Egypt’s Fearful Gays Shy from HIV Testing
Pittsburgh
Post-Gazette, March 14, 2005
By Anita Srikameswaran
 |
Associated
Press
Some of the 52 men arrested at an alleged gay gathering at a Nile River
boat restaurant cover their faces as they enter a state security court
for trial in July of 2001 in Cairo where they faced a range of charges
rooted in the nation’s obscentiy and public morality laws. This widely
publicized raid and subsequent prosecutions heightened gay distrust of
the government and is complicating current measures to combat the spread
of HIV. |
CAIRO, EGYPT—In May 2001, police
raided the Queen Boat, a floating nightclub moored on the Nile River, and
arrested 52 gay men.
Ultimately, judges sentenced one defendant to five years
in prison for debauchery and deriding religion, another to three years for
deriding Islam, and gave 21 others three-year prison terms to be followed by
three years of probation for “habitual debauchery.”
Human rights groups around the world protested that the
arrested men had been beaten and threatened with torture to confess their
“crimes.”
The Queen Boat incident began what many see as a
crackdown on homosexuality, heightening gay people’s distrust of the
government and driving them even further into hiding.
So now that the government is offering anonymous HIV
testing for the first time, many gays are understandably wary.
Some suspect that if they get tested for the infection,
they could be identified publicly as gay, which could lead to imprisonment
regardless of their HIV status.
“It’s not anonymous [testing], don’t believe
that,” warned one gay Egyptian who asked not to be named. “The first thing
they do is call the cops.”
The 22-year-old man said that when his partner visits the
United States, friends ask him to bring back HIV tests that can be done at
home, so that they can learn their status in private.
However, the only home-based test that is approved by the
U.S. Food and Drug Administration requires that the blood sample be mailed to
an American lab. Other home test kits have an indicator window and promise
results in 15 minutes, much like a pregnancy test, but the FDA doesn’t
consider them reliable.
Do Infected Gays Disappear?
Rumors of HIV-positive gay men disappearing add to the
fear.
The Egyptian gay man spoke of trying to track down an
infected acquaintance to offer help. He couldn’t find the man and his family
had no information on his whereabouts.
“Either they disappear or they stop having sex with
people because they are too scared or they leave the country to get
treated,” he said. Besides, “it’s becoming very, very difficult for any
AIDS patient or HIV-positive patient to go and seek medication [in Egypt].
There have been too many horror stories lurking around.”
Dr. Khalil Ghanem, of Johns Hopkins University, said
HIV-positive people in Saudi Arabia and Lebanon, both gay and straight, have
similar concerns about being stigmatized.
Those “who have money are actually leaving the country
and getting treatment somewhere else,” he said. “They go to France, they
go to Switzerland, to the United States for care.”
Ghanem pointed out that people who leave don’t get
counted in official case numbers. A small number of others, he said, may
strongly suspect that they are infected, but avoid being tested.
“They are essentially dying without care,” he said.
In Egypt, the same conservative social norms that make
gays so fearful also make it hard to preach HIV prevention methods.
In this predominantly Muslim culture, both homosexuality
and sex outside marriage are considered sinful, so any discussion of safe sex
among unmarried partners or gays could amount to condoning forbidden behavior.
“Premarital and extramarital sex are not accepted
socially and culturally,” said Dr. Nasr El-Sayed, leader of the AIDS program
for Egypt’s Ministry of Health. “The girls should be virgins. It’s not
accepted for the girl to not be a virgin when she gets married.”
As in other countries, people are not as young as they
used to be when they wed. The marriage contract specifies that the prospective
groom must provide the bride with a suitable apartment, but even down payments
are far out of reach for the average worker.
So some men in the Middle East, unwilling to wait for
years before they can have sanctioned sex with their wives, have sex with
other men—but they don’t consider themselves homosexual or bisexual.
Bob Preston, an American gay man who does consulting work
in Egypt, said these Egyptians “don’t have access to have sex with women,
so they have sex with men and it’s OK because they’re not married yet.
They don’t think of it as gay sex [if] they’re the active partner,”
meaning they take the male role during intercourse.
A Bisexual Pattern
One of Preston’s friends even attended the wedding of
his Egyptian male partner of several years, and Preston broke off a
relationship because he didn’t want to play out the same scenario.
“He showed me the apartment he bought for his
wedding,” Preston recalled. “He was having it remodeled. And we went out
with his straight friends.”
Female prostitutes do exist as another outlet for
unmarried men, but they are believed to have longer relationships with fewer
partners.
The hidden world of gay sex and the obscurity of
prostitution worry those who want to test for HIV.
“In Middle Eastern countries, the prostitution is kept
so hidden that it’s almost impossible to figure out what’s going on,”
said Carol Jenkins, coauthor of a World Bank report on HIV and AIDS in the
Middle East and North Africa.
Meanwhile, the general public doesn’t seem to know much
about AIDS or have much interest in learning about it.
