With infection growth rates second only to Eastern Europe, the pandemic poses a mortal threat in the Arab world. But an effective response seems years away.
Arab countries have some of the world's fastest growing rates of HIV infection, but their governments and religious authorities have been slow to address the problem. That was the message last week from a Cairo conference organized by the Arab League and the UN Development Program, which drew together more than 300 leading religious figures from 20 Arab countries, and was jointly led by Sheikh Mohamed Sayed Tantawi, the Grand Imam of Al-Azhar Mosque — which is influential throughout the Sunni Muslim world — and Pope Shenouda III, head of the Coptic Orthodox Church and President of the Middle East Council of Churches.
The conference was told that a new HIV infection occurs every ten minutes in the Arab world, and the region is threatened with a generalized AIDS pandemic similar to that of sub-Saharan Africa unless bold and effective measures are quickly implemented. Anywhere from 67,000 to 200,000 new infections occurred — and some 58,000 people died from AIDS — in the Arab world in 2005, but accurate data and surveys are lacking.
Religious leaders at the conference addressed themselves to some of the taboos inhibiting an effective response to HIV-AIDS. Some called on the faithful to accept AIDS patients and not close the doors of mercy in their faces even if they are viewed as having sinned — God forgives, and so must society, was the message. Religious leaders have a pivotal role in the campaign against AIDS in the Arab World, given the taboo nature of any discussion of sexuality and sexual freedom and the deeply religious nature of the prevailing social norms. Plainly, as the HIV-infection figures show, sexual relationships outside of marriage are a reality in the Arab world, but those occur behind closed doors. The political and religious authorities tend to deny the existence of homosexuality in their midst, and gays face jail or flagging if exposed.
So how did conference organizers get the clerics on board for a conference dedicated to tackling this taboo? Dr. Ihab Kharrat, a consultant with the regional AIDS program UNDP/HARPAS, says one of the most effective methods his organization used to mobilize religious leaders was to to bring them face to face with HIV-infected people and have them tell their stories. And they framed the discussion with the clerics of AIDS on the basis of non-judgmental religious compassion — the conference saw the signing of what is called the Chahama Pact in Cairo last week, establishing a network of religious leaders under the motto "religions in the service of the community."
Khadija Moalla, the regional coordinator for UNDP/HARPAS, a regional HIV/AIDS program, is extremely depressed and frustrated. She has been active in this campaign since 2002, and admits that she and other activists face a daunting challenge. "There is silence, denial, stigma and discrimination regarding HIV in the Arab World," says Moalla. Although most Arab governments have national programs to combat AIDS, these are nowhere near equal to the scale of the challenge. For example, the amount of treatment drugs made available through the public health system in Sudan is well short of the number of infections in that country. And in civil society, the enormous social stigma associated with the infection hinders efforts to slow its spread. That stigma discourages people from being tested, because acknowledging infection has been known to lead to sufferers being rejected by neighbors, families and employers.
"Eighty-five percent of those who are HIV positive are unaware that they are," says Moalla. Anti-retroviral drug treatment is available through the public health system in many of these countries, but few seek it also because of the social stigma and discrimination. Nor have Arab countries adopted laws to protect the civil rights of HIV-AIDS sufferers. Some statistics suggest that 4 out of 5 women HIV sufferers in the Arab World were infected by their husbands. And when the husband dies of the disease, his family will often disown the woman for fear she may be contagious. It is rare for Arab women to ask their husbands to get tested prior to marriage or to wear a condom during sex.
The wall of silence in the Arab media also hinders efforts to spread awareness about AIDS. Even though the rate of growth in HIV infection in the Arab world is second only to Eastern Europe, most people in the Arab world are barely aware that the disease exists in their society. Amr Moussa, the Secretary General of the Arab League, warned the conference that failure to respond aggressively to the threat of AIDS will reverse economic and development and will cost the region 35% of GDP in the next 25 years.
Even among those aware of the disease, the challenge for AIDS activists is to disabuse people of the conspiracy theory that HIV is coming to the region from the outside. "The reality everyone should know is that AIDS in the region is with us and that we are infecting our own people," says Moalla. But she's not optimistic about how soon people in the Arab world will accept the reality and begin to take responsibility for protecting themselves against infection.
Still, the Cairo conference represents a major step towards breaking the taboos that help HIV to spread unchecked. Regional UNDP director Amat al-Alim al-Soswa, addressing the event, expressed her satisfaction that the topic of AIDS is now discussed at Friday prayers and in Sunday sermons, because the clergy were an indispensable ally in the fight against the disease. By removing the shame of those living with HIV, she said, the religious leaders "went beyond a narrow and contemptuous attitude toward one embodying true magnanimity in knowledge, understanding and innovation."
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