The new millennium witnessed the onset of the UNAIDS' work in Egypt, hand in hand with the National AIDS Programme (NAP), initiated in 1987, just one year after discovering the first case in the country.

The Joint United Nations Programme on HIV and AIDS (UNAIDS) had formed a coalition among 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.

Lately, the International Organization for Migration (IOM) has cooperated with the coalition to address the migrant sector.

Ahram Online: Please tell us more about the latest statistics.

Walid Kamal: According to UNAIDS' latest report in 2024, the registered number of PLHIV in Egypt is around 23,000, while the estimated number reaches up to 43,000.

The number of new cases registered in the last year was around 5,500.

AO: How are these numbers gathered?

WK: UNAIDS cooperates with the Egyptian governorate to gather information each year from January to March, conducting data surveys through various transparent indicators.

The majority of the cases detected are confirmed through lab tests that are required for various medical reasons.

Secrecy and anonymity of the data for those who test are 100 percent guaranteed.

AO: When is testing obligatory? And what about refugees and immigrants?

WK: For Egyptians, some paperwork and medical procedures require testing for HIV, among other infections.

Otherwise, we do not force testing but rather raise awareness regarding doing it voluntarily, especially since there is what we call "the window period," which comes right after infection, lasts for around three months, and gives negative results. So, mandatory testing might not yield accurate results.

HIV testing is obligatory only for foreigners who apply for residence, seek work permits, or study and stay for more than three months. It is not mandatory for refugees or migrants.

AO: What about pregnant women? Does the ministry enforce mandatory tests?

WK: There has been an initiative to test pregnant women for three leading indicators, Syphilis, HIV, and Hepatitis B, since 2020. The test is not obligatory and is conducted in around 5,000 health facilities nationwide.

Pregnancies for women living with HIV in Egypt have produced zero infected babies since 2012. The problem stems when the woman discovers her infection after delivery.

The baby is born healthy as long as the woman abides by the medication provided through the health package and as long as the delivery is through C-section and the mother does not breastfeed the baby.

AO: Are there more cases associated with certain parts of Egypt than others? What is the highest-ranking group in terms of infection in Egypt?

WK: Previously, the prevalence was in the main cities like Cairo and Alexandria, but now many governorates, especially the highly populated ones like Qalyoubia, Dakahliya, and Minya, have a large number of PLHIV.

The highest infection rate is still among people who inject drugs. That is why massive efforts are made to engage with those people and raise their awareness.

AO: In that regard, are there needle-exchange programmers implemented in Egypt?

WK: We implement harm-reduction strategies, one of which is providing clean needles, but only through certain health centres affiliated with the Ministry of Health or through civil organizations. This is also in line with the strategy of eliminating the Hepatitis C virus.

AO: To encourage new testing, what degree of secrecy and confidentiality is provided for people?

WK: The Ministry of Health has dedicated a phone number for receiving any questions. The caller's number remains unseen and anonymous. Those in charge of responding to the calls are qualified and trained.

Many hospitals now place testing and counselling units alongside other units for contagious diseases, like Hepatitis C, to provide some level of anonymity.

AO: According to the latest international guidelines, treatment should start upon diagnosis. Does this happen in Egypt?

WK: We have been working within the latest guidelines. Since 2014, we have been providing free medication in Egypt according to the "Test and Treat" guidelines, regardless of the level of CT4 in the blood, with a maximum of 14 days between diagnosis and medication initiation.

AO: What about the medication provided?

WK: Now, we provide medications that are almost top-of-the-line and conform to the latest international guidelines.

Although the single-dose pill is still not widely available in Egypt, current treatments (two pills daily) are very good, and we no longer provide those which used to result in terrible side effects.

AO: How do you see people's adherence to treatment after diagnosis?

WK: Unfortunately, the percentage of those who periodically perform the PCR test to confirm viral suppression is small.

However, those who performed the PCR test registered 97 percent suppression results.

We have started implementing case management, providing case workers who follow up with the person diagnosed to help him or her adhere to the treatment. We have also provided literacy and awareness networks and social support groups.

Furthermore, many pharmacists volunteer to help provide data for those who get the medications regularly.

AO: Are post-exposure prophylaxis (given after exposure to prevent infection) and pre-exposure prophylaxis (given before exposure) available in Egypt?

WK: The former is available and accessible for health care providers (within 72 hours of exposure) according to an already established protocol under the Ministry of Health, and also for some cases like those subjected to sexual violence or rape.

The latter is not available, but currently, there are pilot projects that will see into rolling it out according to specific operational guidance.

AO: Worldwide, 60 to 70 percent of those diagnosed with HIV suffer from depression. Is there mental health support extended to PLHIV in Egypt?

WK: The percentage here is even greater due to the level of stigma. Since COVID-19, online support has been extended with great success. The embassy of the Netherlands extended help in that regard, and special programmes were designated especially for women in nine governorates.

The embassy also extended job opportunities to 150 women living with the virus to support the women's economic empowerment programmes.

AO: Let us talk about stigma and tackle its most disturbing aspect within the medical profession. Where do reports of stigmatizing and adverse reactions of doctors and nurses stem from?

WK: UNAIDS, the Ministry of Health, religious figures, and NGOs are continuously collaborating to provide awareness. In general, easy access to information means that people are more understanding of the nature of the disease and the means of transmission.

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.

Additionally, take into consideration that panic comes from the scarcity of incidents. Compared to other medical problems, coming across HIV is still rare and unusual. In addition, there is still a lack of trust regarding levels of infection control.

Nevertheless, we cannot generalize, and many doctors can deal with the issue.