New approach towards AIDS in Middle East

Published October 19th, 2000 - 02:00 GMT

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)

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