Lifting the veil of AIDS taboo in Egypt

By, Middle East Online, December 1, 2006

About 2,115 cases of HIV/AIDS reported to health ministry since 1986, UNAIDS reckons number is higher.

CAIRO - Souad never suspected how much her life was about to change when she was summoned four years ago by the Ministry of Health and Population to test for HIV/AIDS. There she was told that her husband had been tested positive for the virus two years earlier.

"He never told me," she said. “He continued to live with me as if nothing had happened.”

Shortly afterwards, she, too, tested positive for HIV.

"In the beginning, I would look into it the mirror for changes in my appearances, thinking that I would die soon," said Souad, who asked not to be identified by her real name.

"But later, I realised I wasn’t alone; that there were many people in Egypt suffering from the same condition."

Altogether, 2,115 cases of HIV/AIDS have been reported to the health ministry since 1986.

However, UNAIDS reckons the infection is much more widespread in this country of 77 million people.

It estimated there were 12,000 HIV positive people in the Arab world’s most populous country at the end of 2003.

According to the UN 2005 Common Country Assessment of Egypt, 64 percent of all reported HIV infections in the country were caused by heterosexual intercourse, while 31 percent were the result of infected blood.

All blood donors in Egypt are now screened for HIV, so blood transfusion has been virtually eliminated as a source of new infection, but doctors suspect that many people are still contaminated by dirty needles in routine medical injections.

The official statistics register very few mother-to-child transmissions and hardly any infections arising from homosexual intercourse between gay men.


Few women are tested


About 80 percent of all HIV-positive people registered with the Health Ministry are men.

But experts say this statistic is misleading because it is not based on the testing of a broad cross section of Egyptian society and because women are less likely to come forward for testing than men.

“This figure does not reflect the true prevalence rate among women in Egypt,” said Doctor Ehab Salah, of the health ministry’s National AIDS Programme (NAP).

He said most HIV infections detected so far had been revealed by screening blood donors and applicants for work permits, both foreigners coming into the country and Egyptians seeking work abroad.

“These are mostly male, so the chances of us learning about their infection is much higher than it is for women,” he noted.

Nana Ahlmark, an AIDS coordination officer with the United Nations Development Programme (UNDP) in Egypt noted that women were generally more vulnerable to HIV infection than men.

"This is not only related to biological factors, but also to the fact that women are more likely to lack access to education and health care," she said.

Souad, who is now living with AIDS, said women were generally reluctant to come forward for voluntary HIV testing because the stigma associated with the virus in Egypt is much greater for women than it is for men.

“If a woman has the virus, people immediately assume she got it from some kind of sexual transgression,” she said.


Still no strategic plan


Although Egypt is still reckoned to have a very low HIV prevalence rate of only 0.01 percent, Salah at the National Aids Programme, says this is no excuse for complacency.

“The fact that we have a low prevalence rate doesn’t necessarily mean we’re safe,” he said. "If we don’t take strong preventive measures, the epidemic will spread."

The United Nations Children’s Fund (UNICEF) reckons that a fifth of Egypt’s population – some 15 million people – are vulnerable to contracting the virus that causes AIDS.

And UNAIDS expressed concern in its 2004 report on Egypt that the country still did not have a National Strategic Plan for dealing with the pandemic.

“Development of a plan must be the priority in 2005,” it said.

Salah, at the government’s National AIDS Programme, said this plan was still being formulated. But he pointed out that the NAP had already made a start in tackling AIDS on the ground.

In 2004, the NAP opened its first Voluntary Testing and Counselling Centre in Cairo, where people can be tested for HIV without having to submit any personal information.

The organisation currently runs five HIV-testing centres nationwide and has nine vans to take mobile testing facilities out to smaller towns and villages.

Salah said these centres not only encourage people to get themselves tested, they also help to establish the profile of groups to be targeted in future AIDS awareness campaigns.

"We ask them questions about their educational background and their age," he explained.

