Stigma, ignorance hampering fight against HIV/AIDS

Ali (not his real name) is living with HIV, the virus that causes AIDS. He says that, from the day he was diagnosed, he has been an outcast, a pariah with whom few want to associate. "Society in Yemen looks at the AIDS patient as a criminal," he said. "Everybody sympathises with cancer patients because nobody knows the cause, while AIDS is associated with illegal sex." He added, "No one thinks that an AIDS patient could have contracted the disease via a faulty blood transfusion, or even while having his hair cut." When he first discovered he was infected, Ali said he went to the police to inform them of his condition and prevent "others from becoming like me." "Instead of helping me, though, the officer just screamed, ‘stay away from me!’ He ordered his men to handcuff me. They called the Minister of Interior, Minister of Health, chairman of the intelligence agency – it was like a state of emergency," he recounted. While people living with HIV/AIDS in Yemen are often publicly disgraced, perceptions associated with the virus are slowly being challenged. The government’s National Aids Programme (NAP), for example, has begun awareness programmes aimed at educating the Yemeni population about the effects and origins of the disease. This is largely due to the fact that Yemen has witnessed a recent rise in the prevalence of HIV/AIDS. This year alone, 121 cases have been confirmed, and a total of 1,714 cases have been recorded overall. The NAP, however, believes that as many as 12,000 people could be infected countrywide, with ignorance and a fear of social repercussions hindering many people from being tested. "Inadequate knowledge and awareness about HIV/AIDS prevention, compounded by widespread stigmatization of the disease, are among the major factors responsible for risky behaviour and the underreporting of cases in Yemen," the UN World health Organization stated in June 2005. Since its inception in 1987, the NAP has not provided any medical support to those diagnosed with the virus, mainly due to a shortage of funds. There are plans, however, to begin treatment programmes in 2006. There are no official statistics on how many people in Yemen have died from AIDS-related causes. Foreigners to blame? Until recently, statistics indicated that the number of non-Yemenis living with HIV/AIDS outweighed the number of infected Yemeni citizens. This led many to blame the disease’s prevalence on immigrants or Yemenis travelling abroad. "With up to 0.7 percent HIV prevalence, Yemen has the third highest HIV rate in the region, after Sudan and Djibouti," said George Ionita, advisor on HIV/AIDS for the UNICEF Middle East and North Africa region. The NAP’s Abdul Hamid al-Suhaibi noted that, before 2000, there were more cases among foreigners than among Yemenis, but added, "Now, Yemeni cases have increased." Medical experts say Yemeni law discriminates against those living with HIV/AIDS. For example, non-Yemenis must undergo HIV tests before obtaining approval to stay in the country. If he or she tests positive, they are immediately deported. The Yemeni government is also trying to deport refugees who are HIV positive. UN refugee agency UNHCR, however, has stated that there was no law obliging it to hand over HIV-positive refugees if they otherwise met the criteria granting them refugee status. "If any refugee is found infected with HIV, he or she must not be deported, they must be treated," Khaled Fansa, the Aden-based UNHCR officer in charge, said. "To address this issue, we are now preparing a programme in cooperation with the Yemeni government to provide assistance and treatment for HIV/AIDS refugees." He added, "AIDS is a disease, it’s not a crime." According to Fouzia Gharamah, NAP executive manager, the NAP has just begun negotiations with the UNHCR over the issue. "We hope to reach an agreement whereby the UNHCR has to deport any refugee found to be infected," she said. HIV/AIDS awareness campaigns largely target the areas of Aden, Hodeidah and Mukalla, considered high risk because they represent transit hubs for migrant populations coming from the Horn of Africa, where HIV/AIDS prevalence is higher than in Yemen. Sub-Saharan Africa has the highest prevalence of HIV/AIDS globally. Despite these initial attempts to deal with the phenomenon, though, issues relating to HIV/AIDS remain taboo in Yemen. Using condoms – or even speaking about them – still stirs up cultural sensitivities in this conservative Muslim nation. While the NAP is not against the use of condoms, the organisation recommends they be used within the context of marriage. "We recommend the use of condoms for the husband or the wife, or for both, if both are infected with HIV," Gharamah said. Raising awareness Awareness-raising is the weapon of choice for all organisations fighting HIV/AIDS in Yemen, where illiteracy levels are still high, experts say. "We need social mobilisation campaigns to raise awareness among the most vulnerable groups and areas," said Naseem Ur-Rehman, UNICEF’s chief of information and communication. In April 2005, 18 students from secondary schools in the southern city of Aden were educated on issues related to HIV/AIDS, in a pilot project launched by the local government in partnership with the NAP and financed by UNICEF. A specially-trained team targeted 1,300 young men and women between the ages of 15 and 24 in the low-income Aden neighbourhoods of Sayaban, Memdarah and Abdulqawee. These areas have been characterised as high-risk due to the large numbers of commercial sex workers living there. The programme provided educational materials with information on HIV/AIDS transmission, prevention and problems associated with discrimination against people living with the virus. "We found that these young people had never heard about AIDS, but they cooperated with us and were happy that we were looking out for them," said Faris Abdul Qawee, an 18-year-old volunteer with the programme. Following a two-month course, UNICEF said 70 percent of the most vulnerable young people in the targeted neighbourhoods had a working knowledge of HIV/AIDS prevention. "In addition to awareness-raising tasks, we provide those living with HIV/AIDS with psychological counselling, from which patients can find support and keep their morale high," said Gharamah. Treatment for HIV/AIDS patients to start in 2006 Following a slow start, treatment programmes are scheduled to begin in 2006, while a new strategy to control the spread of the disease is underway. "We will begin to provide free medical treatment for 150 cases from the beginning of next year," the NAP’s Gharamah explained. The Global Fund to Fight AIDS, Tuberculosis and Malaria is expected to fund antiretroviral (ARV) therapy programmes. ARV treatment inhibits the ability of the HIV virus to multiply in the body and slows down the development of AIDS. "In 2007, we will offer ARV therapy to 300 cases," Gharamah added. In the meantime, there are plans to carry out awareness-raising campaigns among young people in schools, factories and military camps, she explained. Training and legislation needed According to Abdul Majeed al-Qubati, AIDS programme officer for the UNDP in the capital, Sana, HIV/AIDS issues must be incorporated into government policy and legislation. "We plan to send some parliamentarians abroad for training on how to integrate AIDS issues into the law, or at least make the available laws compatible with international legislation on the issue," al-Qubati said. He went on to note that a group of 15 Imams, or religious leaders, had received HIV/AIDS training in September, and would themselves train 400 other Imams on how to spread awareness of the disease through the country’s mosques. "No country is safe, but the national response here in Yemen is strong, and the commitment of the president is a good sign," UNICEF’s Ionita said.