Facing up to AIDS
The government is stepping up its efforts to combat HIV/AIDS. But social stigma and lack of awareness still pose major challenges, reports Gihan Shahine
Although Egypt remains one of the countries with low HIV/AIDS prevalence, most officials and experts agree that more effort needs to be made to keep the levels down. This year, the Egyptian government made significant progress in its ongoing anti-AIDS campaign to both raise awareness and seek ways to provide treatment.
The Ministry of Health's National AIDS Control Programme (NACP) is launching a Voluntary Consulting and Testing (VCT) campaign this month in 10 governorates, including Cairo, Alexandria, and several parts of Upper Egypt and the Red Sea. Unlike mandatory testing and surveillance, VCT is a voluntary service for anyone who wants to undertake an HIV test or is seeking confidential advice. The concepts of volunteerism and confidentiality, according to NACP Deputy Head Mohamed Mehrez, are "likely to encourage potential HIV patients and high-risk behaviour groups to have tests and receive counseling on how to protect themselves and those surrounding them from getting infected".
"The project will include mobile clinics with specialised teams to reach out those hidden in remote areas," Mehrez told Al- Ahram Weekly. "Increasing public awareness of the disease will be one of the main targets of the campaign, since many people don't even know whether they actually fall into the high-risk behaviour category." Awareness "will definitely help curb the rise of HIV/AIDS cases, since most people who are HIV- positive have families and may very well transmit the disease to their spouses and children," he said. "Besides, the VCT initiative is likely to help the government have more accurate records of the numbers of HIV/AIDS patients."
According to official estimates only 1,200 cases of HIV/AIDS have been reported in Egypt between 1986 and 2002. About 59 per cent of HIV/AIDS patients were between the ages of 20 and 39, and men accounted for 89 per cent of those infected. Heterosexuals and homosexuals were both found to be carriers of HIV/ AIDS in Egypt, followed by those who had received blood transfusions and drug injections, according to an NACP study.
Independent experts, however, suggest the actual figure of Egypt's HIV/AIDS cases amounts to almost 10 times the official estimate. Although 12,000 people would still be considered a low prevalence rate in proportion to Egypt's total population of 70 million people, "the real danger lies in the fact that, unlike countries of high prevalence like Uganda, Egypt's prevalence rate is on the increase," notes Dr Samy Kozman, head of the HIV/AIDS section at Caritas-Egypt, a non-governmental organisation which, among other activities, provides support to HIV/AIDS patients.
The Ministry of Health's AIDS hotline, set up in 1996 in cooperation with the Ford Foundation, had received around 50,000 calls -- some from other Arab countries -- by 2002. Mehrez warned that the number of AIDS patients might rise through high-risk behaviour (mainly prostitution, homosexuality and drug addiction) and the increase in the number of those requiring blood transfusions.
However, according to Hussein Gezairy, regional director of the World Health Organisation's (WHO) Eastern Mediterranean region, "the fight against the spread of HIV remains limited in our region because of the fear and taboos associated with infection and the disease." The resulting stigma and discrimination lead people to deny HIV threats, both at the individual and public health levels. "Stigma blocks the way of the most vulnerable to know their sero-status and hinders the timely access of people living with AIDS to care," Gezairy told the Weekly. High-risk groups thus remain "largely hidden and hard to reach" with, according to WHO figures, only 20 per cent of AIDS patients receiving treatment in most Eastern Mediterranean countries.
Kozman said that AIDS patients are "highly discriminated against. Any AIDS patient is stigmatised as gay until proved otherwise," citing the example of a businessman whose business came to a halt after traders found out he was infected. "Such a discriminatory attitude is one reason why people do not admit to their infection or receive proper counseling on how to protect themselves and others from contracting the disease," Kozman lamented. Gezairy maintained that it is "necessary therefore to create a safe and trusting environment in which the most vulnerable people are encouraged to consult VCT services, change their behaviour, prevent their own infection or onward transmission, and receive care".
Treatment, however, remains one of the major problems people living with AIDS face in Egypt. Mehrez conceded some bureaucratic regulations have impeded legal imports of anti-retroviral drugs, which, experts say, have proved effective in prolonging the life expectancy of HIV/AIDS patients by an average of five to 10 years, depending on the case. AIDS drugs can be found only in big private pharmacies for prices as high as $1,000 per month which, in addition to LE2,000 monthly tests, would be unaffordable to most Egyptians. The result? Whereas AIDS death rates have reportedly decreased by 80 per cent in Europe since 1997, after the introduction of anti-retroviral drugs, "almost all AIDS patients in Egypt face inevitable death for being unable to afford medication," Kozman told the Weekly.
Mehrez says this is about to change now that countries like India, Brazil and South Africa are producing AIDS drugs for the much lower price of around $360 per year. "We are currently receiving a stock of AIDS drugs from a UN agency," Mehrez said. While the Egyptian Parliament is studying the possibility of a new health insurance system designed to cover treatment for HIV/AIDS patients in Egypt by 2005, Mehrez said that for now the ministry "plans to provide treatment only to those in critical need".
The British Broadcasting Corporation (BBC) has recently quoted Minister of Health Mohamed Awad Tageddin as saying that AIDS drugs "could be manufactured in Egypt within one year". But, according to Mehrez, local production of the medicine remains "very unlikely" at the moment. "The industry would too sophisticated and costly to establish for a very limited number of patients," he explained. "Besides, AIDS drugs do not fall in the category of treatment since they just help patients cope better with the disease."
To further help AIDS patients cope the NACP is also working with the International Labour Organisation (ILO) on a project to eliminate prejudice in the workplace. The project aims to raise awareness on HIV/AIDS issues, mitigate the epidemic's impact on workers and their families and provide people living with AIDS with social protection. In its first stage the project targeted the tourism and hotel sectors, both of which account for large communities of young adults forming a vital and active part of the workforce. Today, according to Mehrez, the project has expanded to different sectors, including factories and businesses, where workers and managers are both "acquainted with their rights and duties".
According to ILO officials the project focusses on workers because most of those infected and affected by HIV/AIDS fall into that category. "HIV/AIDS is a social and labour issue as much as a biomedical problem," maintained ILO Director- General Juan Somavia. Michele Nahmias, senior ILO specialist in occupational safety and health, explained to the Weekly that fighting HIV/AIDS in the workplace is important because the disease "reduces the supply of labour and available skills, increases labour costs, reduces productivity, threatens the livelihood of workers and employers and undermines rights. This is certainly what we all want to avoid in Egypt."
Besides, she added that workplaces are a suitable venue for holding awareness campaigns, since they involve large communities of people. "We educate employers and workers on their rights and commitments in case an AIDS patient is detected," said Mehrez. The project attempts to protect HIV/AIDS workers' rights and prevent arbitrary firing and discrimination. "Meanwhile, we do not allow AIDS patients to use their health status as a reason to beg for more money."
Kozman is happy "the government is adopting a much more open and serious policy in combating HIV/AIDS and is more cooperative with NGOs working in the field." He emphasised that this is the only way to raise awareness and curb a potential increase in HIV/AIDS cases in Egypt.
