"It's tough living with HIV"

For Alawi Bahumaid, 41, who recently lost his job with a Norwegian oil company in Yemen, the bitter struggle of rebuilding his life and looking for a new job starts again. "This is the second time I have lost my job because of my HIV status," he said in the capital, Sanaa. "I had such hopes this time around."

Those hopes were dashed, however, when two months after Bahumaid started the job, his previous employer was contacted for a reference, and his current employer discovered that their newest staff member was HIV positive. Fearing a revolt by the other workers if he was returned to the production line, his employer summarily dismissed him.

"It's tough living with HIV," said Bahumaid, who has done so since the 1990s. "People in Yemen don't know what HIV is, and are afraid to shake my hand or even talk to me."

He described discrimination against those living with HIV in Yemen as "rampant", and has become a reluctant advocate of sorts. "This time I'm going to speak out," he said.

But in Yemen, a staunchly conservative tribal society of some 20 million people, where over 40 percent of the population live below the poverty line, it is going to take more than speaking out to change things: it will need action, particularly by the government.

Rampant stigma

The government's National Strategic Framework for the Control and Prevention of HIV/AIDS acknowledges that Yemenis living with HIV are heavily stigmatised: they often flee or are even expelled from hospitals where they have sought treatment, and face harassment by the police.

Like other countries in the region, Yemen requires HIV sero-negative status for foreigners seeking residence or employment. HIV-infected foreigners are deported, with many policymakers considering this a necessary and fully justifiable measure, which reinforces the longstanding denial and stigma regarding HIV and AIDS.

People are afraid to disclose their HIV status; they are afraid of the government; they are afraid of the policemen, and even of their families.

Although the government's commitment to controlling and preventing the pandemic is evident in its adoption of a national framework in 2002, it is clear that much more is needed in terms of treatment and assistance to people like Bahumaid, who have to live with the discrimination.

"People living with HIV suffer a lot," said Fouzia Abdullah Saeed Ghramah, director of the National AIDS Programme (NAP) run by the Ministry of Health. "[They] are denied their rights, particularly in the area of employment, which in turn leads to additional social and economic problems. We're working to address that."

But efforts to combat the prevailing stigma and discrimination are up against the negative perceptions held by even the country's most educated inhabitants.

The results of a survey published in the daily Yemen Observer newspaper on 10 July indicate that shame and fear of judgment are among the greatest obstacles preventing HIV-positive people from obtaining diagnosis and treatment.

Photo: David Swanson/IRIN

Yemen remains a deeply conservative, tribal society, making raising people's perceptions about HIV all the more difficult.

The study, conducted by researchers at Sanaa University, compared the attitudes of medical students with non-medical students, and revealed that even educated people harbour a negative bias towards AIDS patients, and often misunderstand the disease.

Low prevalence

According to the NAP, 2,075 cases of HIV have been recorded since the first case was reported in 1987. However, health experts believe the real number to be over 20,000.

"Nobody can prove it; nobody can deny it," said Abdullah Abdulkarim al-Arashi, executive manager of Yemen's AIDS Project Unit, part of the government's National Population Council, which aims to improve awareness levels.

"People prefer to view it as a western problem and are afraid to even talk about it. And without awareness they will never talk about it, nor will people that are infected go to hospitals," he said.

Although life-prolonging antiretroviral drugs are available in Sanaa and the southern port city of Aden, the country's two largest population centres, al-Arashi noted that the lack of openness about HIV prevented many people from seeking treatment.

"Our society here in Yemen is so closed. To talk about HIV is shameful, as people associate it with sex," he said. Most people believe sexual contact is the only mode of transmission.

"People are afraid to disclose their HIV status; they are afraid of the government; they are afraid of the policemen, and even of their families."

One man in Aden was barred from entering his home by his wife and children after disclosing his HIV status. "You are infected with HIV. Get out," his wife reportedly screamed before calling the police.

"Regrettably, this is our mentality toward HIV," al-Arashi said. "This is what we are trying to change now."

Lack of legislation

Although there is no legislation to protect Bahumaid and others from discrimination, the establishment of Yemen's Ministry of Human Rights in 2003 offers some hope.

Referring to the lack of legislation for protecting people living with HIV and other chronic diseases, Nusaibah Ghushaim, the ministry's manager of information, told IRIN/PlusNews, "This is something that needs to change."

She was confident that appropriate laws would eventually be passed, but feared that implementing them in Yemen could take much longer.

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See related PlusNews reports, YEMEN: Sex trade fuelled by poverty, study finds and YEMEN: Stigma, ignorance hampering fight against HIV/AIDS