Since the beginning of 2005, NAP has also provided free antiretroviral (ARV) treatment for about 100 people living with AIDS.

ARV drugs do not cure AIDS, but they can improve the health of people suffering from the disease and prolong their life. And crucially they give hope to people who until now suspected that AIDS would only lead them to an early death.

“Now that people are becoming more aware of the existence of medication for the infection, they are more willing to test for HIV/AIDS,” Salah said.

However, ARV drugs cost about US $2,500 per month to buy over the counter in pharmacies in this country where the annual per capita income is just $1,390, so few Egyptians can afford to buy them without the help of an official subsidy.

Salah said the NAP wanted more Egyptians living with AIDS to come forward to benefit from the opportunity of free ARV treatment, but he gave no target figure.

NAP has produced a series of publications to explain HIV/AIDS to ordinary people along with several NGOs, it is trying to break down the social stigma commonly associated with the infection.


Fear and prejuidice is deep-rooted


But the activists still have a long way to go in conquering fear and prejuidice.

"In one survey, over 70 percent of respondents did not think People Living with HIV/AIDS should be allowed to continued to work. A sample study of secondary-school students revealed that 72 percent of them wouldn’t sit next to someone who was HIV-positive," Ahlmark remarked.

Doctor Sanni Youssef, an AIDS counsellor in the Mediterranean port city of Alexandria, told the story of one 24-year-old shopkeeper he knew who was forced out of business when his customers discovered that he was HIV positive.

"People just stopped buying from his store and he went bankrupt," he said.

After first being tested positive for HIV/AIDS, people are often struck with a sense of fear and isolation. This is largely due to a general lack of awareness about the virus and its characteristics.

"At first I didn’t know much about the disease, or how to live with it,” recalled Souad. “I was afraid to touch my friends and family for fear of infecting them."

However, for the past year, she has had access to a support group run by the Roman Catholic charity Caritas in Alexandria.

Youssef, who heads the Caritas support group, said that patients meet in the support centre twice a month to discuss their concerns.

"Through these gatherings, we provide advice and psychological assistance to help people accept their illness and live a normal life," he said.

Because of Egypt’s relatively conservative Muslim society, however, some AIDS prevention issues pertaining to contraception and safe sex remain sensitive.

Condoms are readily available at local pharmacies, but their use is not widely encouraged.

"We have to be culturally aware when tackling such issues," said Salah at NAP.

“We live in a country where open discussion on sexual matters isn’t the norm, so launching a strong campaign on safe sex can end up exaggerating the prevalence of HIV/AIDS among the public and cause panic,” he explained.

Since the Caritas support centre opened in Alexandria in 2003, it has helped approximately 100 patients come to terms with their condition and reintegrate into society.

Youssef conceded that this was a relatively small number, but he pointed out that attendance at the group’s sessions had been increasing steadily.

Now he is planning to launch a series of new counselling groups run by people living with HIV/AIDS who have already received counselling themselves.

Youssef concedes that Egypt is not yet ready for people living with HIV/AIDS to bring themselves into the open.

“They have to keep it a secret,” he said, calling for a strong media campaign to help break down the ignorance and social prejuidice that still forces HIV-positive people to live in the closet.


Source: http://www.middle-east-online.com/english/?id=18582

Stigma remains greatest hurdle in Kenya's fight against AIDS

By, Karen Calabria, Agence France Presse, December 1, 2006

NAIROBI (AFP) - Three-year-old Ibraham Akinyi pushes a toy car made of scrap metal across a makeshift wooden table, oblivious to the horrors that befell his mother, Beatrice, after his father's death from AIDS in 2003.

"Two days after my husband's funeral, a group of his relatives, including his father, came to my house and forced their way inside, pretending to be drunk," the HIV-positive mother-of-two recalls as she sits in her one-room, mud-walled home in Kibera, sub-Saharan Africa's largest slum.

"They told me, 'Get out and go, take the kids.' They said not to pack anything, it all belonged to them and then tore the whole house down because they blamed me for his death," said Akinyi, 29, who suspects her philandering husband became infected by one of his many girlfriends.

