Al-Ahram Weekly Online   20 - 26 December 2007
Issue No. 876
Published in Cairo by AL-AHRAM established in 1875

AIDS as is

Although Egypt is classified as a low prevalence country regarding HIV/AIDS, officials and experts agree that more is needed to maintain the status quo. At a conference discussing the issue, Reem Leila saw if it can be done

The prevalence of Avian Influenza, as well as the high hepatitis C virus rate are considered more urgent health issues than HIV/AIDS to Egypt's health officials who have seen little reason to consider the disease a priority. With an HIV low prevalence rate, not many people in this conservative Muslim country talk about it, and even less know anyone living with the virus. Still, HIV/AIDS was thoroughly discussed at the National Conference Event HIV/AIDS Epidemiology and Researches Updates conducted at Cairo University's Faculty of Medicine last Thursday.

According to Wessam El-Beih, UNAIDS country officer, an estimated 5,300 adults and children tested HIV-positive in Egypt in 2005, but added that it was difficult to gauge precisely how many people are infected, as many cases are likely to go unreported. "With inadequate surveillance systems, these numbers do not mean anything," El-Beih said. Even more disturbing is the fact that very little is known about HIV infection rates among vulnerable population groups such as injecting drug users, sex workers and men who have sex with men (MSM).

The dangerous and highly infectious hepatitis C virus, which can also be transmitted by needle- sharing among injecting drug users has forced government officials to acknowledge this growing problem. A UNAIDS study conducted recently in Greater Cairo found that almost 60 per cent of drug users had shared syringes, only 14 per cent of those who were sexually active always use a condom, and most were ignorant about the virus.

UNAIDS has warned that effective HIV prevention programmes targeting most-at-risk populations should be set up to avert wider and more serious HIV epidemics in several countries in the Middle East and North Africa.

Despite the Muslim majority and the Coptic Christian minority both condemning MSM and pre-marital intercourse, almost 70 per cent of HIV infections are caused by sexual transmission -- heterosexual and homosexual. Dr Sany Kozman, head of the HIV/AIDS section at Caritas- Egypt, a non-governmental organisation which, among other activities, provides support to HIV/ AIDS patients, is tired of tiptoeing around the sensitive issue of religion, and urges people to be "religious with an open mind". "It is a problem of money. Commercial sex workers are not going to stop what they are doing, and you cannot stop MSM. We need to accept the reality," Kozman said. He pointed out that the considerable stigma attached to homosexuality forced an overwhelming majority of this vulnerable group to get married, and although HIV prevalence data was scarce, studies had revealed infection rates of up to 45.7 per cent among men who have sex with men.

The growing problem of street children was another cause for concern, he added, as they are always engaged in risky behaviour such as drug use and commercial sex. "It is a big problem in Egypt. Poverty and the breakdown of families are pushing these children onto the streets, where they become even more vulnerable," Kozman said. Another population group with a higher risk of HIV infection is youth. Three years ago, a survey issued by Caritas investigating marriage patterns among young people in Egypt found growing numbers of youth engaging in pre-marital sex. In the crowded capital city of Cairo, the sight of young lovers holding hands as they take an evening stroll on the bridge over the Nile River is common. In Egypt's religious society, holding hands used to be the only form of physical intimacy allowed before marriage. But the increasing popularity of the unregistered, secret urfi marriage is slowly adding up. According to Kozman, urfi is an informal, usually temporary marriage that allows a couple to have sex. Health officials have estimated that 8.6 per cent of the country's youth aged between 18 and 30 are practising urfi, but that the figure could be even higher among university students.

Mustafa Murad, head of the Ministry of Health and Population's National AIDS Programme (NAP), estimated that only 2,046 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.

Murad warned that the number of AIDS patients is rising. In 1986 there was only one case, but 10 years later the number increased to 160. "Now we have HIV patients by the thousands."

Independent experts, however, suggest that the actual figure of Egypt's HIV/AIDS cases amounts to almost 10 times the official estimate. Although this would still be considered a low prevalence rate in proportion to Egypt's total population of 72 million people, "the real danger lies in the fact that, unlike countries of high prevalence like Uganda, Egypt's prevalence rate is on the rise," noted Murad. The Ministry of Health's AIDS free hotline 0800 700 9000, set up in 1996 in cooperation with the Ford Foundation, has received around 50,000 calls, some coming from other Arab countries. According to Murad, the hotline service receives around 20 phone calls a day from Egypt.

However, according to Kozman, "the fight against the spread of HIV/AIDS virus 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 status, and hinders the timely access of people living with AIDS to care," explained Kozman. High-risk groups thus remain "largely hidden and hard to reach". According to WHO figures, only 20 per cent of AIDS patients in Eastern Mediterranean countries receive treatment.

Treatment, however, remains one of the major problems people living with AIDS face in Egypt. Murad 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 20 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 in monthly tests, would be unaffordable for most Egyptians. The result? Whereas AIDS death rates have reportedly decreased by 80 per cent in Europe since 1997, after the introduction of antiretroviral drugs, "almost all AIDS patients in Egypt face inevitable death for being unable to afford medication," Murad stated.

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