Ribbons of compassion
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Medical students' random comments on AIDS; UNICEF's publication on AIDS and media; ENNA's hand in hand brochure
At the British Council in Cairo, school children painted colorful pictures on a length of white cardboard to mark the World AIDS day on 1 December, an event to which many parties, including Egyptian Ministry of Health and Population (MHP), contributed. On another level UNICEF's global Unite for Children Against AIDS campaign, launched last year in New York and 70 countries by UN Secretary-General Kofi Annan, who lamented lack of awareness and stressed high HIV-infection rates among children and young people.
The drive to combat AIDS, the sixth Millennium Development Goal, responds to disturbing facts: some 14,000 people, of whom 2,000 children, are infected daily. Statistics also show that 50 per cent of new infections occur among youths aged 15 to 24 years of age. Of these, 95 per cent are from developing countries.
In Egypt, the problem is further compounded by the fact that general information about AIDS is either erroneous, or lacking. Rabie Mohamed, a 27-year-old doorman, heard of the disease from media campaigns. He believes, despite this, that the disease is hereditary. To Mohamed, who has only mastered the basics of reading and writing, most facts related to AIDS remain obscure. In an attempt to address the prevalent misconceptions regarding HIV/AIDS, the Egyptian government has collaborated with international and non- governmental partners in launching the Egyptian national campaign to combat AIDS, an ambitious awareness campaign that targets practically all sectors of the population.
According to Wissam El-Beih, HIV/AIDS officer at UNICEF Egypt, on the local level the five-year campaign which was launched on 23 November, has been strategically modified to cover Hepatitis C, the more widespread virus, which is transmitted in the same way and causes similar symptoms, as well as HIV.
"HIV is currently a [relatively] small problem. However, it is growing and will soon become a major one, just like Hepatitis C. What we are concerned with now, is how to deal with the stigma of being infected with HIV. From a strategic and public awareness point of view, we are addressing both diseases," said El-Beih.
Egypt is currently classified as a "low prevalence country" as regards the rates of infection with HIV/AIDS. Official statistics indicate that only one per cent of the population is infected with AIDS. The disease also appears to be concentrated in specific segments of society, such as sex workers, those who do not practice safe sex, and drug-users.
"Of an estimated 5,000 AIDS victims, only 880 are on government records; yet paradoxically for a campaign intended at raising awareness, El-Beih says they are targeting vulnerable population -- sex workers and drug addicts, for example -- or already infected, "to avoid causing a panic".
For his part Ihab Salah, MHP National AIDS Programme director, explained, "an ongoing national programme to combat AIDS was launched in Egypt in 1986 when the first cases appeared. At present our aim is to keep infection rates low with the help of 10 fixed and nine mobile counselling and testing centres, Voluntary Confidential Counselling and Testing centres (VCCT) and a hotline, as well as to provide support and anti-retroviral medication and to combat misconceptions about the disease -- that it can be transmitted through sneezing, for example.
The programme's voluntary counselling aims to preserve patients' privacy, while providing each individual with a code indicating his/her identity, along with confidential records. "The toll free hotline which answers questions can also refer the callers -- if they should so choose -- to the VCCT which happens to be closest to their residential area," according to El-Beih.
She adds that awareness regarding AIDS is on the rise. Many people now understand that people with HIV can live normally amongst their families and peers. Support groups for HIV/AIDS are also trying to formalise an NGO similar to ones that have been set up in Algeria and Sudan.
Egypt is currently focussed upon the prevention of new infections among young people and children. Since 75 per cent of transmissions in Egypt are sexual in origin, very few children are currently infected. Children who are HIV positive stand at only 15 to 20 per cent of the child population.
The Egyptian Non Governmental Organisation Network against AIDS (ENNAA) has also exerted significant efforts in reaching out to the public. ENNAA Secretary-General Ashraf Abdel-Ghaffar's own Qena-based Feda Association encountered more resistance than expected on the issue of HIV/ AIDS; yet with patience, AIDS and Hepatitis C awareness has increased across Upper Egypt, he says.
According to Abdel-Ghaffar, the public's hesitation about volunteering to be tested at the mobile VCCT (known as the AIDS vehicle), was gradually overcome when Feda/ENNAA team members went in, themselves, to test for HIV and Hepatitis C. "People were more encouraged then."
