Tuesday, August 08, 2006

AIDS in Saudi Arabia

Saudi Arabia Begins to Face Hidden AIDS Problem

Hassan M Fattah

New York Times 8 August 2006

RIYADH —He lives virtually in hiding, his real life a secret from his family and some of his closest friends.Being gay in Saudi Arabia is hard enough. But for a growing number of Saudis like Feisal, middle-aged, gay and HIV-positive, life is a tangle of regret and fear.

“You live in constant fear of being found out and attacked,” said Feisal, who spoke on condition that only his middle name be used, for fear of discrimination. “I’m sure a lot of people would think I deserve what I have if they knew about it.”

If not for a mixture of Saudi doctors, social workers and advocates for AIDS patients who have pushed the government to tackle the disease more openly and encouraged patients to fight for their rights, Feisal’s situation would be even more dire. But change is slowly taking place.
For years Saudi Arabia kept its growing AIDS problem hidden. Statistics on the disease were sealed in envelopes and guarded like national secrets. In mosques, imams spoke of AIDS as the “wrath of God” brought upon people who committed “sexual deviancy.”

Now, the government is opening up. In June, the Ministry of Health announced that more than 10,000 people in Saudi Arabia were H.I.V.-positive or had AIDS, including nearly 600 children. The numbers appear to show a significant increase in infection over 2004, when 7,800 cases were reported, and 2003, when 6,700 cases were reported. Officials say that better reporting is the reason for the growing numbers. But many doctors say even the latest figures are off, with the real numbers likely to be far higher in this nation of 27 million people. One physician who has treated many patients who have been hiding their condition or were unaware of it estimated that the real number could be as high as 80,000.

Some years back, the government passed legislation protecting the privacy of people who were ill and guaranteeing their right to work, which provided some protection to AIDS patients. Saudi citizens with AIDS have also long had the right to free medical care, and today receive expensive anti-retroviral drugs without charge.

But the rights and protections are only for Saudi citizens. More than three-quarters of the reported H.I.V. cases are of foreign residents. Foreigners living here found to be H.I.V.-positive are typically imprisoned and then deported.

Fortunately for Feisal, he is a Saudi citizen. “I have to praise the government,” he said. “We get the drugs for free, the medical care for free, and the treatment is confidential.” But Feisal said that nothing is being done to build acceptance of people with AIDS, much less homosexuality.

Indeed, the lingering challenge for most AIDS patients is their acceptance by society. Ever since the first case was diagnosed here in 1984, the disease has challenged social and religious taboos. Women began to be infected by their husbands, who contracted the disease on trips abroad and, increasingly, inside the country. Children, too, were born infected, and soon the numbers became hard to ignore.

In this highly conservative Muslim nation, where women are forbidden to drive and talk of sex is taboo, even traditional efforts at AIDS prevention face challenges. There is little talk of condom use and safe sex; outreach is focused on abstinence and fear of God.

A growing movement of AIDS patients, doctors and social workers is putting emphasis on teaching Saudis about the disease, though, to help AIDS patients live more normal lives. The King Faisal Specialist Hospital and Research Center here in the capital now holds regular public discussions on AIDS and how to live with it. Doctors like Abdullah al-Hokail, who has worked on AIDS at the hospital since the 1980’s, appears regularly on Saudi television to explain the effects of the disease and to preach safe sex. “The main problem here is not the disease itself,” said Muneera al-Dahhan, a clinical counselor at King Faisal Hospital, the top AIDS treatment center in the country. “It is the tough view of society. People see this as the result of sexual behavior that is unacceptable in our society and are unable to accept it.”

Many other Muslim countries have begun similar programs after decades of underreporting incidence rates. Religious leaders long credited Islam and the region’s conservative culture, which forbids premarital sex, for the low incidence of AIDS. But most clinicians inside and outside the region long suspected that local health agencies were reporting incomplete numbers. When Rami al-Harithi stood before television cameras at a commemoration of World Aids Day in the Saudi capital last year, he became one of the first AIDS patients to come out in the open.

“I wanted to change people’s view of H.I.V.,” said Mr. Harithi, whose story has attracted sympathy throughout the country. A hemophiliac, Mr. Harithi contracted H.I.V. when he was 8 years old. “Just as I’d expected, people were surprised to see me as just a normal guy inflicted with this disease.”
Mr. Harithi has become something of a celebrity here, appearing on almost every Saudi television and satellite channel, profiled in newspapers and invited to speak at medical symposiums. As an advocate he has sought to deliver one consistent message: AIDS patients are nothing to be afraid of and deserve their rights. “I’m not trying to get hugs and kisses by going public,’’ he said. “I just want to ensure that my rights at work and in life are guaranteed and that I will continue to get the care I need.”

Other AIDS patients jealously note that the specifics of Mr. Harithi’s case have allowed him to lead a more normal life than they can. For those who contracted the disease sexually, especially those in Saudi Arabia’s homosexual underworld, life often proves far lonelier. “He’s excusably positive,” said one patient who has kept in touch with Mr. Harithi, speaking on condition of anonymity to preserve his privacy. “Public sympathy is with him because of the way he contracted the disease; it wasn’t through sex. They wouldn’t have been as nice otherwise.”

For men like Feisal, who tested H.I.V.-positive five years ago, the options are markedly different. He attended college in the United States, where he enjoyed an avowedly raucous gay sex life, but returned to Saudi Arabia where homosexuality was a crime and became closeted. He was trying out for a job when a friend warned him that it would entail a blood and urine test. He decided to test independently first, and found that he was infected with H.I.V. Even other gay men have rejected him, he said. He used to frequent a gay Arab Internet chat room. But when he admitted that he was H.I.V. positive to one user, he said, he was banned from one of the sessions. “I did this to myself and take responsibility for what happened,” he said. “If I was a citizen of the U.S. or of Europe, I would want to live. But here there’s no gay life, much less an H.I.V.-positive life.”

The latest efforts have made a difference but only a small one, many AIDS patients say.
“There is a war against the disease,” said one man, who contracted the disease after an encounter with a prostitute in the United States years ago and who spoke on the condition of anonymity out of embarrassment. “They accept the sick, but don’t want to deal with them as people.”


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