Akinyi was diagnosed in 2003 during her pregnancy with Ibraham, who narrowly escaped infection after a course of anti-retroviral (ARV) treatment. But her firstborn son, Clinton, 9, was not as fortunate and has tested positive.

The single mother is one of the 1.3 million people -- in this country of nearly 35 million -- currently living with HIV/AIDS in Kenya, 65 percent of whom are women between the ages of 19 and 45, according to National AIDS Control Council statistics.

Since 1984, at least 1.5 million people are said to have died from AIDS in Kenya, according to health ministry estimates.

Awareness campaigns have succeeded in reducing Kenya's HIV/AIDS prevalence rate to six percent in 2006 from 10 percent in the late 1990s, with condom use rising and a decline in the average number of sexual partners, according to a UN report.

But HIV-positive Kenyans, like Akinyi, are often stigmatized by strangers and family alike who remain ignorant about the transmission and symptoms of the disease.

Since relocating after her husband's death to the capital from her hometown of Kisumu on the shores of Lake Victoria, Akinyi has taken care not to let on she is infected with the virus, fearing similar reprisals from her neighbors.

"I can't tell anyone because I fear for my children and how they would be treated by others," Akinyi said. "My neighbors are already suspicious and are wary of me."

"When people know you're infected with the disease, they fear many aspects of the communal living typical in the slums -- sharing water or toilets, shopping at the same stores," said Dennis Oduor Omondi, an HIV/AIDS counselor with African Medical and Research Foundation (AMREF).

Despite the country's best efforts to educate people about HIV/AIDS prevention and treatment, Omondi said he believes there are large numbers of Kenyans, especially in poor areas, unaware of how it is transmitted.

"They don't understand that they can't get it through greeting someone, touching someone, even breathing the same air," he said. "Stigma prevents people from getting educated about the disease and helps spread it further."

Anne Muthoni, a widowed 33-year-old, echoes Akinyi's concerns that her childrens' future would be adversely effected if she were to disclose her HIV status to her friends and neighbors.

"I don't want my children to suffer, to be teased or beaten up by their peers," said Muthoni, who became infected after she turned to prostitution to support her five children when her husband died of malaria in 1998.

Despite making small strides in the fight against the epidemic, better integrating those living with HIV/AIDS into the community and reducing the stigma attached to the disease remains one of the biggest hurdles, according to Charles Kaduwa, a program officer for Women Fighting AIDS in Kenya.

"Stigma prevents people from going for tests, from seeking treatment, from disclosing their HIV status to sexual partners or spouses," he told AFP. "It helps the epidemic to spread and stigma helps people infected with HIV die."


Source: http://news.yahoo.com/s/afp/20061201/hl_afp/healthaidskenya_061201203317

AIDS stigma hurdles to treatment

By, The Statesman (India), December 1, 2006

NEW DELHI: The current efforts to fight AIDS, including international commitments to achieve universal access to it’s treatment by the year 2010, will all fail if the pervasive stigma faced by people living with HIV is not tackled more aggressively.

According to ‘Unveiling the truth’ a new report to be released globally on World AIDS Day (1 December), hospitals, clinics and other health care settings are among the places where people living with HIV still experience some of the worst HIV-related stigma. This report is a joint publication by Health and Development Networks and the global AIDS Care Watch Campaign.

“Stigma and discrimination are the two major hurdles that continue to hamper rehabilitation of people infected and affected by HIV in India” says India contributor to this report, Swapna Majumdar. She also stated that for women and girls the degree and impact of this stigma is much higher.

The stigma associated with HIV works as a barrier to avail the medical advances. Thus preventing people from accessing testing or treatment services. “A few days ago, it was getting impossible to get treatment for a HIV positive pregnant lady in the particular centres set for them. Doctors too fear infection. If health facilities are not made available then most of the HIV patients will be mortified to go for AIDS test” added Anjali Gopalan, an AIDS activist running a home for HIV positive people.

