HIV in the Middle East: Everyone’s Business

This article has also been published on ilouban
After reading an article on L’Orient-Le Jour by Nada Merhi on HIV (which by the way is an excellent thing in itself as the subject very rarely makes the mainstream media in Lebanon), I feel there is a need for us to re-humanize the HIV epidemic in the middle east. Indeed, the article speaks about numbers and prevalence rates, which for me misses a crucial point: the actual human lives and walks of life behind rates and numbers. Besides, the strong emphasis on at risk groups in the article and the relative complacency with regards to the situation in the Middle East sparked an uneasy feeling while I was reading it. Now don’t get me wrong: Dr. Abu Raddad, the expert quoted in the article from the University of Weil Cornell in Qatar, states nothing but the truth. Indeed, HIV disproportionately affects men who have sex with men in the region, as well as injecting drug users, and the HIV prevalence rate in the region is low compared to other regionsi. However, what the article fails to underline is that the epidemic trends in the region show a consistent increase on all counts: increase in the number of people living with HIV (2.5 times more over the last decade, from around a 180000 in 2001 to around 460 000 in 2009) increase in the number of people newly infected with HIV, increase of the number of children living with HIV and increase in the AIDS related deathsii. This trend is worrying, all the more because consistent data is scarcely available.
The impact of the L’orient Le Jour article could be counter productive, because it tends to over-minimize the HIV presence and potential risk in the region, and most of all, because it does nothing to reduce the discrimination against most vulnerable groups. If a citizen lambda reads that article, he or she will most likely think two things 1) oh I’m not at risk, the prevalence is low and I don’t inject drugs and I’m not homosexual and 2) HIV is a disease that only affect people who take drugs and have sex with people of the same gender, so they brought it on to themselves.
As if being a man who has sex with men or an injecting drug user was not difficult enough in our region given the severe stigma both situations already suffer from, the stigmatisation is now reinforced by the common perception that they’re the carriers on the virus.
Besides, such beliefs could lower the vigilance of the wider public, thus impairing prevention efforts.
The article quickly says it but it’s paramount to reiterate it: HIV can affect and infect each and everyone of us, it could happen to anyone and more at risk groups do not bring anything on themselves, they’re more at risk because they’re simply more vulnerable, being already judged and shunned aside from society, they have restricted access to information, prevention and treatment. Increasing the stigma will only worsen the situation for society as a whole.
It’s a pity that the article misses to say what Dr. Abu Raddad has said in one of his publications “Characterizing the HIV/AIDS epidemic in the Middle East and North Africa”: that many married women with no risky behaviour whatsoever are found to be infected by their husbands who themselves engage in risky behaviours, and that, although there are variabilities in the transmission modes according to different countries, heterosexual sex is in several countries of the region the main transmission modeiii. There are indeed several demonstrated case of married women getting HIV from their husbands, and mentioning it in Ms Merhi’s article would have created a sense of equality of human beings in front of HIV rather than the impression of finger pointing one can get while reading her article.
This tail of thought, to think that HIV is confined to at risk groups, is what has driven the lack of political will from Middle Eastern governments to carry out proper consistent studies and awareness raising and education campaigns. Besides, because of the low prevalence, people tend to think HIV is not a priority in the region, while with increasing spread of sexually transmitted infections (STIs), injection drug users (IDUs), numbers of unemployed youth, a conservative culture and low awareness of HIV  the region is especially vulnerable to a large-scale epidemiciv.
I remember a trainer from the SUPPORT organisation, an organisation dedicated to the promotion of female condoms, who gave last year in Cairo a training on sexual and reproductive health and rights to young women, who were convinced that HIV was not a priority for their region. She told them: “I remember in the early 90’s, during a conference in Africa, where no one was really taking HIV seriously, stating it was never going to be a big pandemic in Africa. I came back two years after, and we showed a movie on HIV on the continent, and everybody was weeping, because they had lost family to the disease”.
Let us not weep: our prevalence is low, let us put in every effort to keep it this way and reduce it, until we reach the UNAIDS vision. Zero new HIV infections. Zero Discrimination. Zero AIDS Related deaths.
Because one is already too much.
iiiCharacterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic actionLaith J. Abu-RaddadWorld BankFrancisca Ayodeji AkalaIris SeminiGabriele Riedner,David WilsonOUSSAMA TAWIL, p. 85-87

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