This paper is slightly outdated. I wrote it two years ago! However, one thing hasn’t changed: HIV is on the rise in the Middle East and North Afria- so as everywhere else for that matter.
HIV Prevalence in the Middle East and North Africa
When I used to hear the word AIDS, a slight shiver used to run through my body. Now that I learned a lot and gained valuable insights about the virus, how it is transmitted and ways in which it can be prevented from spreading, I feel more comfortable in discussing the topic. From sexual contact, to the use of dirty needles to HIV-borne-blood transfusions, HIV has found its way into our population and it is indiscriminately infecting people at staggering rates.
Middle Eastern and North African countries have not escaped the epidemic. Statistics indicate low prevalence of the virus in the region. In a 2007 survey, the Joint United Nations Program on HIV/AIDS (UNAIDS) reported that 380,000 adults and children were living with HIV/AIDS across the
North African and Middle Eastern countries, in comparison with the Sub-Saharan African region that suffered from approximately 25 million cases of the disease. South and Southeast Asia had approximately 6.5 million cases. Data collected from these countries outnumbered that of the Middle Eastern and African regions that represents roughly 1% of the world’s HIV/AIDS caseload.
However, new infections indicate a serious, saddening fact that the AIDS virus is spreading fast in the aforementioned countries. At the United Nations Development Program (UNDP) meeting held on March 29, 2007, it was reported that HIV/AIDS cases have increased 300% in the Arab world over the past three years. “This is against an annual rate of increase of 20 percent in the United States, Japan, Europe, and Australia,” a UNDP analyst and HIV/AIDS program coordinator, stated at the meeting that had more than 40 Muslim and Christian leaders gathered to discuss faith-based strategies to combat the virus.
It is estimated that more than 36,000 deaths occurred in 2006 in the Arab region alone because of HIV/AIDS. UNAIDS recorded 75,000 new infections in the region; an alarming message about the rising epidemic to the countries of the region2. Moreover, available data is not so reliable because not a single country in the Middle East or North Africa conducts a systematic survey of groups at high risk of infection. Consequently, UNAIDS ranges total number of HIV/AIDS cases in the region from 200,000 to 1.4 million people. This broad classification compromises the population and leaves it prone to the virus and higher rates of infections because no concrete data can justify, support the need of organized effort, funding, for instance, to provide antivirals and other care-related expenses.
The Middle East and North Africa regions roughly correspond to the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO). The EMR includes North African countries of Morocco, Algeria, Tunisia, Libya, Egypt, Sudan, Somalia, and Djibouti. Middle Eastern countries include Iraq, Yemen, Syria, Lebanon, Jordan, Palestine, and the Arab Gulf countries of Saudi Arabia, Kuwait, the United Arab Emirates, Oman, Bahrain, and Qatar. From statistical and data-report standpoint, other countries are designated as Middle Eastern by the WHO, but are not actually in the region: Afghanistan, Greece, Turkey, Iran, Chad, and Israel.
Arabic is the most widely spoken language in the Arab states of the region. Islam is the predominant religion among its inhabitants; Christianity and Judaism come next, respectively. EMR countries share common culture, traditions, and beliefs and are generally prone to conservatism across their nations and religions. Culture influences certain practices against HIV/AIDS patients because of lack of HIV education and other sexually transmitted diseases. As a result, those groups are hard to reach which consequently result in poor data and bad execution of intervention measures – should these be implemented.
HIV was introduced into the EMR countries during the mid-1980s mainly through imported blood products. Annual number of HIV/AIDS cases has increased steadily from 71 in 1987 to 974 in 1996; total number of reported cases was about 4,800. Furthermore, it is believed that in case of collecting HIV data that true number of reported cases is usually three to four times higher. Among the AIDS community it is known as the tip of the iceberg and it reflects HIV occurrences that happened 5 to 20 years ago. Therefore, special care should be paid to those numbers as they indicate alarming data about the spread of HIV among EMR communities. It was recorded that most of the 4,800 AIDS cases were reported from Sudan (32.6%), Djibouti (25.9%), Morocco (7.8%), Tunisia (6.7%), Saudi Arabia (5.0%), and Iran and Egypt (3.0%) each5. Sudan and Djibouti represent the highest levels of AIDS cases, whereas Iran and Egypt the lowest. However, this data was collected 14 years ago. In 2008, UNAIDS and WHO released a report on the global AIDS epidemic which alarmingly indicated that number of HIV prevalence in the Middle East and North Africa region had almost doubled. At the end of 2007 there were 720,000 people living with HIV – adults and children.
