Airing taboos
HIV/AIDS is on the rise in the Arab world. Has the time come to discuss sex openly? Hala Sakr reports
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Source : The Millennium Development Goals: Progress, reversals and challenges, UNDP
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Over the past few years, catch phrases such as freedom of expression, transparency, openness, democratisation and the need for change have become increasingly familiar to Arab ears. Discussions and debates about long-standing taboos whether political, social or cultural have been cautiously circulating in intellectual circles across the Arab world. HIV/AIDS is one of the thorniest of these topics.
The taboo that has hindered the discussion of HIV/AIDS in the Arab world has been the stigmatisation of sexual activity and intravenous drug use -- its two major routes of transmission. It is now argued that free discussion and open communication regarding both these issues are crucial in tackling the many misconceptions prevalent regarding HIV/AIDS.
In this context, the United Nations Development Programme's Regional Bureau for Arab States (UNDP/RBAS) organised a workshop on 1 July for Arab arts and media professionals to discuss the alleviation of stigma and discrimination against HIV/AIDS sufferers. The workshop is part of an awareness campaign titled "Breaking the silence" launched last March by the UN in Cairo.
Walid Badawi, regional programme adviser for RBAS, told Al-Ahram Weekly that UNDP sees AIDS as a priority because of its overall developmental impact. "In addition to the burden of care, this is a disease that denies any country of its productive capacity, perpetuates poverty and has a definite human rights dimension," he stresses.
According to the World Health Organisation (WHO) and UNAIDS, an inter-agency UN programme, 42 million people are living with HIV/AIDS. In 2002, five million new infections materialised worldwide and the global death toll was 3.1 million.
Regional estimates show that 550,000 people are living with HIV/AIDS in the Arab world, while 83,000 acquired the disease in 2002. Out of those 55 per cent are women.
"The seemingly low prevalence of the disease in the Arab world does not render it absolutely immune to the threat of further spread. Our ultimate goal should be to sustain the low prevalence status in our region and come out as the first part of the world that managed to do so," says Samir Anouti, RBAS regional programme coordinator.
WHO warned on 3 July that the epidemic is seriously spreading in Djibouti and the Sudan. Six per cent of all youths in Djibouti are living with HIV and 450,000 people in the Sudan are infected.
These figures came as no surprise to Al-Taher Al- Mardi, Sudanese TV anchor and producer -- they have already been published by the Sudanese government. "If the figures for the Arab world were true, there would only be 100 -150 thousand affected persons outside the Sudan. This does not make sense," he said.
Anouti points out that the declared figures are mere estimates. "Under-reporting, related to poor health registration and the stigma linked to the disease, is very much responsible for this misunderstanding."
Al-Mardi counters that the UN should never have circulated possibly inaccurate figures in the first place. "They should not have accepted them and should have pressured [Arab governments] into more transparency," he insists.
Anouti defended his position, saying "We [UNDP] do not see our role as negative players. We prefer to encourage governments positively into exploring the real situation and help them build their capacities to fight the epidemic."
The fact remains, however, that the region is vulnerable. Although the general prevalence is still low (0.03 per cent), HIV/ AIDS is spreading with the escalation of infection rates among younger age groups and women. The persistent lack of information, prevention programmes, voluntary counselling and testing as well as targeted services all play a role.
"We should never forget that the Arab world is sandwiched between three geographic HIV hot spots, namely sub-Saharan Africa, South Asia and Southeastern Europe with some of the highest global prevalence rates," points out Anouti, emphasising a difficulty compounded by "the impact of conflict, displacement, migration and fragmented communities which are all in abundance in the region".
Physicians for Human Rights (PHR) documents further state, "HIV/AIDS is a preventable and manageable disease that has been turned into a pandemic by ignorance, neglect and violations of human rights. The disease most deeply affects those least able to enjoy their rights: the poorest, the weakest, the least educated and the most stigmatised."
Zaven Kouyoumdjian, anchor and producer of the Lebanese talkshow Sira wen Fatahet (A Topic that has been Opened) believes "it is more disrespect rather than discrimination. I see this as a normal reaction in our society. Our culture is inclined towards discrimination. The concept of being 'better' colour- wise, gender-wise, religion-wise, tribe-wise and so forth is widespread."
