On HIV, Women, Middle East and Blindness…

What do you think is the biggest challenge to living with HIV in Lebanon?
The biggest challenge would be that, because we have so many conflicts in our country, HIV-positive people are not considered a priority. For me, as an individual, [my goal is] to fulfill my dreams. I have a lot of dreams regarding HIV-positive people, regarding prisoners in Lebanon. Because I’m a volunteer with the prison infirmary in Lebanon, I visit the prisoners and I know they need a lot of things.
———- Margarita, a Lebanese HIV Positive Women

Following the encouraging and enthusiastic reactions we got after publishing the testimonies of Arab women living with HIV, we thought it was of crucial importance to deepen the subject on this platform.

Arab women and HIV are not two words that are often heard together: the taboo associated with the disease explains why their voices are so little heard.

The statistics regarding the AIDS epidemic in the Middle East have to be taken cautiously due to a lack of cooperation from the governments of the region in providing the appropriate and correct numbers and epidemic trends. According to UNAIDS, approximately 380 000 people were living with HIV in 2007 (statistics for the Middle East and North Africa), including the 40 000 people who were newly infected with the virus in 2008. The main transmission modes seem to be unprotected paid sex and injecting drug use, especially in Lebanon, the Syrian Arab Republic and Egypt. In most cases, injecting drug users either have bought or sold sex, which doubles the odds of them getting infected.
Nevertheless, since our main focus here is women living with HIV in the region, it is tremendously important not to forget that a large amount of women living with the virus (again, the figures are unclear), are married or in what they believe is a faithful relationship and have been infected by their husbands/boyfriends. The husband usually engages in unprotected extra-marital sex, or does drugs and comes back home and infects his wife.

Generally speaking, women are more vulnerable to the virus due to physiological factors, but also because of economical and cultural reasons. This is particularly true in the Middle East, where only around 30% of women are working, which of course leaves a large part of them dependent on their spouses, all the more if they have children. Besides, the mentality that dictates to the woman to seldom question her husband (let alone refuse him sex) and to keep what goes on within the house for herself hardly helps in strengthening women in face of the virus. This accrued vulnerability is also reinforced by the lack of education regarding the disease and its transmission modes of the whole Middle Eastern population as well as some useless and backwards traditions in some pockets of the regions, i.e. genital mutilation. Besides, the region being so prone to conflicts, women are even more so at risk. Indeed, with rape increasingly becoming a weapon of modern warfare, the use of women’s bodies as battlefields is now another vector of the virus. Women living in refugee or IDPs’ camps are also at high risk or being raped, therefore of contracting HIV.

In short, we can not talk about Middle Eastern women and HIV without linking it to violence against women. One can ask itself what sort of world uses bodies that give life as battlefields.

The Arab governments still have a long way to go in developing inclusive policies for people living with HIV in general, and for positive women in particular. It seems that Arab governments are trying to ease their conscience by giving free treatment and ARVs to infected people, like for example Saudi Arabia, Lebanon or Syria. Egypt has even hosted a working group made of specialists actively intervening in HIV and sexual specificity in the Middle East and North Africa, while the Islamic Republic of Iran welcomed the session on equality in health within the Islamic Ummah that encouraged member states to implement HIV prevention programmes, in partnership with WHO, UNAIDS and the Global Fund against HIV, Tuberculosis and Malaria.
These efforts would have been saluted if it wasn’t for a constant taboo regarding HIV and AIDS, coupled with severe repression of the LGBT (Lesbian Gay Bisexual Transsexual) community by the governments. The memory from last year of the scandal of gay and HIV positive people being tied to their hospital beds in Egypt is still vivid, just as, for example, the zero tolerance policy of Arab states in face of injecting drug users and same-sex relationships. These issues are also topped by a total lack of inclusive policies of PLHIVs by the authorities that force HIV+ people to live in hiding for fear of stigma and discrimination. In the words of an HIV positive Saudi man, the governments accept the sick, but don’t want to deal with them as people. Governments, and the same goes for society. In the case of lands of conflicts, governments like to claim that HIV is not their priority, which might be true, but remains nevertheless a dangerous way of thinking. Women who got raped during the conflict might become positive, or might endure violence from their partners that might render them more vulnerable to the virus: there is a plethora of situations that will call for government’s actions, and ignoring them might very well backfire.
Women suffer all the more from this situation as society doesn’t tolerate the image of the sexually active single woman. Even the married woman who gets infected by her husband runs the risk of not finding any support from her family. HIV is still seen by many in the Middle Eastern society as the wrath of God, and it is very difficult for HIV positive people not to feel guilty about it. This self-hatred and extreme guilty conscience leads HIV+ people to severe depression. In this case, they find themselves most of the times with no one to confide in.
It would be unfair to say that only Middle Eastern societies don’t want to know about the existence of the virus on their territory. Many people in Africa and in the United States still consider HIV as a divine punishment. The difference reside in the political will to include HIV positive people, but also in the preponderant presence of the NGOs responding to HIV, whose work had proven central to the reduction of the prevalence and to prevention programmes. Arab governments don’t really allow NGOs in particular, and because of the relatively low prevalence rate of the virus and the taboo that is associated with the virus, don’t really make efforts to develop the network of NGOs related to HIV.
It is thus necessary to approach and tackle the HIV issue in a cultural and gender sensitive way. Governments should develop policies to include and counsel HIV positive people, with a special emphasis on the plight of women, as well as grant them free access to treatment and medical care. We can’t emphasize enough the tremendous need of the advocacy for the equality of sexes. HIV positive people should be able to work in an environment where they’re not afraid to be fired is their status is revealed. Besides, education campaigns should be provided so people stop fearing the disease and start accepting it as a scientific fact and not a punishment coming from above. Once people are educated, there is a chance they might stop panicking at the mention of the disease and people living with HIV would feel empowered enough to feel safer in their own countries. Foreign NGOs should try and adapt culturally to the context they’re helping in so as not alienate themselves to the local population. Besides, some traditions, beliefs and religious values, like acceptance, the importance to love one another, the necessity of monogamy, protecting the people you love etc.. could be recycled into HIV advocacy argument.

By exclusively focusing on conflicts and turning a blind eye on public health issues like HIV, Arab governments are setting a dangerous path for the future, let alone letting down a part of their population that need them. Just as parents and friends from these countries societies are letting down their daughters, sons, friends and relatives…



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