In 2007 world report, so as in previous reports, low rates of infections – in comparison with other regions – have led EMR governments to dismiss AIDS cases as insignificant and to show complacency in taking actions. Crises such as housing, education and economy have taken governments’ attention and had HIV/AIDS labeled as a low priority. Some of EMA countries think conservatism will heal off the epidemic. It is true EMA countries are conservative, however, HIV infects people indiscriminately. Even though complex sets of religion and culture might influence the way HIV/AIDS epidemic is handled, one cannot dismiss it as simply irreligious or culturally taboo to talk about.
Credible and reliable data on HIV epidemiology and preventive measures are limited in Islamic countries. Islam prohibits non-martial sex, homosexuality and intravenous drug use. This, to some extent, explains the relatively low HIV cases – in comparison with international data. In 2004, BioMed Central (BMC) for Infectious Diseases published an eighteen-year surveillance study in Saudi Arabia (SA) focused on collecting data on HIV epidemiology, HIV prevention and care measures6. Sex and sexual practices are considered taboo in the conservative SA society. Those who are publicly chosen to be screened for sexually transmitted diseases are doomed to stigma. There are other detrimental penalties for those who are believed to have the virus. The study has been underway since 1984, conducted by healthcare facilities. Data was collected through screening of individuals who showed “clinical suspicion”6,. It was conducted by various governmental and non-governmental institutions, to facilitate the access to those who already have the virus, and those who are most susceptible of receiving the virus, with maintaining complete confidentiality and autonomy from factors affecting the results.
Results will be reported to the Ministry of Health (MOH) using unique identifying codes. Those groups, who have undergone routine testing, included HIV-infected patients, blood and organ donors, prisoners, intravenous drug users (IDUs), and those who have sexually transmitted diseases – HSV, etc. HIV testing is a compulsory, pre-requisite for employment in the SA. As for expatriates, they are tested upon their arrival and once more after two years, as they file their residency applications. Saudi patients who test positive will be referred to tertiary care HIV-specialized governmental clinics where highly active antiretroviral therapy (HAART) medications, in addition to further important laboratory tests such as the CD+8/CD+4 counts.
As a result, more than 6000 HIV/AIDS cases were recorded. More than half of which were non-Saudis. The study showed increase in numbers as it progressed. Although data was collected in 2001, it sends alarming indications that HIV is spreading throughout the population. Factors that could be put into consideration, such as the world recession and moving from centrally planned economy to a more capitalist economy, have been driving HIV-infections high. Consequently, big influx of expatriates from various countries have come to work in Saudi Arabia, which some of them may be carrying the virus. Moreover, socio-economic status of Saudis and wealth distribution have changed dramatically. It is scientifically proven that whenever a nation interacts more with other nations, it will eventually result in increased levels of HIV prevalence.
Prevention, treatment and care interventions have failed internationally to control the epidemic. They might have worked effectively in developing countries, but the limitation of resources along with the described complacency made the HIV prevail in the Arab region. Moreover, even if the medications are readily available, good slice of the population will not be able to afford them. This is a huge issue that some are working on solving it by introducing free medications7 and/or subsidize them for those who are in need. This will, ultimately, reduce the HIV levels and help those who have AIDS to receive the meds required to prolong their life expectancy.
