The increasingly growing impact of the AIDS epidemic throughout the
world has not spared the Middle East. Although steps are being taken to heighten awareness in the region, there is still a great deal of
information about the disease and means of prevention that does not
reach the general public. Available data reports insubstantial numbers of cases, suggesting either inexact data or a lack of any real problem
across the board. Most likely, reality incorporates a combination of
both.
According to the statistics published by the UNAIDS organization and The
World Health Organization, the figures are quite low. The estimated
total number of people living with HIV in North Africa and the Middle
East (end 1999) totals 220,000. Of these, the country reported as having
the highest number of cases is Sudan, with 140,000 adults inflicted with
the virus. The second country in line is Algeria, with 11,000 cases,
only 0.07 percent of the population.
Kuwait, Oman and Saudi Arabia each are reported as having between
1,000-2,000 cases of AIDS. These countries have kept their numbers low
for two main reasons. Firstly, because the virus entered the region only
in the mid 1980s, when detection of the HIV virus was easily detected
and means of prevention were already known. Secondly, this largely
religion-oriented society discourages promiscuity and, thus, adds to the
suppression of an otherwise out-of-control epidemic.
Compared to worldwide statistics, which paint a morbid picture, it
seems that the Middle Eastern countries have been spared the
overwhelming effects of this modern-day death sentence.
Yet, UNAIDS senior officials have estimated that the figures usually
reported represent only a portion of the actual cases in any country. In
most modern and industrialized countries there are in reality an estimated 10-20 percent more cases than represented by official statistics, while in developing countries the gap is usually much greater. Although this factor may assist in conveying a slightly more accurate illustration of the reality of matters, the numbers are still very low.
For many years, several Arab nations refused to disclose their figures
to the international authorities, and it is believed that misreporting
is still quite common. According to figures published by the World
Health Organization, the number of persons living with AIDS in Jordan at
the end of 1999 was estimated at 660. Surprisingly, a recent report by
the Jordanian Al-Dustur daily printed an official statement by
the General Director of Health Care, stating that the total number of
AIDS cases revealed in the Kingdom since 1986 was 228, of which only 115
were Jordanians. Syria has reported 201 cases, placing the country last
in terms of the number of cases worldwide. The WHO figures estimate the
number of cases in Syria reached 800 at the end of 1999.
Speaking to albawaba.com, Bernard Schwartlander, the UNAIDS Epidemiology
Team Leader, said that the WHO data is estimated and based on local
figures. “We don’t have enough data to base our numbers on. There’s a
lack of new information because the countries’ national programs don’t
have specific studies that we could base our figures on.” He added, “In
general, in the Middle East, the societies have more difficulty to
openly discuss these issues that are related to sex, sexuality and
behavior that is not accepted.”
What seems certain is the fact that AIDS remains a disease of fear and
shame in this region. The Arab and Islamic culture has a conservative
outlook on life. Homosexuality is completely unacceptable and discussing
sex is frowned upon. There is social stigma immediately linked to the
disease, discouraging people from being checked or even reaching out for
help if and when tested positive for the virus. Those known to be carrying the disease will most likely be rejected by society, considering them outcasts and immoral, regardless of the manner by which they contracted the disease. Many AIDS victims are considered perverse, and often fear seeking out treatment.
In a recent report by The Lebanese Daily Star, an HIV-positive
woman described her difficulties in acquiring adequate treatment. The
complicated bureaucracy drove her to seek medication on her own private expense, an alternative that is expensive and not available to many.
Those relying on government supported treatment find themselves queing
to receive medication, filling in endless forms and often having to travel back and forth between their physician, the Health Ministry and the pharmacy.
This hassle, besides causing much tension, can prove to be hazardous and
even fatal. Delaying medication can be very dangerous and may lead to the virus’ developing of a resistance to medication. But, according to that report, the main grievance remains the emotional stress and loss of dignity these patients experience. Extreme cases have even ended in suicide.
There is a general lack of awareness and knowledge concerning sexual
conduct and the means of contracting the HIV virus. Social implications make it difficult to obtain any information. The subject is considered taboo and because of the social conservatism prevailing, anyone known as having the virus will most likely be exposed to more than a fair share of discrimination. Thus, many cases remain unreported and, sadly, untreated.