"Very often fear of being stigmatised is greater than the fear of the disease itself. This prevents people from seeking advice about their potential health status which can lead to faster disease progression. There is also the risk that they can transmit the disease to others," says Andy Seale of UNAIDS.
This fear, however, is not only linked to the infected population. "It is also very much about vulnerable groups such as people with sexual promiscuity, men who have sex with men, sex workers and drug users," adds Seale.
He believes that the existing silence can only fuel the epidemic. "The influence of arts and media on public opinion can help start a dialogue and break the scary silence," he notes, adding "They will know how to sensitively and effectively build the type of environment where society becomes more comfortable in openly discussing issues to do with sex and sexuality -- considerable taboos in this part of the world."
Hani Al-Saadi, a scriptwriter from Syria, favours addressing the issue through drama. A visit to one of the Gulf states triggered the idea. "I visited a night club where, to my surprise, more than 90 per cent of those present were Eastern European females. Any young man could come in and whisper into a girl's ear and they would simply walk out together. And perhaps he would then catch the disease. It was then that I decided to write about AIDS," he recalls.
Abna'a Al-Qahr (Sons of Oppression), the resulting show, was aired on Syrian satellite television last Ramadan addressing AIDS and other taboo topics. "Surprisingly, most of the feedback was related to AIDS despite the fact that the other issues were much more prominent," he says.
However, the implication that AIDS is only contracted through relations with foreigners and outsiders can only be misguiding. "We have to stop exteriorising the disease. It is inside our region -- not an imported disease. It can spread without any external intervention. If we are not aware of this, the result will be an obviously wider prevalence," underlines Anouti.
A UNAIDS paper highlighted the role of mass communication, stating "the media can [either] ... help form positive social attitudes through accurate reporting, fair and accurate representation of people living with HIV/AIDS... [or]... incite discrimination and prejudice against the same populations."
"Images and stories that stereotype sex workers, men who have sex with men and drug users can reinforce the message that HIV can only affect certain groups [and] can reinforce stigma around the disease," the paper warned.
The message made at the workshop is that people must be made to realise that no one is spared; AIDS can be transmitted from mother to child, from husband to wife, from dentist to patient, from contaminated blood transfusion, and even through the use of un-sterilised equipment at beauty salons.
Kouyoumdjian was the first to discuss AIDS on Lebanese TV back in 1992. When the patient he interviewed died one year later, he "realised that AIDS can kill like other diseases. If we know the modes of transmission, prevention should be easy. Instead, it is spreading. Things are not that simple because AIDS is linked to an extremely sensational and sensitive taboo -- sexuality and drug use," he opined, adding "That is why the problem of AIDS cannot be solved unless we tackle the taboos head-on."
Open public discussion of such taboos in the region continue to be tainted with a great deal of uneasiness and obscurity if not totally prohibited. Advocacy for safe sex is highly controversial. AIDS TV spots currently tend to skirt the subject of safe sex, only stressing the need to adhere to religious values and chastity. Condoms, meanwhile, are only advertised as contraceptives within family planning campaigns.
Stigma and discrimination can deprive people of receiving adequate care even within the health arena which should be the very source of maximum understanding, care and support. In an AIDS conference that was held in Aswan a couple of years ago, there was discussion of a possible governmental subsidy of AIDS medication for those who cannot afford it. One of Egypt's most renowned venereology professors claimed that the government was not ethically bound to assume the costs. If the patient had acted recklessly, then he or she must spend recklessly, too.
"But then that would mean denying lung cancer or coronary patients treatment because they chose to smoke although they knew the risks", argues Seale.
According to Kouyoumdjian, "The real problem for AIDS patients is access to medication. This is something we really have to work for. What's the point of being diagnosed when adequate medical care is not available -- medication is rare and very expensive."
WHO has documented that Lebanon, Morocco and Tunisia have each succeeded in obtaining AIDS drugs at a price of 85 per cent less than the original, through group negotiations with pharmaceutical companies, providing a model for the rest of the Arab world to emulate.
"Media people are the key. They are in a position to ask difficult questions of governments and other agencies who have a major part to play. They can certainly help pressure those people into action at all levels," concludes Seale of UNAIDS.