“We used to have in our [news]paper that this disease
is not present in our country because we are morally, culturally and
religiously” superior, said Dr. Mervat El Gueneidy, a consultant with
Egypt’s AIDS hotline. “So people would not even try to learn about it
because it’s not our disease, it’s the disease of those bad people.”
An October article in a student newspaper of the American
University in Cairo noted mixed feelings about having HIV education available
on campus. Some said they knew enough already; others thought there was no
such thing as too much information.
And some, like the student union president who called HIV
a “shameful disease,” worried that an awareness campaign would encourage
people to have sex.
In 1996, with the assistance of the Ford Foundation, the
health ministry’s El-Sayed started the AIDS hotline as a way for people to
get information anonymously. In the early days, callers had questions about
basic reproductive biology and sexuality, not just HIV.
The hotline’s El Gueneidy hoped the service would also
discreetly broaden sex education for women, but men make up the overwhelming
majority of callers. Women are more likely to be illiterate, so they may not
be aware of the service, she said. There may be no phone in the home, and they
may be uncomfortable asking sensitive questions on a public phone.
There are still myths that need to be dispelled, such as
the idea that AIDS can be avoided by not having sex with a foreigner—which
does not keep young Egyptian men from trying to strike up conversations with
female tourists, whom they think are more promiscuous than their countrywomen.
Another common belief is that HIV patients are
quarantined, a rumor that is hard to refute because not even foreign and local
health experts are convinced that it’s an urban legend.
“Once you’re found to be HIV positive, the police
show up at your house and accompany you to the fever hospital,” Jenkins
said. “If international donors came and talked to people they would be told
that doesn’t happen. But we know it happens.”
Others say AIDS patients were quarantined in the past,
but it doesn’t happen anymore.
“This is 10 years before,” said Dr. Cherif Soliman,
of Family Health International, the agency that helped develop the new
anonymous HIV testing program. “Now, they can go out and in, they have no
problem.”
El-Sayed, of the health ministry, just laughed at the
quarantine notion.
“Never happened,” he said emphatically. “This
happened in a movie and the people believe the movie was fact. They mentioned
in this movie that any person who had HIV, they put in quarantine. But we
never had a quarantine.”
There is far less stigma attached to AIDS now, El-Sayed
continued. Fifteen years ago, his experience was that family members typically
demanded that their HIV-positive relative be kept in a hospital.
“They didn’t want to take [them],” he said. “Now
almost 97 percent of the families are accepting.”
Could It Explode?
So far, low infection numbers and conservative sexual
behavior seem to have prevented the rapid spread of the virus in Egypt.
How long that will last, though, no one knows.
To get an epidemic rolling, an HIV-positive person “has
to infect more than one person,” said Karen Stanecki, a senior advisor on
demographics for the United Nations AIDS agency.
“People tend to think that once it gets started, it’s
just going to explode,” she said. “But that’s not necessarily the case.
If it’s just a very small group of people then it’s not necessarily going
to break out into any kind of major epidemic.”
But behaviors can change, especially with globalization
increasing the movement of people and ideas across borders, and very little
research is being conducted to keep tabs on the cultural landscape.
For example, even though sex outside marriage is
considered illicit, a study conducted by Family Health International and the
U.S. Agency for International Development found that 16.5 percent of about
1,200 unmarried Egyptian university students have had sex.
And there has been an increase in unofficial “orfi”
marriages, which fulfill people’s desires for a romantic, sexual
relationship in a climate where weddings are extremely expensive. Orfi unions
are not legally binding, so there are no protections for the partners, or
their children, if the relationship sours.
“You have to be ever vigilant as to what’s happening
in terms of changes in behaviors,” Stanecki said.
Public health experts say societies cope best with HIV
and AIDS when leaders talk about it openly. But such discussions can still be
divisive in the Muslim world.
In 2003, American professor and Muslim theologian Amina
Wadud presented a paper at an HIV conference for Muslim scholars in Kuala
Lumpur, Malaysia.
Among other things, she said that Muslim women are more
vulnerable to getting HIV because they’re expected to have sex with their
husbands, who are under no obligation to say whether they are infected with
the disease.
Those remarks infuriated some audience members, 10 of
whom walked out. The moment became a hallmark of the tension between religious
traditionalists and reformers.
Theologian Farid Esack, who cofounded a South African
group to support HIV-positive Muslims, said he believes some people rely too
much on the moral code of Islam to protect them from HIV.
“I think the religious factor is overplayed in the low
prevalence rate in Arab countries,” he said. “Real Muslims are . . .
having sex outside marriage regardless of what the Quran says. And somebody
has to deal with the real consequences of this.”
Even if a rigorous surveillance effort were to confirm a
low prevalence of HIV, “it doesn’t let you off the hook,” said
Hopkins’ Ghanem. “In fact, it should prompt you to be more aggressive from
the prevention standpoint.”
As the experience of other nations has shown, he and
other experts say, it’s never too soon to act.
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