Even if we can cure AIDS, do we really want to?

Amani Massoud

When the Egyptian army's medical team announced it had invented two devices to detect and cure the viral infections HCV and HIV, it came under a fire of criticism from the scientific community.

The official announcement and subsequent statements by military spokespeople were fiercely ridiculed across social media platforms, but at the same time, others gave a standing ovation.

People who up to that point would have denied the existence of AIDS in Egypt were now applauding the Armed Forces for a device meant to cure a disease that the country supposedly didn’t have.

The more society rejects and marginalizes people living with HIV, the more reluctant the government is to address the real issues that are fueling the epidemic. The question is not whether or not we can cure AIDS, it’s whether or not we really want to.

My aim here is neither to critique nor support either argument. As far as I’m concerned, the device to “cure AIDS” could be as successful as its creators claim it to be.

What really caught my attention was that both supporters and skeptics were now openly talking about AIDS, as though it had always been on the public agenda. So if we now openly acknowledge that AIDS exists in Egypt and apparently know how to cure it, let’s actually talk about the virus.

In one if his many television appearances following the announcement of the miracle device, Major General Ibrahim Abdel Atty said, “A day will come when AIDS patients will be flaunting their disease, rather than being ashamed of it.”

His statements came only weeks before four gay men were sentenced to up to eight years in prison. Of all known HIV cases in Egypt, 20 percent have occurred through homosexual transmission and 30 percent through the criminalized act of injecting drugs. I wonder how many of those cases will present themselves to the Egyptian army and its miracle treatment?

No one wants to hear this, but not all the medicines in the world, nor all its medical devices, could ever cure HIV or AIDS in Egypt. Not unless the alleged miracle device could also cure the stigma and discrimination against people living with the virus, a stigma that is so demeaning that it drives some patients to opt out of seeking treatment altogether.  

Can the military medical team somehow guarantee that the detection device won’t be used to test people against their will? Will operators of the device report an HIV-positive person to the police, or detain him or her at the hospital, as readily as some uninformed doctors do to AIDS patients today? Will newspapers that once published the names of people “caught having AIDS” continue to violate patient confidentiality and privacy? Will those who engage in criminalized practices that put them at higher risk of contracting the virus voluntarily come forward for testing?

These are not questions emanating from hypothetical scenarios or random thoughts. The reality is that thousands of people who live with HIV in Egypt, or are at a higher risk of contracting it, live in fear of “getting caught” with the virus due to the stigma surrounding the disease.

This is the reality the inventors of the device should have addressed before coming forward with the bold claims that come next year, there will not be a single person living with AIDS in Egypt.

The number of people living with HIV or AIDS in Egypt has been slowly but steadily growing since the first case was reported in 1986. The estimated number is around 10,000, of which only 3,000 are registered with the Ministry of Health. And only around 1,000 of those registered are receiving treatment.

While the overall prevalence is estimated at less than 0.02 percent of the population, that is no cause to celebrate. The number of new infections continues to rise, contrary to global trends. The Middle East and North Africa is one of only two regions in the world where the AIDS epidemic is rising rather than declining.

Yet despite this trend, our effort to respond to AIDS is nowhere near what it should be to control the epidemic, while we still can.

In Egypt, AIDS prevention, treatment and healthcare services are provided in the context of a wretched national health system. Heath services are provided by underpaid and untrained doctors more concerned with their own safety against potential attacks from resentful patients and families, or against acquiring infections, because no protections are in place.

But more importantly, AIDS services are delivered within a culture of misconception, hostility and prejudice toward the disease, which not only hampers but also informs and directs the AIDS response in Egypt.

The more society rejects and marginalizes people living with HIV, the more reluctant the government is to address the real issues that are fueling the epidemic. The question is not whether or not we can cure AIDS, it’s whether or not we really want to.

If the proud inventors of the device are sincere in their desire to cure AIDS in Egypt, here is a non-exhaustive list of what must be done before we even begin discussing the viability of the military-sponsored curative device.

