Lifting the veil of taboo on HIV/AIDS

Souad never suspected how much her life was about to change when she was summoned four years ago by the Ministry of Health and Population to test for HIV/AIDS. There she was told that her husband had been tested positive for the virus two years earlier. "He never told me," she said. “He continued to live with me as if nothing had happened.” Shortly afterwards, she, too, tested positive for HIV. "In the beginning, I would look into it the mirror for changes in my appearances, thinking that I would die soon," said Souad, who asked not to be identified by her real name. "But later, I realised I wasn’t alone; that there were many people in Egypt suffering from the same condition." Altogether, 2,115 cases of HIV/AIDS have been reported to the health ministry since 1986. However, UNAIDS reckons the infection is much more widespread in this country of 77 million people. It estimated there were 12,000 HIV positive people in the Arab world’s most populous country at the end of 2003. According to the UN 2005 Common Country Assessment of Egypt, 64 percent of all reported HIV infections in the country were caused by heterosexual intercourse, while 31 percent were the result of infected blood. All blood donors in Egypt are now screened for HIV, so blood transfusion has been virtually eliminated as a source of new infection, but doctors suspect that many people are still contaminated by dirty needles in routine medical injections. The official statistics register very few mother-to-child transmissions and hardly any infections arising from homosexual intercourse between gay men. Few women are tested About 80 percent of all HIV-positive people registered with the Health Ministry are men. But experts say this statistic is misleading because it is not based on the testing of a broad cross section of Egyptian society and because women are less likely to come forward for testing than men. “This figure does not reflect the true prevalence rate among women in Egypt,” said Doctor Ehab Salah, of the health ministry’s National AIDS Programme (NAP). He said most HIV infections detected so far had been revealed by screening blood donors and applicants for work permits, both foreigners coming into the country and Egyptians seeking work abroad. “These are mostly male, so the chances of us learning about their infection is much higher than it is for women,” he noted. Nana Ahlmark, an AIDS coordination officer with the United Nations Development Programme (UNDP) in Egypt noted that women were generally more vulnerable to HIV infection than men. "This is not only related to biological factors, but also to the fact that women are more likely to lack access to education and health care," she said. Souad, who is now living with AIDS, said women were generally reluctant to come forward for voluntary HIV testing because the stigma associated with the virus in Egypt is much greater for women than it is for men. “If a woman has the virus, people immediately assume she got it from some kind of sexual transgression,” she said. Still no strategic plan Although Egypt is still reckoned to have a very low HIV prevalence rate of only 0.01 percent, Salah at the National Aids Programme, says this is no excuse for complacency. “The fact that we have a low prevalence rate doesn’t necessarily mean we’re safe,” he said. "If we don’t take strong preventive measures, the epidemic will spread." The United Nations Children’s Fund (UNICEF) reckons that a fifth of Egypt’s population – some 15 million people – are vulnerable to contracting the virus that causes AIDS. And UNAIDS expressed concern in its 2004 report on Egypt that the country still did not have a National Strategic Plan for dealing with the pandemic. “Development of a plan must be the priority in 2005,” it said. Salah, at the government’s National AIDS Programme, said this plan was still being formulated. But he pointed out that the NAP had already made a start in tackling AIDS on the ground. In 2004, the NAP opened its first Voluntary Testing and Counselling Centre in Cairo, where people can be tested for HIV without having to submit any personal information. The organisation currently runs five HIV-testing centres nationwide and has nine vans to take mobile testing facilities out to smaller towns and villages. Salah said these centres not only encourage people to get themselves tested, they also help to establish the profile of groups to be targeted in future AIDS awareness campaigns. "We ask them questions about their educational background and their age," he explained. Since the beginning of 2005, NAP has also provided free antiretroviral (ARV) treatment for about 100 people living with AIDS. ARV drugs do not cure AIDS, but they can improve the health of people suffering from the disease and prolong their life. And crucially they give hope to people who until now suspected that AIDS would only lead them to an early death. “Now that people are becoming more aware of the existence of medication for the infection, they are more willing to test for HIV/AIDS,” Salah said. However, ARV drugs cost about US $2,500 per month to buy over the counter in pharmacies in this country where the annual per capita income is just $1,390, so few Egyptians can afford to buy them without the help of an official subsidy. Salah said the NAP wanted more Egyptians living with AIDS to come forward to benefit from the opportunity of free ARV treatment, but he gave no target figure. NAP has produced a series of publications to explain HIV/AIDS to ordinary people along with several NGOs, it is trying to break down the social stigma commonly associated with the infection. Fear and prejuidice is deep-rooted But the activists still have a long way to go in conquering fear and prejuidice. "In one survey, over 70 percent of respondents did not think People Living with HIV/AIDS should be allowed to continued to work. A sample study of secondary-school students revealed that 72 percent of them wouldn’t sit next to someone who was HIV-positive," Ahlmark remarked. Doctor Sanni Youssef, an AIDS counsellor in the Mediterranean port city of Alexandria, told the story of one 24-year-old shopkeeper he knew who was forced out of business when his customers discovered that he was HIV positive. "People just stopped buying from his store and he went bankrupt," he said. After first being tested positive for HIV/AIDS, people are often struck with a sense of fear and isolation. This is largely due to a general lack of awareness about the virus and its characteristics. "At first I didn’t know much about the disease, or how to live with it,” recalled Souad. “I was afraid to touch my friends and family for fear of infecting them." However, for the past year, she has had access to a support group run by the Roman Catholic charity Caritas in Alexandria. Youssef, who heads the Caritas support group, said that patients meet in the support centre twice a month to discuss their concerns. "Through these gatherings, we provide advice and psychological assistance to help people accept their illness and live a normal life," he said. Because of Egypt’s relatively conservative Muslim society, however, some AIDS prevention issues pertaining to contraception and safe sex remain sensitive. Condoms are readily available at local pharmacies, but their use is not widely encouraged. "We have to be culturally aware when tackling such issues," said Salah at NAP. “We live in a country where open discussion on sexual matters isn’t the norm, so launching a strong campaign on safe sex can end up exaggerating the prevalence of HIV/AIDS among the public and cause panic,” he explained. Since the Caritas support centre opened in Alexandria in 2003, it has helped approximately 100 patients come to terms with their condition and reintegrate into society. Youssef conceded that this was a relatively small number, but he pointed out that attendance at the group’s sessions had been increasing steadily. Now he is planning to launch a series of new counselling groups run by people living with HIV/AIDS who have already received counselling themselves. Youssef concedes that Egypt is not yet ready for people living with HIV/AIDS to bring themselves into the open. “They have to keep it a secret,” he said, calling for a strong media campaign to help break down the ignorance and social prejuidice that still forces HIV-positive people to live in the closet.