Egypt reported its first case of HIV/AIDS in 1986. This was about the same time that other countries in the Middle East and North Africa region also started seeing their first cases of HIV. In 1987, one year after the discovery of the disease in Egypt, the National Aids Program (NAP) in Egypt was formed.
Recent data shows that the HIV epidemic in Egypt has grown but remains mostly concentrated and affecting key and vulnerable populations. With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. The overall HIV prevalence among the general population remained largely unknown but estimated at below 0.02%.
Still, the HIV prevalence rate in MENA is less than that of tuberculosis and diabetes. Even though great progress has been made in the HIV continuum and the general understanding of the disease globally, progress in the MENA region has been limited due to lack of data and surrounding controversy. While it is estimated that only two percent of people with HIV are from the MENA area, the region has one of the fastest growing epidemics.
An estimated 12,000 Egyptians are currently living with HIV/AIDS. But experts believe there's underreporting of cases because of insufficient surveillance and because, until 2005, the country had no anonymous testing centers. People who suspected they might be infected were unlikely to be tested for fear of being ostracized.
Structure of HIV Virus
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HIV Prevalence and Transmission
Evidence has shown that HIV is affecting specific key population groups. In Egypt, HIV is most prevalent in high risk groups including street children, female sex workers (FSWs), men who have sex with men (MSM), and injecting drug users (IDUs). An Integrated Biological and Behavioral Surveillance Survey (IBBSS) conducted in 2010 indicated an overall prevalence of 0.5% among SBG, 6.1% among MSM, and 7.2% among PWID.
Among officially reported cases, heterosexual intercourse is the primary mode of transmission of HIV (49.1 percent), followed by homosexual intercourse (22.9 percent), renal dialysis (12 percent), and blood transfusion (6.2 percent), according to the National Aids Program (NAP) in an official report issued in January 2008.
Globally, the average percentage of HIV infections through blood transfusions/products is only 5 percent. However, in Egypt, about 24 percent of all its known HIV cases are from infected blood products. There have also been five outbreaks in renal dialysis because of unsterile equipment.
One study explored sexual relations within the Egyptian population to determine prominence of HIV transmission and found that of the 74 percent in the study that were sexually active, 15 percent had more than three partners in the last month and 58 percent had never used a condom. About 26 percent of all HIV cases in Egypt occur in MSM and studies conducted by the NAP revealed very low rates of condom usage, along with multiple sexual partners among the MSM population.
Challenges and Cultural Context
Egypt still faces several challenges in maintaining low prevalence of HIV/AIDS. There is a general reluctance on the part of the government and civil society to discuss issues related to marginalized groups such as MSM, FSWs, and IDUs. The conservative nature of Egyptian society stigmatizes these high-risk groups, making HIV surveillance studies in Egypt more difficult.
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In some parts of Egyptian society, it is considered immoral to have HIV. In addition, there a lack of effective STI/HIV/AIDS education programs and other preventive measures, such as peer education, outreach work, and behavior change communications among at-risk groups. This stems from the lack of overall knowledge about the disease.
The General Penalties Laws in Egypt criminalize prostitution and intravenous drug use, as many other countries do. However, there are also other laws that criminalize homosexual activity, stating that it is inappropriate social conduct and an insult to religion.
Although HIV prevention is not as comprehensive in Egypt as other parts of the world, the conservative religious beliefs in the country, both of the Muslim majority and the Coptic minority, provide their own form of protection. For instance, they frown upon promiscuity, homosexuality, and sex before marriage. These religious norms, along with widespread male circumcision, have resulted in decreased HIV transmission rates.
However, over-reliance on the protection created by religious and cultural values has made HIV stigma and denial a problem. The protection that these values provide is counterbalanced by the stigma and discrimination that accompany those who defy these boundaries, leading to less HIV testing and treatment.
Breaking the silence on AIDS in Egypt
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National Response and Prevention Efforts
Egypt’s national response is guided by global priorities in addressing HIV/AIDS and aligned with the Sustainable Development Goals and the 2016 Political Declaration on AIDS High level meeting 2016 globally set targets. The National AIDS Program (NAP) leads the national response to the HIV/AIDS epidemic in Egypt. The NAP has, in July 2018, concluded a consultative and inclusive process of reviewing and revising the National HIV Strategic Plan (NSP).
The NAP is the official governmental body responsible for HIV/AIDS prevention. Its goal is to maintain the low prevalence of HIV/AIDS and improve health care services for those infected or affected by the disease. It performs blood screening, provides free antiretorviral therapy (ART) for those infected, encourages HIV testing, and provides support for those with HIV and their families.
The organization also aims to raise awareness about HIV in the general public and among high risk groups, using mass media as one of the means of doing so. Additionally, they established anonymous hotlines, distributed condoms, and partnered with various non-governmental organizations (NGOs).
Since 2005, the Government of Egypt has become more actively involved in the fight against HIV/AIDS. The government established nine mobile VCCT (Voluntary Confidential Counseling and Testing) centers and 14 fixed centers around the country. With the help of Family Health International, it also conducted trainings for physicians and nurses on clinical management and nursing care, created self-care guides in Arabic and started to promote the use antiretroviral therapy.
In the years before 2004, the majority of HIV cases recorded in Egypt were due to mandated testing, such as for blood donors, foreigners staying in the country for more than six months, and citizens applying for permits to work overseas. Agency for International Development), established a system of voluntary confidential counseling and testing (VCCT) for anonymous testing, which encouraged more people to find out their HIV status.
Moreover, many people who get diagnosed with Tuberculosis get tested for HIV. More specifically, in 2010 about half of the TB patients got tested for HIV. Currently, less than 1 percent of adult TB patients are HIV-positive.
According to recent studies, there is an imminent need for improved education of healthcare workers about HIV/AIDS in Egypt. A collaboration between UNAIDS, the Egyptian Ministry of Health, and numerous Egyptian universities was established to help better train medical personnel to deal with the disease, as a way to fight the present stigma and misconceptions.
Antiretroviral Therapy (ART) and Treatment Access
By the end of 2006, according to UNAIDS, 22 percent of HIV-infected women and men were receiving antiretroviral therapy (ART). In 2014, about 1,323 people received ART treatment. In 2016, that number increased to 3,100 people, which is about 27 percent of the infected population.
In 2010, a qualitative study was conducted to gather data about ART adherence and limitations. They interviewed 27 HIV positive Egyptian women who had been receiving ART for at least three months. Additionally, the Ministry of Health has also been fighting the issue of lack of adherence to drug treatments by many HIV positive citizens.
| Year | Number of People Receiving ART | Percentage of Infected Population |
|---|---|---|
| 2006 | Data not specified, but 22% of HIV-infected women and men were receiving ART | 22% |
| 2014 | 1,323 | Data not available |
| 2016 | 3,100 | 27% |
Antiretroviral therapy
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