Financial Journalist

The Middle East March 1988

Lack of knowledge about the Acquired Immune DeficiencySyndrome (AIDS) has led to a multitude of misunderstandings about the virus. However, one definite fact is that every country in the world is concerned by the rapid spread of the disease. In January, health ministers from 140 countries met in London to pool their ideas on how to combat AIDS. Gerard O’Kane attended the conference and he looks at how Middle East countries are tackling the virus.

By 1991 there is expected to be a sixfold increase in the number of AIDS victims around the world bringing the total to one million. That was the message delivered to health ministers from over 140 countries - including 17 in the Middle East and North Africa during a three-day summit in London at the end of January.

Dr Jonathan Mann, Director of the World Health Organisation (WHO) AIDS prevention campaign, told delegates it is estimated that between five and ten million people have already been infected with the virus without developing the immune deficiency syndrome. “We are still in the early phases of a global epidemic,” he said.

The summit meeting was an unprecedented gathering of health ministers organised and financed by the British Government and the WHO. “This summit gives us all a precious, doubly precious opportunity”, said Dr Mahler, director general of the WHO. “We will be shown what others have done to inform and educate about AIDS. We will see through their work, how we can best proceed, if we have not already done so. And we will, through the fact of our meeting together, through our commitment to the Global AIDS Strategy, draw strength from a common purpose.”

Growing fears?
Middle East and North African countries have approximately 152 AIDS cases, as reported to the WHO by the beginning of this year. Observers note, however, that this is unlikely to be a full picture since some states are reluctant to either admit to having the disease or have not reported cases to the WHO. Indeed of the 152 cases, 143 have been reported by only four countries. It should be pointed out that there have been eight other cases which have not been reported to the WHO, all officially relating to blood transfusion infections.

There is, however, growing fear about the disease through out the Middle East. Last month, Kuwait hosted the second Middle East conference on AIDS. Health officials stressed that, although the incidence of the syndrome was low in the region compared to other parts of the world, concern was growing. The UAE, for example, with a population of only 1.7m, said in January that 22 residents of the country had died of AIDS last year and nearly 300 were found infected with the virus.

Blood screening is now the major method of prevention in Saudi Arabia, Kuwait, the UAE and Oman. Throughout the Middle East the WHO has been impressed by the willingness to face up to and tackle the AIDS disease. “During 1987 an extraordinary positive change in the attitude of national authorities has been observed,” noted one official document. That year saw 13 states requiring WHO collaboration in the development of national programmes and all but one of the Middle East states have established national committees and identified national focal points on AIDS. There have also been a series of conferences for the Middle East to help medical personnel become familiar with identification and screening techniques. Partly as a result of these three seminars, two medical facilities have been designated WHO collaborating centres - the US Naval Medical Research Unit in Cairo and the Kuwait Unversity Faculty of Medicine.

Speaking at the London conference, Oman’s Under Secretary for the Ministry of Health, Dr Salim bin Hamdan Al Akhzamy, argued: “We believe that in our situation blood transfusion would be the main possible mode of transmission of AIDS.” This is generally the mode of transmission that the health ministries in the Middle East admit when AIDS cases are revealed. Little information is available and little research has been done on the extent of homosexuality or intravenous drug use, which are the main patterns in North America and Europe. Heterosexual transmission is the main way the disease is spread in Africa. As a result any educational AIDS prevention campaign is directed to the whole population rather than the identified high risk groups, as in African and European countries.

Many states argue that the religious culture of the region protects it from the worst of AIDS. The Kuwait Minister of Public Health has been quoted as saying that AIDS “will remain out of our region if we stick to the guidance of our Islamic religion.” He added that Islam prohibits the p-ractice,of homosexuality which he saw as the main cause of the disease. The WHO is thankful that this attitude is no longer official policy in most Middle Eastern states since, as Dr Mann pointed out in his opening speech to the conference, the Pattern 11 mode of transmission is mainly heterosexual, as in Africa.

Compulsory testing?
The last day of the London conference saw a final declaration on the global fight against AIDS. Critics argued that important points had been glossed over. The Indian Minister for Human Resource and Development, Shri P V Narasimha Rao, said that the issue of compulsory testing had found no consensus and that was reflected in its absence from the final communique.

Although pressure groups had pointed the finger at Cuba for its massive compulsory screening programme, which HIV victims are detained in a camp and at Belgium and the West German state of Bavaria, the Middle East looked on with interest. In Dubai, for example, all those engaged in handling food are expected to undergo screening before getting their health cards. In Iraq, it has been reported that all visitors should carry HIV-free certificates, but it is not known if this has been implemented. Other countries also have restrictions. It is now open to question if countries with restrictive travel laws and screening requirements for HIV victims will change their minds, despite the WHO’s official line that the social, political and moral consequences of discriminating against HIV victims could be detrimental to everyone concerned in the long term. The conference finally warned of the need “to protect human rights and dignity”.

Dr Mann, nevertheless, was optimistic at the end of the conference, saying: “This is a family of many members … an extraordinary amount of consensus has been achieved in a relatively brief period of time.” With some justification he said that the meeting would not have been possible two years ago.

Consensus, at least officially, did appear in the final statement on the issue of discrimination and the need to take account of various moral values. The London Declaration on AIDS Prevention accepted that individual countries’ policies had to take account of these values to combat AIDS. The declaration succeeded in pleasing the homosexual pressure groups, the Islamic States and the Vatican.

War against AIDS