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Stigma helps HIV spread in silence in Egypt

HIV is spreading at an alarming rate in Egypt, where those at risk fear the social stigma almost as much as the health issues that come with it.
A man places a placard as he prepares a message during an HIV/AIDS awareness campaign on the eve of World AIDS Day in Kolkata, India, November 30, 2017. REUTERS/Rupak De Chowdhuri - RC1104607C00

While HIV infection rates are declining globally, the disease is spreading dramatically in Egypt. According to UNAIDS, HIV infections in the country are increasing at an annual rate of 25- 30%. An estimated 11,000 Egyptians were living with HIV as of 2016, most of them under 49.

“The 25-30% annual increase has been estimated by the number of people undergoing HIV testing and being diagnosed with the virus,” Ahmed Khamis, the country manager of UNAIDS Agency in Egypt, told Al-Monitor.

However, the real numbers could be much higher. Testing is still not common despite government efforts to provide free and anonymous HIV testing in governorates across Egypt. Fearing stigmatization, people are still reluctant to get tested for HIV, preferring not to know. At the root of the stigma is HIV's association with immoral behavior, such as illicit sexual relations and drug use.

“The problem is that there is an assumption that those who have HIV are drug users, homosexuals or sex workers, but this is not true. Those indeed could be the ones who are most at risk of contracting this virus. But they also have families — husbands, wives and children — who if infected are forced to live with this disease for the rest of their lives in a society that heavily discriminates against anybody living with HIV,” said Khamis.

In December 2017, Egypt Independent, one of Egypt’s English-language newspapers, reported that an Egyptian housewife committed suicide soon after discovering she had contracted HIV from her husband, who was a drug user. While initially trying to keep her HIV status a secret, the woman’s neighbors found out and forced her and her family to leave their home. The plan was to move in with her mother-in-law until they found another home, but the woman decided to climb the stairs to her apartment on the fifth floor and jump out the window.

While this story is tragic, it is by no means unique. People living with HIV fear not only discrimination from family and friends, but losing their jobs, homes and the right to live freely.

Sherin Mahmud, a 35-year-old HIV patient who contracted the virus from her husband's extramarital affairs, told The Arab Weekly that she decided to visit a dentist because she had a painful toothache. When she informed the dentist of her HIV status, he asked her to leave the clinic immediately.

“Some health care providers do not know how to deal with patients who have HIV,” said Evette Adel Ramzi, the head of HIV prevention at Caritas Egypt, a nongovernmental organization that provides support and counseling to people living with HIV. “This is why at Caritas we work with several hospitals to train physicians and nurses on how to deal with HIV patients. When any of our members need to see a physician, we send them to these hospitals to receive medical treatment in a discrimination-free environment.”

In addition to training medical practitioners, Caritas also has a number of programs dedicated to supporting people living with HIV, from counseling drug users on their addictions and safe injections to reconciling HIV patients with their families and teaching people how to adhere to their HIV treatment for life.

The National AIDS Program (NAP), an initiative of the Egyptian Ministry of Health, also has a number of programs in place to raise awareness on HIV prevention and treatment. But with funding running low, such outreach programs will struggle to keep running.

“Our concern is that we will not have enough financial support to continue,” Ramzi told Al-Monitor. Khamis is also worried about the lack of funding needed to invest in prevention and outreach programs. He explained that while the government has pledged to provide free treatment for people living with HIV to the tune of thousands of dollars for each patient, much needs to be done about prevention.

“In a country like Egypt, where there are a lot of development priorities, it is difficult to allocate a lot of funding for preventing HIV. … The international community and donors really need to step up and show commitment to preventing new infections,” said Khamis.

Having limited prevention programs at a time when there is a rising trend of new HIV infections will likely result in more Egyptians contracting the virus. “What will happen when we have zero coverage?” asked Khamis.

To date, Egypt ranks behind only Iran, Sudan and Somalia in the Middle East for the rate at which the epidemic is spreading, according to UN figures.

UNAIDS, NAP and the Ministry of Health have all run awareness campaigns involving celebrities and organized social events to increase awareness of HIV among Egyptian youth, but they are struggling to reach the country’s large population of 95 million.

One effective way of reaching them is through religious leaders. In a country where religious and conservative values are an integral part of everyday life, religious leaders can play an important role in preaching tolerance and acceptance of all people, including those diagnosed with HIV.

In a recent conference on AIDS, Islamic scholar and cleric Ali al-Jifri spoke about the stigma and discrimination surrounding HIV and AIDS patients. “A person diagnosed with HIV is still a human being. We should never judge them for their diagnosis,” he said in the conference. Priest Bolous Soror said in the same conference that Egyptians should accept others, regardless of their HIV status.

One thing is sure: To meet NAP’s goal of curbing HIV rates within five years, cooperation among civil society groups is key. “We all need to work together to decrease rates of HIV and to end the stigma of the virus. The more stigma there is, the more money is needed to overcome it. With the limited resources we have, civil society needs to work together to curb the spread of the virus that is threatening the lives of many Egyptians,” Ramzi told Al-Monitor.

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