"The continuing presence of stigma represents a failure in HIV policy-making and programme design. All HIV policies, programmes and services should address the impact of HIV stigma, and improving the attitude of health workers is particularly important to restoring the element of hope about AIDS." says Nadine France, Director of Health & Development Networks, Unveiling the Truth.

To this adds Celina D’Costa, another AIDS activist, “most of the people in India are reluctant to access HIV testing services because of stigma and the fear of losing life associated with a positive diagnosis”.

“To reduce HIV-related stigma, we must very honestly look at the realities that health workers face and try to understand the epidemic from their personal perspective” said Aditya Bandopadhya, an AIDS activist.


http://www.thestatesman.net

Stigma remains greatest hurdle in Kenya's fight against AIDS

By, muzi.com, December 1, 2006

Three-year-old Ibraham Akinyi pushes a toy car made of scrap metal across a makeshift wooden table, oblivious to the horrors that befell his mother, Beatrice, after his father's death from AIDS in 2003.

"Two days after my husband's funeral, a group of his relatives, including his father, came to my house and forced their way inside, pretending to be drunk," the HIV-positive mother-of-two recalls as she sits in her one-room, mud-walled home in Kibera, sub-Saharan Africa's largest slum.

"They told me, 'Get out and go, take the kids.' They said not to pack anything, it all belonged to them and then tore the whole house down because they blamed me for his death," said Akinyi, 29, who suspects her philandering husband became infected by one of his many girlfriends.

Akinyi was diagnosed in 2003 during her pregnancy with Ibraham, who narrowly escaped infection after a course of anti-retroviral (ARV) treatment. But her firstborn son, Clinton, 9, was not as fortunate and has tested positive.

The single mother is one of the 1.3 million people -- in this country of nearly 35 million -- currently living with HIV/AIDS in Kenya, 65 percent of whom are women between the ages of 19 and 45, according to National AIDS Control Council statistics.

Since 1984, at least 1.5 million people are said to have died from AIDS in Kenya, according to health ministry estimates.

Awareness campaigns have succeeded in reducing Kenya's HIV/AIDS prevalence rate to six percent in 2006 from 10 percent in the late 1990s, with condom use rising and a decline in the average number of sexual partners, according to a UN report.

But HIV-positive Kenyans, like Akinyi, are often stigmatized by strangers and family alike who remain ignorant about the transmission and symptoms of the disease.

Since relocating after her husband's death to the capital from her hometown of Kisumu on the shores of Lake Victoria, Akinyi has taken care not to let on she is infected with the virus, fearing similar reprisals from her neighbors.

"I can't tell anyone because I fear for my children and how they would be treated by others," Akinyi said. "My neighbors are already suspicious and are wary of me."

"When people know you're infected with the disease, they fear many aspects of the communal living typical in the slums -- sharing water or toilets, shopping at the same stores," said Dennis Oduor Omondi, an HIV/AIDS counselor with African Medical and Research Foundation (AMREF).

Despite the country's best efforts to educate people about HIV/AIDS prevention and treatment, Omondi said he believes there are large numbers of Kenyans, especially in poor areas, unaware of how it is transmitted.

"They don't understand that they can't get it through greeting someone, touching someone, even breathing the same air," he said. "Stigma prevents people from getting educated about the disease and helps spread it further."

Anne Muthoni, a widowed 33-year-old, echoes Akinyi's concerns that her childrens' future would be adversely effected if she were to disclose her HIV status to her friends and neighbors.

"I don't want my children to suffer, to be teased or beaten up by their peers," said Muthoni, who became infected after she turned to prostitution to support her five children when her husband died of malaria in 1998.

Despite making small strides in the fight against the epidemic, better integrating those living with HIV/AIDS into the community and reducing the stigma attached to the disease remains one of the biggest hurdles, according to Charles Kaduwa, a program officer for Women Fighting AIDS in Kenya.

