In Egypt, HIV and AIDS happen to other people; namely foreigners, the promiscuous, drug addicts and generally the morally corrupt, who should be avoided in case they infect you with a handshake, cough or unwashed cup.
Which is why Ahmed Turky’s Friday sermon at a small Cairo mosque was unusual. In a Muslim country where hard drugs are relatively rare, gays are imprisoned and sex before or outside marriage is furtive, Turky’s talk of compassion turned heads.
“The sermons had three points, first what AIDS is, secondly how it is spread and thirdly that if someone has AIDS it is an obligation of us all not to ostracize them,” Turky said.
The majority of Egypt’s health workers believe those with HIV should be removed from society, while most university students think “lewd” people, or those “who have neither values nor principles” are likeliest to get AIDS, a 2004 study found.
Turky started preaching about HIV and AIDS after attending a workshop organized by the U.N. Development Programme (UNDP), which in a new initiative aims to spread awareness about the disease by training religious leaders at a local level.
Although senior Arab religious leaders publicly backed efforts to combat the spread of HIV and discrimination against carriers of the virus in a declaration in 2004, spreading the message to local religious leaders has proved more difficult.
“You can always do good advocacy on top…But then trickling down is a completely different story,” said Maha Aon of U.N. AIDS body UNAIDS.
Workshop information packs illustrate Islam’s willingness to tackle sexual topics, and call for Koranic verses and sayings of the Prophet Mohammad that urge compassion and care for the welfare of others to be applied to those affected by HIV.
According to 2003 figures, fewer than 0.1 percent of Egyptian adults carry HIV, but conditions exist for the disease to spread rapidly.
With about 73 million inhabitants, Egypt is the most populous Arab state. About 56 percent are aged under 25. Despite cultural prohibitions against pre-marital sex, experts say the young are particularly vulnerable to HIV.
Furthermore, chronic youth unemployment means fewer people can afford to marry, increasing the risk of HIV spreading as men turn to temporary marriage, prostitutes or sex with other men.
Illiteracy, especially among women, is high, making AIDS awareness more difficult. The social standing of most women in Egypt is such that they have little control over their sex lives. Many with HIV contracted the disease from their husbands.
Combined with widespread poverty, low levels of condom use, public discomfort with discussing sexual issues and the fear and ignorance surrounding AIDS, activists fear the disease could be more prevalent and spreading faster than once believed.
“There are two things that make us worry. If you plot the number of cases reported to the Ministry of Health it’s quite a steep rise. The other thing is that we don’t know what the situation is among the most vulnerable groups,” Aon said.
Generally, men who have sex with men, injecting drug users and prostitutes are hardest hit by HIV epidemics. Each of these groups is strongly condemned in Islamic societies and consequently difficult for activists to reach.
Turky’s sermons did not address these groups directly, or mention the use of condoms, which are mainly considered in Egypt as contraception for married couples. However, he said even those who contracted HIV in “vulgar” ways should not be shunned.
“When a man told the Prophet he was addicted to forbidden sex, the Prophet’s companions were angered. But the Prophet listened, and by appealing to his mind and heart, not through anger, the Prophet persuaded him to stop,” Turky preached.
Gay and bisexual men fear that, if they come forward for HIV testing, police will use their medical records to find and arrest them, and doubted that religious preaching would change state or public attitudes toward them or HIV.
In a high-profile crackdown in 2001 a number of men were arrested when police stormed a Cairo gay haunt, and later in sting operations arranged through Internet chat sites.
“It won’t change a thing. The government wants to pretend gays don’t exist, not help them. People like to believe that this is an Islamic society, so there are no gays,” said one man.
Like many young men, he said, he was bisexual and would eventually marry. Although he himself tested regularly for HIV, he said most of his friends did not, and described a sub-culture in which rumor and ignorance discouraged condom use.
“Some think that if you only see Egyptians you won’t get AIDS, or that if the whites of their eyes are very clear, they don’t have HIV,” he said, adding that female prostitutes he knew considered clients from strictly Islamic countries HIV-free.
Despite these attitudes, Aon said Egypt had made progress in combating the spread of HIV. Since 2004 HIV testing for Egyptian nationals has been anonymous, and from 2005 the Health Ministry made the costly drugs to treat HIV available free of charge.
Earlier this year, activists founded a drop-in health center for commercial sex workers, and although practical AIDS advocacy through religious leaders is limited, they have great influence over Egypt’s increasingly religious society.
“We don’t have a visible or very prevalent epidemic. It’s very much a silent epidemic…Of course if you sit back and think logically, the time to act is now, before it becomes much more difficult to control and much more expensive,” Aon said.
Revision date: July 6, 2011
Last revised: by Sebastian Scheller, MD, ScD