Step out of the dark ages

Step out of the dark ages: the spread of the HIV/Aids virus is a tragedy not a stain on the honour of the world community. And until all nations--including those of the Middle East--stop apportioning blame and direct their attentions towards education and prevention programmes, the devastation will continue

THE HIV/AIDS PANDEMIC has officially been with us since 1981, when it was recognised by the US Centres for Disease Control and Prevention. The trickle of recorded cases in the previous decades turned into something more worrying and the World Health Organisation (WHO) figures estimate that, just a quarter of a century on, 33m men, women and children worldwide are living with the disease, with 25m having died from it during that time.

The joint United Nations programme, UNAIDS, reports that 380,000 adults and children in the Middle East are living with HIV, with 35,000 newly infected last year alone.

And those are just the reported cases. It is feared the true number is much higher, but that cultural pressure has rendered many sufferers reluctant to come forward even to be tested.

That fear could only have been reinforced by the arrests, in recent months, of 12 men in Egypt for allegedly being infected with HIV. Egyptian police, it seems, look upon HIV infection--not as a disease to be treated--but as incriminating evidence that a crime has been committed. Four have already been sentenced to a year in prison for the offence of "habitual debauchery".

The Egyptian authorities, on being presented with those men, inferred from the presence of HIV in their bodies that they had committed homosexual acts. Homosexuality itself is not against the law in Egypt; but there are a raft of other laws under which those suspected of conducting homosexual acts can be prosecuted--habitual debauchery being one of them.

Quite apart from the argument that homosexual acts are not necessarily debauched (depending entirely, admittedly, on how you feel about the act itself), the inference drawn by the Egyptian authorities is flawed to begin with.

HIV, or, to give it its full name, the human immunodeficiency virus, can be transmitted in a number of ways. Unprotected sexual intercourse is the most common method, with women just as vulnerable as men. However, transfusions of infected blood--largely eradicated in the developed world since the introduction of automatic screening of blood donations--is one and the sharing of infected needles is another; as is the passing on of the virus from pregnant women to their unborn children in the womb.

Although the pandemic first came to international attention due to the infection rate among gay men, we have learned that heterosexual men, women and children of either sexual orientation can and do become infected for a variety of reasons. Therefore, any conviction for debauched acts based solely on HIV/Aids infection can only be unsound.

Particularly so in the case of the Egyptian men convicted on that basis as no other evidence was offered and the men pleaded not guilty.

Among the groups anxious about the ramifications of these arrests and convictions, Human Rights Watch (HRW) has voiced concerns that such actions will make preventing the continued spread of HIV/ Aids in the Middle East even more difficult. Speaking on behalf of HRW, Rebecca Schleifer, advocate for the HIV/Aids and Human Rights Programme noted: "In their misguided attempt to apply Egypt's unjust law on homosexual conduct, authorities are carrying on a crackdown against people living with HIV/Aids. This not only violates the most basic rights of people living with HIV, it also threatens public health, by making it dangerous for anyone to seek information about HIV prevention or treatment."

Of further concern to HRW was, according to the Egyptian Initiative for Personal Rights (EIPR) the "coercion" of names of further suspects from the men in detention. And in all the cases, the men were forced to provide samples of blood for testing, without their consent, and, when found to be infected, all were chained to their hospital beds: the authorities citing concerns for public health.

The chain of events which led to the 12 men being arrested was put into motion when two men were arrested for fighting in the street. When one of the men admitted to being HIV-positive, both men were taken to be interrogated by the Morality Police where, it is alleged by the men's lawyers, they were beaten into providing the names of friends and former sexual partners. According to HRW, the examinations that the men had to endure, which were designed to "prove" the men had taken part in homosexual acts, amount to torture. Allegations of torture against the police have also been made by the other men arrested.

The organisation also reminds the Egyptian government that in criminalising consensual homosexual conduct they are in violation of their obligations under international human rights law, particularly in regard to the right to privacy and personal autonomy.

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Traditionally, governments in the Middle East have been in denial of the full extent of the problem that HIV/Aids presents. Much of the blame for the presence of the virus in the Middle East is placed on foreign workers and tourists. The idea that members of their own population could be engaging in pre-marital, unprotected sex, homosexual relations, the sharing of needles for injecting drugs and prostitution is simply not one they have hitherto been prepared to consider.

Countries that are more accepting of the reality of the spread of the virus, for the most part, have been able to restrict it to high risk groups, such as drug users who share needles, and sex workers. The lack of public information and programmes to deal with the spread of the virus in much of the Middle East means that ordinarily low risk groups, including married women, are falling victim at an alarming rate.

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In many parts of the world, the social status of women means they are not able to negotiate the use of condoms, which are an effective method of preventing infection. And that is only where education regarding prevention has reached them. In many areas, this is simply not the case and women's ignorance of the facts is proving fatal.

Awareness of HIV/Aids among Egypt's population as a whole has been found to be low and among the country's women it is even lower, with surveys putting the figure at well below 10%. Testing for the infection is also low.

UN programmes have been initiated to improve both aspects of prevention, but they admit their reach is limited and that, without greater partnership with the government, will remain so.

One way around the reluctance to test for the virus is to combine the test with that for hepatitis C, itself a significant problem, but one that does not have the same social stigma attached to it.

But as long as infection is used as evidence against the carrier, the efforts of groups whose aim, in the absence of a cure, is to prevent the spread of the virus through testing and education, will be undermined. As will the safety of the public, for which any government is ultimately responsible.