More than 35 students from 22 countries across sub-Saharan Africa, the Middle East and North Africa, Haiti and France have completed a course on HIV as part of their Master’s Degree in International Health at the Senghor University based in Alexandria. The module was established by UNAIDS and the Department of Health at the University in 2011 in a bid to give students a better understanding of the complexities of the global response to HIV.

This is the second year that students have participated in the programme. “I welcome this strong cooperation between UNAIDS and the Senghor University,” said Professor Albert Lourde, Rector of the Senghor University. “It shows how Francophone expertise is unique and how we need to encourage education and knowledge sharing across Francophone countries to effectively deal with issues related to HIV.”

The course comprises of 10 sessions which aim to strengthen the student’s scientific and global public health knowledge and enable them to support their national AIDS responses once they return to their home countries. This year’s course included sessions on sharing epidemiology and medical knowledge on HIV and the contribution of communities and civil society to the AIDS response.

During the course, students were encouraged to reflect on some of the major challenges to achieving the targets and commitments in the 2011 United Nations Political Declaration on HIV/AIDS. The course concluded with an interactive video-conference opened by Professor Lourde that highlighted the major international initiatives to promote effective and efficient responses to HIV. These include an initiative that aims to ensure 15 million people are on antiretroviral treatment by 2015 as well as the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. During the conference, participants also discussed human rights in the context of HIV and analyzed the specific challenges faced by the West and Central African region.

As part of the programme some of the students had the opportunity to complete a mandatory three month internship at UNAIDS offices in West and Central Africa and the Middle East and North Africa where they learnt first-hand about the complexities of responding to HIV. UNAIDS will continue its partnership with the University to ensure that AIDS remains as part of the curriculum of its Master’s degree in International Health programme as the university expands its campuses to other French speaking countries throughout Africa.

A new handbook to help design and implement HIV programmes focusing on men who have sex with men (MSM) in the Middle East and North Africa (MENA) was released on 27 September by UNAIDS in Cairo, Egypt. The handbook was presented at a workshop organized by the World Health Organization entitled "HIV Among Key Populations at Increased Risk of Sexual Transmission".

Entitled “HIV and Outreach Programmes with Men who Have Sex with Men in the Middle East and North Africa: From a Process of Raising Awareness to a Process of Commitment”, it aims to provide countries that are currently implementing MSM programmes with additional tools to improve them. It also provides other countries willing to initiate MSM programmes with sufficient elements to do so.

The new publication describes in four modules the whole cycle of a national HIV outreach programme aimed at engaging MSM. These four modules include: Situation analysis; outreach programme conceptualization, outreach approach, and monitoring. Each module contains scientific data and practical steps.

Prevailing taboos hamper the AIDS response

Sexuality and sexually transmitted infections (STIs) are sensitive issues that are rarely discussed in the MENA region and homosexuality and transexuality remain taboo subjects, according to the new report.

"Most countries in the region criminalise same sex relations making it virtually impossible for this key population to seek or receive the necessary HIV prevention, treatment and care services," said Ali Feizzadeh, Senior Strategic Information Advisor at UNAIDS.

An increasing number of bio-behavioural surveys in the region show that the AIDS epidemic is concentrated within key populations at higher risk—notably MSM. The same surveys reveal that MSM regularly change sexual partners, and may be drug users or sex workers while their knowledge of STIs remains limited.

The new UNAIDS publication stresses that, while the current regional AIDS response is characterized by low coverage of HIV prevention programmes for key populations at higher risk, there is a growing awareness of the need to work with populations such as MSM on HIV prevention in the region. Currently, these efforts are mainly undertaken by non-governmental associations.

"All the countries in the region approved the Human Rights Declaration, however, some sensitive areas of work cannot be undertaken by the present governmental bodies. The role of the Civil Society is to bridge the gap between national support and the actual need,” said Elie Aaraj, President of the Regional/Arab Network Against AIDS (RANAA) and Executive Director of MENAHRA. “This handbook will give a strong theoretical and technical background and support to outreach workers; be it health care providers or peer educators," he added.

The UNAIDS handbook provides useful information, tips and tools to effectively reach MSM communities, establish trust and build relationships through continuous dialogue. The handbook emphasizes the importance of engaging the MSM population in the effective design of HIV outreach programmes.