Furthermore, stigma plays major role in combating the virus. More than hundred Non-Governmental Organizations (NGOs) have been active in a number of prevention efforts in the EMR region to reach out for stigmatized patients and those of high risk5. These particular groups might be hesitant or reluctant to seek a conventional governmental help since their behavioral is not accepted in the society, and the virus is highly stigmatized in the region. These groups include prostitutes, IDUs, and homosexual males. All previously noted indications have funneled in the creation of a new policy that advocates for the universal access of treatment for HIV, malaria and other diseases. The program is introduced by United Nations Developing Group (UNDG) to help introduce the HIV/AIDS topic and break the stigma associated with it – in addition to providing key medications needed – in the Arab region. The United Nations Education, Scientific and Cultural Organizations (UNESCO) office in Beirut, Lebanon has mobilized several financial and human resources to work on the issue. These resources will also be working on the UN initiative Focusing Resources for Effective School Health (FRESH)9 to utilize the public and empower local NGOs to effectively addressing the key health issues afflicting their country. In addition to that, the initiative acknowledges the lack of awareness and education about HIV/AIDS and pledges that more openness should be applied to topics such as sex, sexual diseases, and blood-borne diseases.
Because NGOs are grassroots organizations that operate locally, they tend to understand their community and have a better understanding about its needs. They understand the sensitiveness of the cultural as well as speak the language of people. Those organizations have proven themselves reliable and instrumental in tackling the HIV epidemic. Those organizations include the Arab Scouts Movement, the Somalian AIDS Protection Group, the Egyptian AIDS Society, the Syrian Women Union, the Health-Environment Club of Djibouti, and the National Society Facing AIDS – Egypt, among other Moroccan, Sudanese, and Lebanese and Iranian societies. Those societies were instrumental in organizing a World AIDS Day in the EMR, and organizing educational activities such as that of the Health-Environment Club – Djibouti – that incorporated HIV education in an environmental protection program. These programs, among numerous others, raised awareness and broke some of the chains that were locking HIV/AIDS patients.
As noted earlier, it may seem that EMR is not as important region as others are with a high HIV prevalence, nevertheless, I believe that a region with a steady increasing rate is far more important and risky that a regular region with steady HIV rates. In addition to that, I chose this region because it pertains to me personally since I was exposed to overwhelming HIV/AIDS data and research points, in the class, that made me think about my original region – the Middle East. Another reason why this region was chosen is that there is no reliable data that can prove what the HIV-prevalence rates are like there. That subsequently drives people off researching the region to solidify the data.
Apart from that, since the actions of high-risk groups are highly intolerant and unacceptable by the people of the EMR countries, it was hard to focus on one group and talk extensively about. In addition, because simply there was no credible data to draw conclusions from and to draw lines as to which group is mostly at risk. However, it is universally known that the members of high-groups are injection drug users, prostitutes, homosexuality and men who have sex with men10. Therefore, factors such as religion and conservatism sometimes have a say in this, and might determine the future of those individuals.
Moreover, religions and conservatism among EMR communities not only combat HIV/AIDS in their own classical ways – intolerance and stigma, but also they were proved instrumental as they can alter preconceived notions concerning HIV-related issues. Patients will suffer detrimental effects if they were to be neglected. Proper care and treatment interventions are yet to be provided. Basic medical needs hard to be provided if the international committee and HIV-organizations are not able to acknowledge the need of this small number of people. If those HIV-carriers could not get a proper education about their virus, or did not get their medicine, that will result in devastating events that have multilateral affects among the EMR region. My goal is to draw attention to the dangerous region in hoping for people to acknowledge its importance in terms of HIV-prevalence. And since various groups and regions were mentioned throughout the quarter, EMR was not one of them. Hopefully by writing this paper, I’m contributing to help the EMR countries by spreading the word about them. This is one of the lessons that I learned in the Discover Chicago AIDS class – speaking out and letting people know about HIV-related issues.
Those all noted reasons were driven from the fact that I gained so much knowledge, and learned a lot about HIV/AIDS throughout the Immersion Week and the Fall Quarter that made me think about my original region. This concern, empathy, and determination are important things that I believe I will walk out of the class with. I not only learned about the politics surrounding the epidemic and legality issues, but also learned about different levels of discrimination among homosexuals and other members of the high-risk group. In addition to that, the class drew to my attention the facts and statistics of the Chicago HIV/AIDS community in particular and the United States’ in general. I also learned about the various services and intervention measures applied by a number of community-based and not-for-profit or corporate setting organizations, which ultimately lead to the process of decision-making.
