Battling AIDS' Stigma in Egypt

By Laura Sheahen

"I've seen friends reject friends," says Sany Kozman, a doctor who manages AIDS programs in the Egyptian city of Alexandria. "I've seen husbands reject wives, and siblings reject a brother or a sister."

"But I'd never seen a mother reject her child."

Kozman sighs while telling the story of a patient whose family learned his secret: He had AIDS. Ashamed of her son, his mother forced him to live in the family's damp, sunless basement, and told his siblings not to visit him. The man died shortly after.

"In Egypt, AIDS is surrounded by three S's," says Kozman, a physician who works for Catholic Relief Services partner Caritas. "Shame, silence and stigma."

Taboos and stereotypes about HIV transmission plague many Middle Eastern countries, and Egypt is no exception. Some people lose their jobs when it's discovered they have the virus. Egyptian newspapers have printed the names of HIV-positive people. Dr. Kozman recalls an HIV-positive woman in Alexandria who needed a gallbladder operation. "No surgeon would operate on her," he says. She died, leaving three children orphaned.

Though the Middle East is considered a low-prevalence area for HIV, the United Nations estimates that 380,000 people in the region are infected. According to the U.N., 25,000 people died of the disease in 2007. Egypt has recorded 2,500 cases based on testing; of these, 1,600 people are still living, says Kozman. The U.N. estimates that the true number of infected Egyptians is 9,000.

No Longer a Death Sentence

Lifesaving antiretroviral therapy was slow to make its way to Egypt.

"In the late 1990s, I would just give my patients counseling and pray with them, because there was no treatment here," says Kozman. In 2003, Kozman brought two HIV-positive Egyptian men to an AIDS conference in Kampala, Uganda. There, they met HIV-positive Sudanese men who had been alive for a decade.

The Egyptian men wept, remembers Kozman. "They realized, 'This is not the end of my life.' " In 2004, antiretroviral drugs became more widely available in Egypt.

For years, Caritas Egypt has offered medical care, run HIV support groups and helped people who run a higher risk of contracting HIV. Kozman is particularly worried about sexually transmitted diseases among Egypt's many street children, who grow up in cities on their own. "Their lives are not so important for them, because no one cares about them," says Kozman. "We teach children that their lives have value. Then we can teach them how to protect their lives and their health."

Educating Teens

Teaching young people about AIDS is the goal of a new Caritas program funded in part by Catholic Relief Services. Reaching hundreds of Alexandria's teenagers, the program works with both Muslim and Christian leaders to organize youth awareness activities in mosques and churches. The teens—ages 14 to 18—design their own projects, like awareness fairs, mini-magazines and computer projects. Teens are also trained to talk to their peers, "making sure that positive messages on HIV are rolled out in the communities," says Radwa Rabie, program manager at CRS Egypt. Abstinence and marital fidelity are cornerstones of the program.

The program combats stereotypes by showing teens that people living with HIV are not to be feared. For example, HIV-positive people play soccer and basketball with teens during special sports days.

Kozman has already seen similar programs pay off. "We've succeeded in schools. We want to succeed in churches and mosques," he says. One of his patients saw a Caritas youth program and commented, "If I had had the chance these young people do, I would never have gotten HIV."

New Beginnings

Caritas Egypt continues to support people most of society has written off. In addition to offering medical care and testing, Caritas found jobs for seven people who were fired when their HIV status was exposed.

For people who thought their lives were ending, the Caritas support groups have led to surprising new beginnings. "We've had five marriages between HIV-positive couples who met at Caritas," says Kozman. "One had a baby who is HIV-negative." The mother had a Caesarean and avoided breastfeeding to ensure the baby would remain HIV-free.

Kozman has faced criticism for helping people who have HIV. Even some of his family members are skittish. "My wife is understanding, but my mother is afraid I might get HIV," says Kozman. "She wants me to change to another job."

Despite the fear around him, Kozman draws strength from his Coptic Christian faith. "This is the goal of my life. God wants me to be here," he says. "He's pushing me to do these things. He gave me a gift for this."

Laura Sheahen is CRS' regional information officer for Europe and the Middle East. She is based in Cairo.