Credit: Courtesy of UNAIDS/P.Virot
Although the incidence of HIV in the Middle East and North Africa (MENA) region is one of the lowest globally, with only 270,000 reported cases (1) that does not mean that the spread of HIV isn’t a threat. Since 2001, the number of new HIV infections has increased by 52 percent (2), the largest increase of all the world’s regions. According to another study, the total number of AIDS-related deaths has increased sixfold (3) since the 1990s. The majority of the reported cases of people living with HIV have been male, though experts have suggested that the epidemic is becoming more feminized. It is critical not only to curb the spread of HIV, but also to educate and protect women who may be less knowledgeable about the disease.
The first AIDS cases appeared in the MENA region in the 1980s, and were the result of HIV-contaminated blood products and organs, or exposure from individuals abroad. In the Middle East, HIV has certainly been an outside disease that did not pose a significant threat to the Arab people. The region’s low prevalence of HIV is often attributed (4) to the conservative social framework present in Muslim majority countries. Discouragement of the consumption of alcohol, as well as strict moral guidelines concerning premarital and extramarital relations that are characteristic of Islamic doctrine, reduce risky behaviors that could lead to the spread of HIV, but social conservatism also presents significant difficulties when it comes to education and prevention of the disease. Statistics of the number of incidents in the region could be greatly underestimated given the social risk involved with admitting one’s illness, and the perceived illegal or immoral behavior that caused it.
The majority of HIV infection in the MENA region is concentrated within the high-risk groups of men who have sex with men, female sex workers, and injection drug users. In North Africa, the prevalence of HIV among these risk groups is between 5 percent to 10 percent (5). The social stigma associated with these groups makes education, tracking, and treatment extremely difficult. These at-risk populations, while at the fringe of society and highly stigmatized, are not that far disconnected from the general population. Men in the region have more freedom of mobility and choice, particularly when it comes to choices regarding their sexual activity, and female sex workers are present in the region, particularly in wealthier countries and cities.
These risks not only impact the lives of these men, but their wives and children as well. Several countries, such as Oman, test all pregnant women for the disease. Through these tests, HIV infections have been found among pregnant women (6) who have displayed no identifiable risk behaviors, which could indicate that their husbands’ choices are endangering their health. “The single biggest risk factor for women is actually marriage, because most women in the region who have HIV have gotten it through their husbands,” said Dr. Jocelyn DeJong, professor and associate dean of the Faculty of Health Sciences at the American University of Beirut, in an interview with the author. Other gender-based cultural norms such as early marriage, polygamy and large age gaps between spouses further expose women (7) due to the higher number of sexual partners to which their spouses were exposed.
For women who have contracted HIV, a decision to go public with their status and seek treatment and support will likely lead to public scrutiny and abandonment. An announcement of an HIV positive diagnosis, which is often associated with immoral practices, is especially detrimental to women due to the societal expectations surrounding female behavior and modesty. The MENA-Rosa Association, dedicated to providing a voice for women living with HIV in the Middle East, provided a heartbreaking account of women’s experiences with the disease. “I live on charity. I even started to beg … I am even asking for money for transportation in order to come to the hospital,” (8) shared a Moroccan woman living with HIV.
In order to curb the rapid increase in HIV infections, policy must be set in place to advance education about the disease, with a focus on the ways that women typically contract the disease and a compassionate rather than disdainful approach to those living with HIV. “Politicians need to link these issues more to public health and the common good,” said Dr. Rana Jawad, lecturer in social policy at the University of Bath in an interview with the author. This year the Council of Arab Ministers of Health have endorsed a regional strategy (9) to combat HIV/AIDS, yet the stigma against people living with HIV continues to prevent people from getting tested and treated. Premarital HIV testing should be a requirement for both men and women to allow partners to protect themselves. The U.S. and other international organizations can help by establishing clinics to treat those living with HIV, as well as educate individuals who could be at risk, including married, monogamous women, without judgment and with full anonymity.
Footnotes
1. Hamidreza Setayesh, Farzaneh Roudi-Fahimi, Shereen El Feki, and Lori S. Ashford. HIV and AIDS in the Middle East and North Africa. Population Reference Bureau (2014), 3 Accessed June 24, 2014. http://www.prb.org/Publications/Reports/2014/middle-east-hiv-aids.aspx..
2. Hamidreza Setayesh, Farzaneh Roudi-Fahimi, Shereen El Feki, and Lori Ashford. HIV in the Middle East: Low Prevalence but Not Low Risk. Population Reference Bureau (2013). Accessed June 20, 2014. http://www.prb.org/Publications/Articles/2013/hiv-aids-in-middle-east.aspx.
3. Carol Jenkins and David A. Robalino. HIV/AIDS in the Middle East and North Africa: The Costs of Inaction (Washington: The World Bank, 2003), 13.
4. Setayesh et al., HIV and AIDS, 5.
5. Setayesh et al., HIV and AIDS, 4.
6. Laith J. Abu-Raddad et al., Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa (Washington: The World Bank, 2010), 61.
7. Carla Makhlouf Obermeyer, “HIV in the Middle East,” British Medical Journal 333(2006), accessed June 20, 2014, doi: 10.1136/bmj.38994.400370.7C.
8. Standing Up Speaking Out: Women and HIV in the Middle East and North Africa, UNAIDS (2012), 18.
9. Technical Secretariat of the Council of Arab Ministers of Health League of Arab States, Arab Strategic Framework for the Response to HIV and AIDS (2020-2014), accessed June 20, 2014, http://www.menahra.org/images/pdf/Arab_AIDS_Strategy_-_English_-_Final.pdf.
Ariana Marnicio is the research analyst for the Women and Human Rights in the Middle East Program at Rice University’s Baker Institute. She graduated from Georgetown University with a degree in Arabic, and has lived in Egypt, Jordan and Oman. Her areas of interest include Arab culture, Islam and sexuality studies.