Breaking a Social Taboo: AIDS Hotline in Cairo

Karim El-Gawhary

"AIDS is God's punishment for all those who pollute the country with their sins," writes the Egyptian weekly newspaper Al-Liwa Al-Islami (The Islamic Banner) under the headline: "To Follow the Path of Islam is the Best Way Not to Get Infected."

In the Egyptian media, attacks on people with HIV are common. Those, however, who do not want to sweep the issue of AIDS under the carpet are ready to deal with the 600 officially registered Egyptians who have been "punished by God" since the disease first appeared in Egypt more than 11 years ago. The World Health Organization (WHO) puts the figure at ten times the official estimate.

Dr. Mamduh from the Ministry of Health AIDS Hotline in Cairo tries to be encouraging. "Ask whatever you want, the call is not recorded. Everything remains anonymous." Another long moment of silence before the caller finally plucks up the courage to speak. What follows is a 15 minute conversation about modes of transmission, the possibility of anonymous testing and the symptoms of AIDS.

Since the establishment of the Cairo Hotline in September 1996, the telephone number, which is advertised on public buses, in metro stations and in newspapers, has been called 17,000 times. "Calls come in from all provinces of Egypt. Sometimes Arabs call long distance from the Gulf states and we have even had cases when Egyptians living in Europe call for our advice," says Nasr Al-Sayyed, who initiated the Hotline with funding from the Ford Foundation. He got the idea during a trip to the US and Britain. Back in Egypt, he turned his phone at the Ministry of Health into an anonymous counseling service, which was so successful that Al-Sayyed was soon overburdened with calls to his office.

Now, 12 staff members-women, men, Muslims, Christians, social workers, doctors and psychologists-work in shifts to staff the two lines 12 hours daily, receiving a total of between 30 and 150 calls. Everything is asked: from how to acquire HIV, places offering anonymous testing, treatments and different sexual practices, to enquiries about homosexuality and the use of condoms. All of these issues rank at the top of the list of taboos in a conservative society.

Most of the callers-young and unmarried-are unable to discuss the risks of premarital sex, homosexuality or drug use at home, in school or even with friends. It is the young age of the callers that Al-Sayyed and his team find encouraging. In seminars with students at Cairo University, they try to provide a basic AIDS education-hardly an easy task. So as not to be accused of "immoral propaganda," the advisers discuss the problem in a "dry scientific way" and emphasize at the end that they do not intend to encourage premarital sex.

It is not surprising that the few television spots that have addressed AIDS since the early 90s use quite indirect ways to deliver the message of "safe sex." In one television advertisement, a young man gets briefed before his departure from Cairo International Airport on the dangers of contracting HIV. The man is warned of premarital sex in general. "In other countries people use condoms to protect themselves," is the strong hint at the end for those who do not want to listen to the initial advice.

Television ads, the AIDS Hotline and two movies shown during prime time with AIDS as a central theme, have had an effect. Times have changed since the days when AIDS was seen simply as a problem of promiscuous foreigners, or even as an Israeli conspiracy. Now the Minister of Health supports the national AIDS program although he still hesitates to associate with it directly.

The few available studies on AIDS in Egypt show that much remains to be done. According to an opinion poll of student and industrial workers conducted by the Faculty of Mass Communications at Cairo University, nearly one-third believed that AIDS can be transmitted through insects. Another one-fifth of those polled feared infection from public toilets or from "kisses during a greeting." The concept of safe sex has not yet prevailed. "If we go to universities and tell them that condoms can protect against infection, most students ask: 'What is a condom'?" explains Al-Sayyed.

The results of the poll show the necessity for further education. Currently, the European Community (EC) is drafting a program for AIDS prevention in Egypt. "The rate in Egypt is still relatively low and this is exactly the right time to prevent an outbreak," says Martine Leveque, social programs officer in the European Community office in Cairo. A study commissioned by the US Agency for International Development (USAID) states: "Egypt is currently in a very early phase of the AIDS epidemic. This is likely due to the general adherence to traditional values regarding sexual behavior." According to the study, however, things will not necessarily remain this way. A sexually active youth, poor health care, three million Egyptians who work outside Egypt without their families, several million tourists, male visitors from other Gulf countries and a large number of refugees and maids who come from high-risk countries might soon change the picture.

The biggest problem is that it is hard to reach high-risks groups, such as prostitutes, homosexuals and IV-drug consumers. Prostitution is not centrally organized. Everyone knows about drug users who get the amphetamine Maxem Fort injected by the dealer with a used syringe. Nobody, however, knows anything about the size of the scene, nor of the extent of homosexuality in Egypt. The National AIDS Program does pioneering work here. In a unique study of homosexuals, most of the 58 individuals questioned knew of the increased HIV risk, but only one-fifth used condoms. The study states, "due to social pressure to marry, many are married or intend to get married," adding that in 90 percent of the cases the wife or family has no idea about the husband's homosexual orientation.

Most of those "punished by God" prefer to keep their HIV-positive status to themselves. A 32-year-old man has known for five years that he is HIV-positive. Neither his mother, his siblings, nor his best friends know anything about his infection, not to mention his colleagues at work. "I do not want to create frustration and I especially want to avoid upsetting my mother," he explains.

Others who are HIV-positive have become more daring, appearing in public and admitting their condition although still with caution. In a widely-seen program on Egyptian TV, an HIV-positive woman from Alexandria was interviewed. Her identity remained hidden as she was filmed from behind and was veiled. She has known about her condition for 14 years. Her long survival became an inspiration for others with HIV. Her immediate family and close friends know about the disease which she contracted through a blood transfusion in one of the Gulf states. She refuses to condemn those who get infected through sexual intercourse outside of marriage. "There is no difference if the disease was transmitted through blood transfusion or sexual intercourse. Forget the past and believe in God today."

It took until April 1997, more than a decade after the first HIV case was discovered in Egypt, for an HIV carrier to speak out openly about his condition. The individual came to the lectern at the first national AIDS conference in Cairo and made an emotional speech in front of 300 physicians, nurses and religious leaders. The end of the speech was lost in the thunderous applause. For those who have worked for the anonymous AIDS counseling service, this was one of the most moving moments in their careers. "I ran to the front and kissed him in front of everyone," remembers Al-Sayyed.

Quoting a Qur'anic verse, a sign in the office of the director of Cairo's fever hospital reads: "Say: he is the merciful, we believe in him and put our fate in his hands." "Here we can only treat symptoms of AIDS with antibiotics. The new cocktail combination medicine is too expensive for us," says director Yahia Sultan. The disease is only monitored and, where possible, some of the symptoms are treated.

Egypt's only AIDS hospice lies in an old Victorian style villa in the midst of a hospital complex built under British rule. The six designated beds are the final stop for Egyptian AIDS patients. Of those who reside here, most are painfully aware that of the 600 HIV cases registered in Egypt over the last 11 years, one-third have already died. Three months ago, the Minister of Health opened the new department without any press present in contrast to the usual practice. "We hope they can enjoy the rest of their lives in this beautiful villa," says Elias Michael, the former hospital director.

For the five-year-old boy who sits in a jogging suit on one of the beds, however, life has not really started. His grandmother, in her rural dress and black shawl, looks nearly as lost as the boy. "Both of his parents have died," she says, shaking her head as if she has a hard time understanding all this in her old age. "I came to Cairo because I am the only one left who can take care of the little child."

Karim El-Gawhary is MERIP's regional program coordinator in Cairo.