Breaking the silence on HIV in Egypt

Magid, with his mother, credits his family’s support for allowing him to speak out about the virus [Adam Makary]

Thirty-one-year-old Magid is tired of being silent.

Diagnosed three years ago with HIV, the virus that causes AIDS, Magid, a resident of Alexandria, Egypt, kept his health status a secret from most, opting to tell only a handful of friends and family members weeks after he discovered he had been infected.

But he chose June of 2011 as the month in which he would shed his relative anonymity in Egypt and speak out as a voice for people living with the virus.

“Last week, I broke the silence by becoming the first Egyptian to speak out about AIDS,” he tells Al Jazeera, days after his appearance at a press conference organised by the Forum to Fight Stigma and Discrimination against People Living with HIV/AIDS in Egypt.

“I was scared. But Egypt [was] in urgent need for someone to do that, because people with HIV are suffering from stigma and discrimination. Policy makers, health workers – they consider us criminals. They say ‘there is no HIV in Egypt, we are a country of religion, of tradition, of good behaviour’. But they are in denial.”

Slim, soft-spoken and admittedly shy, Magid (who declined to give his last name) is one of an estimated 34 million people living with HIV/AIDS across the world, with about 11,000 estimated cases in Egypt. Of those, the UN estimates only 400 are seeking treatment in Egypt.

June marks 30 years since the first reported case of HIV was diagnosed, but the joint United Nations programme on HIV/AIDS (UNAIDS) estimates that nine million people eligible for treatment still do not have access.

Officials say many other people infected with the virus do not even know they have it.

‘Waiting to die’

Magid says he now knows how he got the virus, but at the time of his diagnosis the news came as a complete “shock”.

In depth

Magid has been billed as the first HIV-positive person to speak out in Egypt; he told his story to Al Jazeera’s Adam Makary

“I went to submit my papers for military service and found out I had to go through a series of blood tests – one of them was for HIV,” he says.

“But I wasn’t told they’d be testing me for AIDS. The results came out and it turned out I was HIV positive.”

Magid describes the time that followed as the “worst six months of my life”.

“I spent my days in complete and utter shock. I could only think about what others would now think of me now that I had HIV.

“I didn’t know anything about getting treatment or how I could live or what I could do or couldn’t do because of HIV. I was just waiting to die. And I remained like this for half a year in complete denial – I couldn’t come to terms with the unclear future that stood before me.

“I realised only after getting tested that I had taken the virus from someone else. Until now, I’m not sure if that person knows whether or not they are living with HIV because I haven’t seen them since that day.”

If he had not been tested by the military three years ago, Magid wonders if he would have ever known he had been infected. He says there is no excuse for forced testing, and says it is wrong for the military to make people undergo the tests without their knowledge or consent. And yet, Magid considers the experience a “God-send” – an opportunity that could have saved someone from catching the virus from him – and thus subsequently saving a life.

Months after his diagnosis, Magid joined Friends for Life, a non-governmental organisation in Egypt that works with people living with HIV/AIDS, where he says he was able to find “strength again”, learn about living with the virus and meet others facing the same challenges.

Earlier this year, Magid addressed a session of the UN General Assembly in New York, becoming the first Arab to speak publicly about his struggles with the virus.

Amidst his advocacy work, Magid remains wistful, and says often he wishes he could return to a time when he was considered “normal”. But these days, normal has a new definition.

Fastest-growing epidemics

Though he may be the first Egyptian to speak publicly about his HIV-positive status, Magid is certainly not alone, according to statistics provided in a new UN report.

Titled AIDS at 30: Nations at the Crossroads, the UNAIDS report says the Middle East and North Africa (MENA) region is one of two regions in the world with the fastest-growing AIDS epidemics.

Despite recent progress in getting the disease under control in many places around the world, UNAIDS says the MENA region has one of the highest rates of new infections, with an estimated 460,000 people currently living with HIV.