"Stigma prevents people from going for tests, from seeking treatment, from disclosing their HIV status to sexual partners or spouses," he told AFP. "It helps the epidemic to spread and stigma helps people infected with HIV die."


Source: http://dailynews.muzi.com/news/ll/english/10027762.shtml

In Africa, HIV Stigma Lives Off Silence

By, Masimba Biriwasha, Ohmy News - International Global Watch, December 1, 2006

"HIV is just like any other disease and until people accept and tackle it, we will continue to be reduced in numbers like animals drinking from a poisoned well." Sazini Ndlovu, a sex worker and member of the Hwange AIDS Project, The Daily News [Zimbabwe], Aug. 15, 2001

HIV stigma is a social construction founded on a mixture of myths, misinformation, fear and ignorance, as well as some real life experiences of the disease. In spite of the bio-medical and social work that has been done to fight HIV, stigma and discrimination remain like two towers blocking progress. The fight against HIV will not be won on the medical front if the social phenomena that propagate the disease are not addressed.

In Africa, a continent where HIV is predominantly transmitted through heterosexual sex, being HIV positive is seen as a sign of promiscuity. Being infected is seen as a curse and in such a context naturally carries shame with it.

Lack of access to antiretroviral (ARV) drugs and other therapies that prolong life for people living with HIV (PLHIV) has only worsened levels of stigma within society. HIV is perceived as a death sentence. Many people are afraid of the disease, and they turn their fear into disdain and discrimination of anything associated with HIV, including people living with the disease.

In many instances, people who are open about their status are poor and impoverished. This has a major impact on the negative perception of PLHIV, who are stigmatized not only for carrying the virus but also for their poverty. As a result, most prefer to die slowly in silence.

People's experiential knowledge of HIV in Africa often consists of the pain that they have seen their loved ones experience as they die of the disease, and this undoubtedly influences their attitude. Many people prefer to live without knowing their HIV status. The majority of infected people in Africa do not live with HIV, instead, they die of the disease, intensifying the belief that to have HIV equals death. The conspiracy of silence surrounding the disease is so entrenched and pervasive that burials often happen without a single mention of the disease.

Due to the nature of the illness, people with AIDS may need a great deal of intensive care and support. If these people are to receive the expert and compassionate care that they undoubtedly deserve, one paramount issue that has to be addressed is that of stigmatization and coping behaviors among health care workers. When caring for the chronically ill, unprejudiced, sympathetic and comprehensive care is essential as it helps maintain psychological health, and prevents pain and suffering.

In most African countries, the health care infrastructure has inadequate facilities, inadequate manpower and poor logistics such as drug supplies and other equipment. Low quality of services has further worsened the levels of stigma within society. High levels of poverty also prevent the infected and affected from accessing services. In many local settings throughout Africa, HIV is frequently still equated with hopelessness and death.

Such perceptions of HIV have fueled prejudice towards people living with the virus. Where there is stigma against PLHIV, they retreat, driven by both internal and external stigma. As a result, millions of people living with HIV are at risk of infecting their partners because stigma forces them to choose silence.

Stigma discourages infected and affected people, and their partners and families, from seeking counseling and other services that may prolong their lives. According to UNAIDS executive director Dr Peter Piot: "It is unfortunate that we are still hampered by our old enemy: stigma. Eliminating stigma must be central. It is about breaking silence, and breaking silence means breaking secrecy, not confidentiality, about AIDS."

Breaking the culture of secrecy about HIV is essential in combating stigma. An intensive and appropriate communication campaign could go a long way to reducing stigma in Africa. The media is central to such an initiative. Such a program would have to utilize all the channels available to encourage a positive change in the perception of HIV. Otherwise, HIV stigma will remain the biggest hidden killer in African today.

Until people in Africa accept and tackle HIV just like any other disease, they will continue to be reduced in numbers like animals drinking from a poisoned well.


Source: http://english.ohmynews.com/articleview/article_view.asp?at_code=376706