UNAIDS is a joint United Nations programme on HIV and AIDS, forming a coalition between 11 entities, many of which took part in helping coordinate and build capacity for assessing the situation of people living with HIV (PLHIV) in Egypt and providing them with help and solutions to the many obstacles they face in the community.
Ahram Online caught up with Dr Ahmed Khamis, UNAIDS Egypt country manager, to understand more about HIV in Egypt now, and to separate fact from myth.
Ahram Online (AO): When exactly did the cooperation between UNAIDS and Egypt begin?
Dr Ahmed Khamis (AK): The work of UNAIDS in Egypt started with the new millennium. We gladly work hand in hand with the National Aids Programme in Egypt (NAP), which was initiated in 1987, just one year after the discovery of the first case in the country.
(AO): Please tell us more about the real numbers.
(AK): We cannot deny that for years contradictions and inaccuracies were reported with regards to the numbers of (PLHIV) in Egypt.
The UN would report a number, and the ministry would report another. This stopped four years ago, and the consensus number currently agreed upon is around 7,500.
(AO): What is the truth about a surge occurring in the numbers recently?
(AK): It is true that the regional numbers have increased by a whopping 300 percent from 2001 to 2011. As for Egypt, confirmed new cases used to be around 400 each year, till 2011.
In 2012 and 2013, this increased to 600 new cases yearly, and in 2014, the number of new cases reached a staggering 880.
(AO): And the reasons behind this surge?
(AK): Of course, civil society does a lot to raise awareness, so people undergo the tests. Nevertheless we cannot deny that unguarded risk activities are on the rise, and the social stigma hinders many efforts aimed at curbing the problem.
D Ahmed Khamis , Photo by Ahram Online
(AO): When is testing obligatory?
(AK): Only for foreigners who apply for residence or seek work permits. For Egyptians, some paperwork and medical procedures require testing for HIV, among other infections, but we don't encourage forced testing, but rather raising awareness regarding doing it voluntarily, especially that there is what we call "the window period," which comes right after infection, lasting for around three months and giving negative results. So mandatory testing might not really yield accurate results.
(AO): What about pregnant women? Does the ministry enforce mandatory tests?
(AK): No. Testing is encouraged, but not provided automatically, because there are other priorities. Testing the millions who get pregnant each year will burden the budget of the ministry. They simply cannot do it.
(AO): How are these numbers gathered?
(AK): Many through voluntary testing, while the majority of the cases detected (around 70 percent) come to be known through lab tests that are required for various medical reasons.
(AO): What is the highest ranking group in terms of infection in Egypt?
(AK): People who inject drugs. That’s why huge efforts are made by generous civil organisations and ex-drug users to engage with these people and raise awareness.
(AO): In that regard, are there needle exchange programmes implemented in Egypt?
(AK): This is a complicated issue in Egypt. What we do is that we implement other harm reduction strategies, like targeting certain groups and providing them with alternatives to reject abusive habits.
(AO): Are the cases associated with certain parts of Egypt more than others?
(AK): People still believe that touristic cities tend to have more PLHIV. This is a myth.
Cases in Egypt are not restricted to one place or governorate, neither are they restricted to some social segments. In general, most PLHIV live in Cairo, Alexandria, and Gharbia governorate.
(AO): What degree of secrecy and confidentiality is provided for people, to encourage new testing?
(AK): The Ministry of Health has dedicated a number (0-800-700-8000) for those who have any questions. The number of the caller remains unseen and anonymous. Those in charge of responding to the calls are qualified and trained.
Many hospitals now place testing and counseling units alongside other units for contagious diseases, like Hepatitis C for example, to provide some level of anonymity.
We encourage that people test in hospitals that provide pre- and post-counseling, rather than just private labs.
(AO): Post-exposure (given after exposure, to prevent infection) and pre-exposure prophylaxis (given before): are they available in Egypt?
(AK): The former is available and free for medical personnel according to an already established protocol under the Ministry of Health. The latter is not.
(AO): What about the medication provided to patients?
(AK): Now, we provide the medications that are almost top of the line and conform to the latest international guidelines.
Although the single-dose pill is still not available in Egypt, current treatments are very good and no more do we provide those that used to result in terrible side effects.
(AO): Let's talk about stigma and tackle the most disturbing aspect of it — within the medical profession. From where do reports of stigmatising and negative reactions of doctors and nurses really stem?
(AK): This is complex and has a lot to do with the general perception of the public, which results in panic when encountering an HIV positive person in a medical facility.
Take also into consideration that the panic comes from the scarcity of incidents. Compared to other medical problems, coming across HIV is still rare and unusual. Add to that that there is still a lack of trust with regards to levels of infection control.
Nevertheless, we cannot generalise, and many doctors are perfectly capable of dealing with the issue.
UNAIDS, the Ministry of Health, and many Egyptian universities are collaborating now to provide medical personnel with more training in that regard.
We have been working with the medical sector that deals with PLHIV according to the latest guidelines, issued May 2014 in Egypt.
(AO): According to the latest international guidelines, treatment is recommended to start upon diagnosis. Does this happen in Egypt?
(AK): We have been working within the latest guidelines issued May 2014 in Egypt. Nevertheless, we don’t do "Test and Treat," but rather start when the level of CT4 in the blood is 500.
Our problem in Egypt is not the initiation of treatment, but rather adherence to it.
(AO): And how do you see to it that people adhere to treatment after diagnosis?
(AK): We have started the implementation of case management, providing case workers that follow up with the person diagnosed, to help him or her adhere to the treatment.
This started already in many health centres associated with the Ministry of Health. Many civil society organisations reach out with a helping hand in that regard.
(AO): Worldwide 60 to 70 percent of those diagnosed with HIV suffer depression. Is there a psychological help extended to PLHIV in Egypt?
(AK): The percentage here is even greater in term of depression, due to the level of stigma. A few years ago there was help extended through grants given from abroad.
Unfortunately, these grants have ceased to exist, but psychological support now is extended through the efforts of many civil society organisations, who organise support groups and so forth.