6 - 12 December 2001
Issue No.563
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Al-Ahram Weekly Online 6 - 12 December 2001 Issue No.563 |
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I care... do you?
Will the World AIDS Campaign counter the rapidly spreading pandemic despite all taboos? Hala Sakr reports on the effort
For the second year the World AIDS Day Campaign has focused on the role of men in the spread and control of HIV/AIDS. Although many factors are behind the AIDS pandemic, the main variables determining how quickly it spreads concern men's sexual behaviour and attitudes. Understanding how men contribute to the epidemic has defined the extent to which they can make a difference. A more active role in caring for partners and families is required of men, now more than ever. Therefore the campaign aims at promoting the increased involvement of men, particularly young men, and male community leaders in national responses to the epidemic.
World Aids Day: a time to highlight the danger of macho attitudes photo: Ketan Joshi
World Aids Day on 1 December was an opportunity for the World Health Organisation (WHO) to highlight that by the end of 2000, 36 million people worldwide were living with the disease and 22 million had died of it. WHO states that in both categories men outnumber women. According to UNAIDS, a UN programme among the organisation's agencies, two-thirds or more of those living with HIV/AIDS are men. Young men are at an even higher risk, as one in four people with HIV is a young man under 25 years of age.
Cultural norms, including traditional concepts of masculinity and behaviour related to men's perception of risk, heighten their vulnerability and that of their sex partners. Men are expected to be physically and emotionally strong and daring. This image of immunity to illness or the negative consequences of taking risks is reflected in the under-use of health services. Masculinity and "macho" attitudes can also be associated with multiple sex partners putting both partners at risk of contracting HIV.
Violence further increases AIDS spread through wars and migration as well as forced sex. Men living away from their families may pay for sex and use drugs to cope with anxiety and stress. Sexual violence by men against women, as well as men, is a worldwide phenomenon in which victims may be from inside or outside of the family.
In 2000, United Nations Children's Emergency Fund (UNICEF) issued a report stating that worldwide at least one in three women has been beaten, coerced into sex or otherwise abused in their lifetime. Last month, Carol Bellamy, UNICEF's executive director, said that one of the most troubling and complex aspects of the spread of HIV/AIDS is its connection with the sexual exploitation of children. "Whether it is myths about the curative powers of sex with young girls or macho attitudes that sanction violent sexual behaviour toward women and girls, the links between sexual abuse of children and the spread of HIV/AIDS are clear," she warned. "In tackling this issue... we will call on everyone who can help us -- governments, health workers, brothel operators, the media, school teachers, sex work collectives and people of influence," she added.
Similarly, the World AIDS Campaign calls upon community leaders to renew their commitment to dealing with HIV constructively. The campaign is an opportunity to highlight the concerns about the rapid spread of the epidemic and the need for unified action.
Based on the campaign's main theme, local organisations designed their own information programmes in accordance with domestic conditions and local priorities. Hany Ziady, of the AIDS and sexually transmitted diseases unit of the Eastern Mediterranean Regional Office of WHO (EMRO), points out that this year's campaign is totally regional culturally. "The approach and discourse are more adapted to the region," he adds.
In the Eastern Mediterranean region which has shown for years low rates of AIDS incidence, recent estimates suggest that by the end of 2000, more than 400,000 people had contracted HIV. Hussein A Geziary, EMRO's regional director, comments, "Although some countries are more affected than others, we should nevertheless be cognizant of the fact that AIDS knows no international borders nor does it distinguish between races or countries given the increase in this era in the mobility and intermingling of the peoples of the world."
EMRO intends to continue supporting AIDS programmes throughout the region and to begin implementing new policies. Success in this regard, says Geziary, "requires the serious participation... of all parties starting with the commitment of the political leadership and the collaboration of government sectors... with religious leaders, community leaders, the private sector, non- governmental organisations and community members at all levels."
AIDS vulnerability in a given location is related to cultural norms and taboos. In the region, many people believe that AIDS is a result of promiscuity and homosexuality, neither of which are regarded sympathetically. Strangely enough, people sympathise with victims of other diseases for which sexual contact is a mode of transmission such as hepatitis C. "It could be that AIDS, from the beginning, was associated mainly with homosexuality -- which is unacceptable in our society -- to the extent that people engaging in heterosexual sex, but illegally through prostitution, thought that they were invulnerable, something that is absolutely untrue," says Safwat Ishaq, head officer of Caritas Egypt's AIDS programme. This is the case even though over 70 per cent of HIV infections are transmitted by heterosexual sex acts. Only 10 per cent of infections are transmitted by sex between men and five percent are passed by injected drug abuse.
Public discussion of AIDS in the region tends to be uncomfortable and vague if not totally prohibited. Advocacy for safe sex practices is highly controversial. Running advertisements on television about safe sex and using condoms requires making statements affirming the need for youth to adhere to religious values, meaning at times that the message is not delivered clearly.
But a direct approach to discussing AIDS, given that it is a topic dominated by shame, often has the effect of leading people to try to sweep the problem under the carpet. Patients and high risk groups such as prostitutes, men who engage in homosexual sex as well as intravenous drug users may refrain from seeking counselling, medical help or admitting that they are infected for fear of ostracism and even legal action. Ishaq of Caritas said that not one AIDS patient sought his organisation's counselling in person. Patients often send a relative or intermediary to inquire about the service on their behalf. The prevailing social attitude about AIDS raises concerns that those afflicted with the disease might even become hostile and aggressive and try to get back at society by deliberately infecting others through sexual contact or donating blood. Conveying the right message in such an atmosphere is highly problematic.
"We are not the Ministry of Interior. They are concerned with security. In health our task is prevention," says Nasr El-Sayed, head of the National AIDS Programme of the Ministry of Health. The programme is collecting data on the incidence of AIDS to determine the extent of the problem and trends. According to El-Sayed, the total number of reported cases of HIV in Egypt is 1,017 of which 90 per cent are men. WHO estimates that the actual number is between 2,500 and 5,000. Most cases resulted from sexual activity or blood transfusion.
Infection through contaminated blood was again brought up last month when the proceedings of a lawsuit resumed for a case filed against doctors and nurses of Ahmed Maher Hospital concerning the alleged transmission of the virus through a blood transfusion in 1997. Since then, procedures for accepting donations have changed. Professional blood donations are prohibited, private blood banks were closed and blood screening procedures were initiated that include quick testing for hepatitis B and C and the HIV virus, a process that takes about five minutes.
The National Programme is also concerned with raising public awareness and reducing the adverse social impact of HIV infection by providing care and support for patients and their families. Along the same line, Caritas Egypt is planning to start a support group for patients and their families. "We hope that the group will be an outlet for those people, providing them an opportunity to socialise and facilitate their social integration," says Magdy Garas, co-director of Caritas Egypt. "They cannot continue to live as aliens in their own society," he said.
The Egyptian AIDS Hotline, run by the National Programme, was set up in 1996 allowing people to request information anonymously about the disease, obtain counselling referrals or support. A total of 45,000 calls have been received since. Caritas Egypt has a established a hotline for the same purpose.
"Although things are better for AIDS programmes, much is still needed from international agencies and national authorities," says Sawsan El-Sheikh, head of the Egyptian AIDS Society. She complains that while health projects for women or children invite ample funding and vast support, AIDS does not seem to be on the agenda4. "Perhaps the magnitude of the problem is still not big enough. Why not strike now before it gets out of hand, especially that there is no vaccine or affordable treatment?" she laments.
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