We need to correct misconceptions surrounding AIDS

Societal reaction toward people living with HIV or AIDS is a natural consequence of years of the negative depiction of the disease in state media and formal education.

Anyone who grew up in the 1980s and 1990s can still remember the movies depicting young men contracting the killer virus from engaging in sexual activities with foreign girls, who were usually spies with an agenda to destroy Egyptian youth. AIDS “awareness” television spots showed us scary-looking people dying because they engaged in extramarital sex or used drugs. Until recently, secondary school science curricula taught children that AIDS “is a dangerous disease caused by forbidden sexual practices.”

The message that AIDS is caused by culturally unacceptable practices lived on long after the movies and television spots were gone, causing not only prejudice and discrimination toward those who contract the virus, but also a false sense of immunity to the disease: “I would never do that, so I can never get AIDS.”

Everyone seemed to agree that shutting out those immoral enough to “bring AIDS onto themselves” is sufficient to protect everyone else.

If the state is committed to curing AIDS, then it must step up to correct the blunders of its predecessors and launch a plan across all relevant sectors, including health, media and education, to change public perceptions regarding the disease.

We need to know the true extent of the epidemic in Egypt

People are not getting tested because they are not aware they should, they’re afraid to or they simply don’t want to know the results. The false sense of immunity and lack of awareness as to how HIV is transmitted does not impel people to get tested.

People living with HIV in Egypt typically find out if they are infected by chance after they’ve been inexplicably sick for some time, or after a partner is diagnosed. Those who are aware they should get tested rarely do for fear of how their lives might change if they find out. Those who engage in practices known to increase the risk of infection would rather not know their HIV status than risk being prosecuted for their often criminalized behaviors.

The result is that potentially thousands of Egyptians are going about their lives not knowing that they are carrying the virus, compromising the safety of those around them, especially the safety of women, despite the availability of tried and true preventative measures.

If we want to cure AIDS, we need first to encourage testing and disease prevention in a way that is safe and confidential, and that reaches everyone.

We need to address and protect AIDS-related human rights

We now know from evidence that human rights violations and stigma and discrimination are detrimental to any effective response to AIDS. Nowhere is the complex linkage between health and human rights more evident than through this disease, which is a health condition that both leads to and is caused by a myriad of rights violations.

People living with HIV in Egypt have been fired from their jobs, expelled from their homes, had their children taken away from them and been denied treatment and healthcare by doctors. Society condemns AIDS patients in a way that makes their lives unbearable, when they could be leading normal lives with the necessary physical and emotional care and support.

It is no surprise, then, that people who know they are HIV-positive often opt not to receive treatment, and that a large percentage of those who do eventually drop out of the treatment regimen.

Similarly, human rights violations against certain individuals increases their risk of contracting HIV. Men who have sex with men, commercial sex workers and injecting drug users are often harassed by the police and arbitrarily arrested off the streets for carrying condoms or clean syringes — essential, simple preventative measures that dramatically reduce the risk of disease prevention.

Outreach workers providing awareness around prevention to these groups are often subject to such harassment themselves. And while there are no laws against homosexuality, the state continues to prosecute men who engage in same-sex sexual practices. And once caught, they are often subjected to humiliation and violated by the police with torture methods such as forced anal probing.

Such violations are not going to disappear on their own once the miracle cure miraculously works and hits the market. Unless we are prepared to shout “human rights” loud and clear in our response to AIDS, we will continue to push people living with HIV and the most at-risk populations underground, with no way of ever reaching them or controlling the epidemic.  

Ignoring the sheer absurdity of Abdel Atty’s statement I mentioned above, I too like to believe that a day will come when people living with AIDS will be no more ashamed than someone with any other disease, and believe they have the right to receive medical treatment and care with dignity.

But this will not happen because of some device that a doctor can point at someone’s chest and cure all diseases. Only when we address the real issues that hamper our fight against AIDS can we begin to claim that we even want to cure it.  


This article was published at Mada Masr on the 15th of April, 2014.