“We are a region that has our norms and culture and religion, so talking about sex and having an open dialogue is not that easy. “[But] we are all interconnected. If we don’t tackle the issue, it will come back to us” Lara Dabaghi, UNAIDS adviser

That number is still relatively low compared to other regions, UN officials say, but it indicates a rise in the rate of new infections among the most at-risk members of the region’s society.

The report places part of the blame for the rise of HIV/AIDS cases on stigma and discrimination that it says is prevalent across the region, imposing major obstacles to those seeking health services.

Lara Dabaghi, UNAIDS regional communications adviser for the Middle East and North Africa, says new infections also appear to be spreading due to low access to HIV prevention programmes for the most at-risk groups: sex workers, injecting drug users and men who participate in same-sex relations.

“These groups are highly stigmatised, so they don’t seek treatment,” she tells Al Jazeera from Cairo.

“Governments in the region do have treatment centres and they do offer treatment for free, but people do not access the treatment because of stigma and discrimination.”

Punitive laws also hinder many from seeking the treatment they require, Dabaghi says, driving those living with HIV/AIDS underground, but failing to address the root causes of the epidemic.

“We are a region that has our norms and culture and religion, so talking about sex and having an open dialogue is not that easy. But if you don’t address the topic and talk about it openly, [people infected with HIV] will hide,” she says.

“We cannot reach them with prevention programmes. If I know I’m going to prison, there is no way I’m going to seek prevention services. So I become the ‘hard-to-reach’ population: males having sex with males who then get married because of social pressure, then infect their wives. Or drug users who then infect their wives, who then pass it on to their families.

“We are all interconnected. If we don’t tackle the issue, it will come back to us.”

‘Concentrated epidemic’

In Egypt, part of the problem lies with the perception that the government does not fully acknowledge that there is a problem, says Dr Amani Massoud, the deputy director for the Right to Health Programme at the Egyptian Initiative for Personal Rights (EIPR), a human rights organisation based in Cairo.

The government has several programmes in place, including testing sites across the country and voluntary counselling, free anti-retro-viral medications and programmes targeting at risk groups.

But Massoud says stigma still surrounds the disease.

“We have a very small prevalence of HIV in Egypt, but it’s a concentrated epidemic and it’s growing among certain groups. The problem with ignoring these groups is that it hampers prevention efforts,” Massoud tells Al Jazeera.

“For years it was [believed to be] the disease you got from having sex with foreigners. So people are afraid to get tested; they don’t want to find out and they don’t want others to find out.

“The most severe stigma is in the health care treatment. Then of course you have stigma in the workplace – girls forced to leave their jobs once they reveal their HIV status. But there is very little knowledge of the way HIV is transmitted. Women often contract it from their husbands, but it’s because of lack of knowledge on how it’s spread.”

Tragic stories

However, that lack of knowledge can often seem pervasive among the general public for those living with the virus.

“I don’t hear anything about HIV in Egypt,” says Cairo taxi driver Hussein AbdelFattah, 28.

“I just know that it’s a serious disease and that it has something to do with blood and sexual intercourse. I probably don’t hear about it because of poor journalism and lack of awareness. I only have a vague idea of how someone can get HIV. Most people you find won’t know anything more.”

World leaders are meeting at UN headquarters in New York this week for a three-day summit to address the very issue of awareness and call for a sustained global response to the epidemic.

For Magid, that response must first start at home in Alexandria, Egypt.

“I see tragic stories everyday: someone who is banished from his home, someone who is not able to see a doctor because the doctor is refusing to see him,” Magid says.

“There are many people who have a high risk of acquiring HIV, for example a woman married to a man with HIV, so she will have HIV. If a parent with HIV has a baby, they too will have HIV – and when this baby grows up, society will think they did something sinful to turn out that way. Was this the baby’s fault? No, it’s not.

“The stories of my colleagues inspired me and encouraged me to [speak out],” he says, in a quiet moment of triumph. 

“There is no time for more silence. We have to raise our voices.”

Follow Malika Bilal @mmbilal and Adam Makary @adamakary on Twitter.