In a culture strongly based on religious rules, in which the Koran is
largely depicted as the sole source of protection, it is hard to
implement changes in attitude or education towards the dangers of
unprotected sex and the use of contaminated needles. The UNAIDS Egypt InterCountry Programme Advisor, Oussama Tawil told albawaba.com, “The attitude of this region is not that different from other countries at the beginning of the AIDS epidemic. You might have stigmatization and
discrimination, but this is not so different than other countries five
years ago.” Regarding the unique religious and social aspects typical of
this area, Tawil remarked, “There is a dialogue between religious
leaders and official leaders about HIV. There is no standard policy by
religious leaders. Some of the times it is not even religious but
social. Social taboos (exist), like talking about sex which is
generalized in society. There is stigmatization because they’ve had less
contact with AIDS, and even less counseling services, so there is a cycle...”
AIDS has been widely perceived as an imported disease brought by outsiders or foreigners seeping into the country. While the culprit linked with the disease is most often a foreigner, religion remains the most trustworthy savior. The message passed by the local
authorities is that if you remain true to the way of Islam, you will
suffer no harm.
In an Egyptian television commercial from the early 1990’s, a verse from
the Koran prohibiting illicit sex was shown, then a picture of the
globe, while the narrator’s voice is heard saying: “Abroad, people use condoms to prevent AIDS, but our youth, if they maintain their religious
principles and morals, will not suffer any danger.” This general
attitude may seem innocent and even idealistic, or perhaps ineffective
in the face of reality. But how can authorities get the message across
without being disrespectful of the religious and social etiquette?
The media in the Middle East does not disregard the subject entirely,
however, it usually limits exposure of cases revealed to those directly
connected with foreigners in their countries. On July 18th, Egypt’s
Health Ministry warned its citizens against employing foreign female
workers, strongly implying the possibility they were carrying the AIDS
virus. The Ministry added that 16 cases have already been discovered
among these workers, resulting in their immediate deportation - a common
way to deal with the problem.
Besides associating the disease with foreigners, there is a clear
tendency by the local media to portray the problem as one belonging
mainly to the outcasts of society, usually those linked to drugs, crime and overall immoral behavior. The Iranian press recently reported on AIDS in one of its local prisons and its head’s plea for support in controlling the epidemic within the penitentiary walls.
Over the past few years, more light has been shed on the subject. Local
authorities have finally come to terms with the need for more education
reaching its public. A general openness is still far off, but there are
some steps being taken to supply the public with comprehensive
information, especially the young.
On December 1st, 1999, World AIDS Day was observed by the Arab world,
focusing this year on children. The idea that recognition was given to
an event of this sort, especially linked to the more sheltered part of
an already reserved society, says a lot about the possibly changing
attitude towards this sensitive subject.
Health authorities are making increasing efforts to protect their
citizens traveling abroad. AT Cairo airport, brochures about AIDS
are handed out, while Saudi men traveling to Bangkok receive discreet
warnings about the epidemic’s magnitude there. Realizing that AIDS is no
longer only an imported disease, a growing number of internal efforts
are being made by local authorities.
In Lebanon, for example, a recent service has been launched geared
toward expanding the awareness of AIDS by reaching as many people as
possible. This campaign, brought together by four different
organizations, takes the form of a hotline run by healthcare workers
with extensive experience in this field. This service is rendered as
part of a campaign directed mainly towards vulnerable groups in need of
answers and counseling otherwise unavailable. The hotline has been
advertised on billboards throughout the country, a step which has widely
increased the number of people seeking assistance. The callers’ ages
range between 17 and 35, while 70 percent of them are male. Experts
working for the service strive to educate and assist while trying hard not to cross the fine line between being informative and invading one’s privacy. They are aware of the limitations involved and hope they
will succeed in getting an educated message across to as many people as
possible.
As the world enters a new millennium, it faces immeasurable problems, one
of which seems to be wiping out millions of people. While Africa is by
far the most severely stricken, a continent slowly disappearing, the
Middle East still seems to be in a relatively safe state. Yet, this
evasive disease seems to be winning in the great race against time.
There is an urgent need for education and support. Without the proper
attitude, many will inevitably lose this already prolonged battle.
The Arab world, often sheltered by its customs and traditions, has kept
itself protected. However, the growing need for a different approach has
created certain changes. It has, in effect, led to more openness when
dealing with the AIDS epidemic. This process is a slow one, but will
hopefully contribute to the general feeling that something must be done,
and the sooner the better. -(Albawaba)
© 2000 Al Bawaba (www.albawaba.com)
