BBC On-line - November 27, 2003
Magdi Abdelhadi, BBC Arab affairs analyst

In an exclusive interview with the BBC, Health Minister Dr Mohammad Awad Tag El-Din said the country is negotiating with international pharmaceutical companies to produce cheap antiretroviral drugs locally.

At present, Aids patients in Egypt have to buy the medicines on the black market at exorbitant prices.

Dr Tag El-Din also said the new health insurance system which parliament is currently considering would cover treatment for HIV and Aids patients in Egypt.

An Egyptian Aids patient can pay up to $1,000 a month to buy antiretroviral drugs, a price that very few can afford.

Foreign drugs are generally too expensive for the average Egyptian - and Aids medicine even more so, because it is smuggled into the country.

This is because the government has not authorised legal imports.

But this is about to change, as Dr Tag El-Din, himself a medical doctor, told me when I met him at his office in Cairo.

He said the medicine could be manufactured in Egypt within one year. But he gave no further details.

These antiretroviral drugs are vital in increasing life expectancy for Aids patients. Those who cannot afford to buy such medicines in Egypt face inevitable death.

Isolation

But lack of affordable medicine is not the only problem facing an Aids patient in Egypt.

Widespread stigma and isolation face anyone diagnosed with HIV.

A patient I met at one of the few private clinics that treat Aids patients in Cairo agreed to talk to me only on condition that I did not disclose his identity.

His doctor spoke to me of the appalling state of knowledge about HIV in the country - even among physicians.

His patient was misdiagnosed several times before he was finally advised to have an HIV test.

Stigma

Mamdouh (a fictitious name) told me that, in order to avoid revealing his identity, he had to get his father to put his name to the blood test.

Mamdouh says the worst thing facing people like him is that they have no one to talk to about their ordeal.

He says he knows he is not the only person with HIV in Egypt, but it does feel as if he is.

The stigma attached to the disease is also hampering an open and candid discussion of the threat and how best to protect oneself.

International experts estimate that the number of HIV and Aids patients in Egypt is around 8,000. In a country of 70 million people, this is a very small figure compared with sub-Saharan Africa. The challenge facing Egypt is to keep that figure low. In order to do that, it will have to fight prejudice and increase awareness.

Safe sex

The problem is that cultural attitudes constitute a major obstacle to that. A young doctor told me that Aids in Egypt is known as "the foreigners' disease".

The implication is that Egyptians do not have sex outside marriage, hence Egypt is immune.

But nothing could be further from the truth.

Egypt by all accounts has a vibrant sex industry and a sexually active gay community - two of the most vulnerable groups.

Religious leaders in Egypt - Muslim as well as Christian - say the best way to protect oneself is to avoid sex outside marriage.

This may very well be true, but only up to a point. As reality clearly shows, moral indignation alone does not stop the spread of the infection.

Dilemma

A senior Muslim cleric, Sheikh Ibrahim Abu-Steita, who advises social workers trained by the Catholic charity Caritas on how to help Aids patients, insisted he would not recommend the use of condoms.

If a young man cannot resist the temptation of illicit sex he should masturbate instead, Sheikh Abu-Steita told me.

The concept of safe sex is alien to this culture, where sex by definition is considered safe, because it is between a husband and wife.

Condoms are used - to the extent that they're used at all - as contraception.

The Egyptian government faces an enormous dilemma. Promoting safe sex, for example, could be interpreted as encouraging promiscuity in this deeply religious society.

But international experts have warned that, unless there's a change of attitude, there's a real possibility of an epidemic in Egypt.
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Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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