To conclude, I’m planning on doing several things in the course of near future. First thing is to speak out and let people know that HIV/AIDS is a serious epidemic and we should join efforts in combating it by simply being opened up to HIV/AIDS education. I believe that being open about the epidemic and accept those who have the virus is as crucial as administering medications that prolong life because if those individuals were not accepted and embraced by their loved ones, devastating psychological and epidemiological effects might happen. I remember visiting the Broadway Youth Center – a non-for-profit organization – and seeing a wall of sticky notes in which some of their clients wrote things. One of the notes that grabbed my attention was a one that said ‘I want to be loved and embraced’!
Second thing I want to do is that I will volunteer to an organization called Project VIDA – a non-for-profit community-based organization. Since they are community based, they know exactly what their community needs and what things have to be done to combat the virus. Their services range from food catering and free testing, to case management, free condoms, and others. Some of their services grabbed my attention – massaging and acupuncture. Among the things I learned there, I learned that providing services such as massaging and acupuncture are crucial to those who live with HIV/AIDS. I previously thought that services like that were not to be offered for the fear of contracting the disease.
The third thing, I will try to talk about the Needle Exchange Programs and write about them in the DePaulia newspaper. My story was previously rejected; however, I will keep on pushing the story on them and see what happens. The fourth thing I want to do is talk to my friends back home and explain to them what HIV really is. There is huge misconception about HIV/AIDS among my friends. This is definitely an area I have not tackled before, but thanks to discover class, now I am. In addition to that, the International Fund activity that Andrew conducted with the class has drawn a better picture of the logistics of the combating HIV/AIDS and that tied some loose ends I had. Therefore, I have recently made a contributed to the Chicago AIDS Foundation, and will send them an email asking about a monthly program, similar to Children International and Doctors Without Borders, that I can enroll in and make my monthly contributions for a great cause.
Finally yet importantly, I’m planning on distributing condoms to the Lincoln Park campus by dressing up as a big condom. I have previously distributed condoms to my floor mates without their knowing. They woke up in the morning with a condom and a sticky note that says ‘be safe’! A big number of college students engage in sexual intercourses throughout their college life. Drawing from the Discover Class experiences, such as Chicago Women’s AIDS Project (CWAP), safer sex practices are highly recommended since college campuses have a mixture of students from virtually everywhere.
 The Joint United Nations Program (UNAIDS) “Insight into AIDS responses in Middle East and North Africa
 Sandy, Sufian. “HIV/AIDS in the Middle East and North Africa: A Primer.” Middle East Report.
 U.S. Centers for Disease Control and Prevention, . “HIV/AIDS in Arab World Up 300 Percent.”
2 Sandy, Sufian. “HIV/AIDS in the Middle East and North Africa: A Primer.” Middle East Report.
 “Middle East.” Encyclopædia Britannica. Encyclopædia Britannica 2009 Student and Home Edition. Chicago: Encyclopædia Britannica, 2009
 A., Raymond. Encyclopedia of AIDS: a social, political, cultural, and scientific record of the HIV epidemic. Ill. Routledge, 1998. p355-58
 BioMed Central . “Epidemiology of the human immunodeficiency virus in Saudi Arabia; 18-year surveillance results and prevention from an Islamic perspective.
 Draper, Robert Franklin. “Antiretroviral drugs help HIV patients, specialists say.” Yemen Times
6 BioMed Central . “Epidemiology of the human immunodeficiency virus in Saudi Arabia; 18-year surveillance results and prevention from an Islamic perspective.
 UNDG, “MDG-6: Combat HIV/AIDS, Malaria and Other Diseases.” UNDG/Middle East 1-2.
7 Draper, Robert Franklin. “Antiretroviral drugs help HIV patients, specialists say.” Yemen Times
5 A., Raymond. Encyclopedia of AIDS: a social, political, cultural, and scientific record of the HIV epidemic. Ill. Routledge, 1998. p355-58