EGYPT: Lack of official concern over silently rising HIV infections

Photo: Kanya Ndaki/IRIN
There are still low levels of awareness about HIV/AIDS in Egypt
cairo, 6 December 2006 (PlusNews) - HIV/AIDS is 'invisible' in Egypt. With an HIV prevalence rate of less than 0.1 percent, not many people in this conservative Muslim country talk about it, and even fewer know someone living with the virus.

The recent appearance of avian influenza, as well as a soaring hepatitis C rate, are more urgent health issues to Egypt's leaders, who have seen little reason to make HIV/AIDS a priority.

According to UNAIDS, an estimated 13,000 adults and children were HIV-positive in 2005, but it is difficult to gauge precisely how many people are infected, as cases are likely to go unreported.

"People get fixated with numbers ... this is useless. With inadequate surveillance systems, [these numbers] don't mean anything," UNAIDS country officer Maha Aon told PlusNews. 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.

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.


The dangerous and highly infectious hepatitis C virus, which can also be transmitted by needle sharing among injecting drug users, has, however, forced government officials to acknowledge this growing problem. Egypt has the highest prevalence of hepatitis C in the world.

In the cool of the evening in the Mediterranean port city of Alexandria, recovering drug addicts Ahmed Khaled and his friend Mohamed Hassan (not their real names) slip into a building that houses the offices of a drug rehabilitation centre run by the Roman Catholic charity, Caritas. After regular visits to the centre, Mohammed has been clean for the past six months, while Ahmed, who has been injecting "brown sugar" (heroin) on and off since 1992, is attending his second counselling session.

"I haven't managed to stop using completely. The longest time I stayed away [from heroin] was for 14 months. But it's hard ... [heroin] is easily available and cheap - you can get it for less than US$10," the neatly dressed young man told PlusNews.

The more articulate of the two, Ahmed frankly discussed the difficulty of accessing help in a religious country, where "people don't understand and know how to deal with ex-drug users". But he quickly dismissed suggestions that injecting drug users were at high risk of HIV infection. "Syringes are available at pharmacies and they are also cheap - we don't have that problem. Only very poor people share needles," he said.

Caritas counsellor Phillip (last name withheld) disagreed, saying that most of his clients, regardless of wealth or class, reported having shared a needle. A UNAIDS study in Greater Cairo found that almost 60 percent of intravenous drug users had shared syringes, only 14 percent of those who were sexually active always used a condom, and most were ignorant about the virus.

Ahmed said he had never met anyone who was HIV positive, and claimed never to have seen a sign or a billboard mentioning HIV/AIDS. He was under the impression that people living with HIV/AIDS were locked up, away from "other people". The only AIDS education Ahmed had received was when he travelled to the United States of America.

When drug users arrive at the centre, they receive support from a psychologist as well as a former drug addict, and are encouraged to test for HIV next door at the Caritas voluntary counselling and testing facility.

Ahmed became ill at ease and less loquacious when asked if he would consider being tested, but after some prodding by the counsellor, admitted that "it's a good thing to get tested". Mohamed had worked in Kuwait and had to get a "virus-free certificate" showing he was not infected with HIV, hepatitis C or B in order to obtain a visa allowing him to work in any of the Persian Gulf countries.

Dr Ehab El Kharrat is an elder in the biggest Protestant church in the Arab region, and also runs Freedom, a non-governmental organisation that is the largest provider of outreach services to injecting drug users in the country, including HIV/AIDS education.

Mistrust among drug users is a major barrier to reaching them with HIV prevention messages. "It's a big problem. Stigma fuels everything ... drug users are in denial and they don't know enough to protect themselves," he said.


Despite the Muslim majority and the Coptic Christian minority both condemning men who have sex with men (MSM) and pre-marital intercourse, almost 70 percent of HIV infections are caused by sexual transmission - heterosexual and homosexual.

Dr Sany Kozman, head of Caritas Alexandria, is tired of tiptoeing around the sensitive issue of religion, and urges people to be "religious with an open mind".

"It's a problem of money: commercial sex workers are not going to stop what they are doing, and you can't stop MSM ... we need to accept the reality," he told PlusNews.

Kozman 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 6 percent among men who have sex with men.

UNAIDS's Maha Aon said the organisation was looking to start outreach programmes targeting this vulnerable group with condoms and information on HIV/AIDS.

The growing problem of street children was another cause for concern, she added, as they were engaging in risky behaviour such as injecting drug use and commercial sex work.

"It's a big problem in Egypt," Kozman said. "Poverty and the breakdown of families is pushing these children onto the streets, where they become even more vulnerable."

Another population group with a higher risk of HIV infection is the youth. Three years ago, a survey 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 putting paid to this. According to young people PlusNews spoke to, urfi is an informal, usually temporary marriage that allows a couple to have sex.

Health officials have estimated that 4 percent of the country's youth aged between 18 and 30 are practicing urfi, but this could be even higher among university students.

Maha Aon acknowledged that young people were engaging in premarital sex, but expressed concern about the poor levels of knowledge - particularly among girls. Condoms, for instance, were "highly stigmatised" and viewed as "a bad thing", she commented.

Given the low official prevalence rate and inadequate systems for tracking infection levels, Aon is more concerned by trends revealing that the number of newly reported HIV cases in Egypt is on the rise. But Egyptians are barely aware that HIV/AIDS exists in their society.


Theme (s): Care/Treatment - PlusNews,

[This report does not necessarily reflect the views of the United Nations]

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