Nevertheless working with mobile testing units, he complains of the 25-tests-per-day limit and his inability to test people younger than 18. According to Salah, however the latter rule is due to human rights regulations requiring the legal consent of anyone taking the test, while there is no reason a mobile unit cannot undertake more than 25 tests a day if the will and the manpower was to be forthcoming. Equally significant have been the UNICEF-funded campaigns launched by the AIDS committee of the Egyptian Medical Students Association (EMSA).
Ahmed Magdi, EMSA's association director, explained that, by reaching out to over 16,000 medical students, the committee is in itself a force against the stigma attached to AIDS, while Walaa Al-Bedeiwi, committee head, four years ago, when the committee was established, awareness levels among medical students was appalling. "People, especially medical students, must realise that HIV transmission is not limited to debauchery as such; we're trying to help them do so through peer education."
Lack of awareness makes patients more vulnerable. Speaking on condition of anonymity, one 41-year-old patient -- who found out about his condition when he offered to donate blood -- explained, "I haven't come out to admit publicly that I am HIV positive simply because of ignorance and social misconceptions. I must confess I was like that myself until I got infected." But it is not out of shame that he keeps it secret: "not that they would have banished me, but I wanted to spare my old mother and siblings the agony. I thought they would get obsessive about my health and I wanted to be treated normally. I told my close friends because they were the ones who understood and supported me." According to this patient, national AIDS service has been effective, and so have the support groups but only insofar as they remain virtually clandestine. "Which is not fair because the disease is spreading fast and there are those who need to know about it." As an individual he faces the same dilemma as the medical authorities: he feels the need to "address the issue more boldly" but is compelled at the same time to protect himself from stigma. Medical care, he was less enthusiastic about: "it's okay but there are two major problems with it."
First, the MHP provides neither the Viral Load Test (which measures the quantity of HIV RNA in the blood) a better predictor of the risk of HIV disease than the CD4 Test (which measures the number of T- helper lymphocytes per cubic millimetre of blood), though they should be administered twice a year and are essential indicators of disease progression. At a private lab the tests cost LE2,300. Secondly, the MHP does not deal with second-line, or advanced state cases; such patients have to seek treatment abroad. Once again Salah countered with the view that, by WHO standards, the Viral Load Test is not mandatory and that second-line treatment should only be provided in countries where first-line treatment has been enforced for five-six years. Yet the patient has other hopes for the campaign: "the media remembers us only on World AIDS Day and is silent for the rest of the year. At the same time media warnings about AIDS abroad have contributed to the stigma and fed misconceptions, spreading the ideas that AIDS is only transmitted by sex and that it is not an Egyptian problem. I wish more television dramas dealt with AIDS, so as to raise awareness at the grassroots level where information comes exclusively from TV..."
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EMSA's 2005 survey conducted to assess Al-Qasr Al-Aini medical students' reactions towards dealing with AIDS patients, found out that:
- 2,544 medical students out of 9,827 think that taking a shower at least once a day can help prevent HIV transmission.
- 4,121 medical students out of 9,874 think that HIV/AIDS is not present in Egypt.
- 3,368 medical students out of 9,986 think that HIV/AIDS only affects gay people.
- 2,297 medical students out of 9,923 would feel comfortable treating an HIV positive person.
Facts and figures
AIDS stands for Acquired Immunodeficiency Syndrome, describing the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV (Human Immunodeficiency Virus) has been established as the underlying cause of AIDS. AIDS is the final stage of HIV infection. The level of HIV in the body and the appearance of certain infections are used as indicators that HIV infection has progressed to AIDS. HIV destroys the body's ability to fight off infection and disease, which can ultimately lead to death. Currently, anti-retroviral drugs slow down replication of the virus and can greatly enhance quality of life, but do not eliminate HIV infection. Until 2005, an estimated 250,000-720,000 people were infected with HIV; that number rose by 64,000 in that year alone. Though still very low at 0.2 per cent (until 2005), in the Middle East and North Africa AIDS is among the fastest growing diseases. In Egypt some 12 per cent of the infected population are in the 15-24 age bracket.