black to signify their grief, and the third is blue for the sea they long for.

‘It is impossible to accept that other people can live in our birth place, but we are not able. We will not give up, Chagossians will be on Chagos very soon. It is our right. To live in peace and harmony as we did in the past,’ says Olivier Bancoult, a refugee from Diego Garcia, and leader of the Chagos Refugees Group.

Olivier Bancoult.

Katie McQue

The Chagossians are now rallying for their next battle – a battle they might be able to win.

From 2014 to 2015 a new feasibility study exploring scenarios in which some Chagossians could return to live on Diego Garcia was undertaken by the international consultancy, KPMG.

‘On that assumption scope exists for supporting the resettlement,’ said Lord Mance, in his closing remarks at the Supreme Court. ‘Circumstances have changed in the light of this study. It is now open to any Chagossian to mount a fresh challenge in light of the new 2014/15 study’s findings.’

The Chagossians demand that two steps be taken immediately. First, that the right of return be immediately restored. Second, a decision be announced to set up a resettlement programme. Such a decision has been promised long before the end of this parliamentary term, but remains outstanding, with one month to go, says Richard Gifford, a consultant at Clifford Chance Solicitors, and a lawyer for the Chagossians.

‘This delay in putting to right the injustices of the past can no longer be sustained,’ Gifford adds.

Some of the Chagossians believe these delays for resettlement is a tactic by the UK to keep postponing the problem until it goes away. Almost all the first generation of refugees are elderly, and dying.

‘For nearly 50 years we’ve been suffering in silence. Everybody is dying. These old people… there are only a few of us left,’ says Ginette. ‘I think the UK government is waiting for us to die. So afterwards, they can say there were no human beings ever living on the islands.’

South Africa: dying for justice

South Africa’s High Court recently ruled that 27,000 goldminers with silicosis, an incurable lung disease, could collectively sue their former employers.

The miners’ relief, however, was short lived. The 32 gold-mining firms have appealed against the ruling, causing delays that will mean many miners will not live to see justice.

Silicosis is caused by inhaling silica dust from gold-bearing rocks. Often fatal, it causes shortness of breath, a persistent cough and chest pains, and also makes its victims highly susceptible to tuberculosis. About a quarter of long-term goldminers in South Africa are thought to have developed the disease.

Should it come off, this will be the largest class-action law suit ever to take place in the country. And the gold-mining industry could be forced to pay up to $3.4 billion in compensation.

However, delays caused by this latest appeal – the fight for adequate compensation has spanned 15 years – will mean some miners will never see justice done.

‘These miners are dying. They are frail. It is very sad,’ says Charles Abrahams, of Abrahams Kiewitz Attorneys, who is representing the miners in the class action.

‘The death rate of the victims is increasing as they are increasingly older,’ agrees Richard Meeran, an attorney at Leigh Day, who represents victims of silicosis. ‘It is important a settlement is reached for the class-action claimants.’

The gold-mining firms – which include the giants Anglo American, AngloGold Ashanti, and Sibanye Gold – are opposing the suit on the grounds that the victims are not similar enough to be regarded as a ‘class’.

But miners’ lawyers say that multiple lawsuits would ultimately cost the companies more, arguing instead for a speedy out-of-court settlement.

The cause of the disease has been known since the early 1900s. Mines in other countries, such as Germany and Canada, virtually eliminated silicosis decades ago by implementing safety measures. In South Africa, however, these measures were not adopted.

Katie McQue

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