The handbook is the result of the analysis of existing programmes and fieldwork conducted by partner civil society organizations in nine countries across the region. It complements the recently published WHO Guidelines that focus on good practice recommendations in the area of prevention and treatment of HIV and other STIs among MSM and transgender people.

In “Standing Up, Speaking Out”, a new UNAIDS report launched on 12 July in Cairo, Egypt, 140 women living with HIV from 10 countries in the Middle East and North Africa (MENA) express the realities that shape the hopes and grievances of their lives. The voices in the report belong to members of MENA-Rosa, the first regional group dedicated to women affected by HIV.

Through face-to-face meetings, and long-distance networking, MENA-Rosa offers women living with HIV an opportunity to talk about their many trials, and occasional triumphs, in dealing with HIV, from medical matters to family affairs. But for change to take root in their personal lives, the members of MENA-Rosa are looking to fix the big picture, raising awareness among key decision makers of their many needs, and mobilizing money to reach their goals.

“There is a lot to do for women living with HIV in MENA. They face particular circumstances and have particular needs,” said Hind Khatib-Othman, Director of UNAIDS Regional Support Team for Middle East and North Africa. “The solutions are available, but we have to confront the stigma and create awareness. All efforts protecting women’s rights should include the rights of those living with HIV.”

Of the estimated 470 000 people living with HIV in MENA, approximately 40% are women. In a region that remains one of the only two where HIV infections and AIDS-related deaths continue to rise, the new report sheds light on a complex set of social, cultural and economic factors that leave women most vulnerable to infection.

One testimonial after another reveal in the report that information about living with HIV is weak at best, if not altogether missing, deeply affecting the lives of women who often face stigma and discrimination as a result of their HIV status. “At first, when they knew that I was infected, my family told me not to sleep or sit by the side of my daughter. They took her away from me. Afterwards, they started to understand that it was ok,” reveals one woman living with HIV from Yemen.

The new report stresses that women engaging in risk-related behaviour, including sex work and injecting drug use, without adequate protection are wide open to HIV infection. Some women are infected through their husbands and others through harmful traditional practices such as early marriage. Economic dependency, which reduces women’s power to negotiate safe sex or to leave violent relationships, is also associated with heightened risk of HIV infection. Gender related violence runs deep in MENA as indicated by a number of national surveys.

Sexual and reproductive health is a pressing concern in the region, the report notes. Around 20 000 pregnant women across the region are estimated to be in need of services to prevent new HIV infection among children, while only an estimated 5% are receiving the care they need.

“Women have been at the heart of change in a region where people have taken to the streets demanding a life of dignity, equality, justice and human rights,” said Amr Waked, actor, activist and UNAIDS regional goodwill ambassador. “These are the same demands of women living with HIV and they deserve no less.”

Education, HIV prevention and access to quality HIV treatment are core to the solution according to the report. Efforts to engage governments, religious and community leaders to change policies, promote gender equality and confront stigma should not be spared.

The new report compiles the changes and recommendations put forward by women living with HIV in the MENA region. Some of these changes include improved access to quality education and employment for girls and women; guaranteed access to the best available care for HIV, including sustained anti-retroviral therapy; special training of doctors, nurses to reduce stigma and discrimination towards people living with HIV; and better access to sexual and reproductive health information and services, including HIV prevention and testing, for both married and single women.

“I hope, in future, people become more open so that the person living with HIV does not become isolated from society. We did not run towards this disease, nor choose to have it,” said a woman living with HIV from Algeria.

While the task is vast, the MENA region is still at an early stage of a major epidemic and has an opportunity of stopping HIV in its tracks. Groups like MENA-Rosa are raising their voices and advocating for a reform. The shifting political order in the Middle East and North Africa presents new challenges to, and new opportunities for, a better life for all citizens. For women living with HIV, the changes they want to see cannot come soon enough.

To highlight the power of people to create social change including ending HIV-related stigma, a photography exhibition has opened in Cairo. It displays a combination of portraits from the Egyptian revolution that took place in January 2011 and portraits submitted to a World AIDS Day photo contest in 2010 by young photographers under the theme Positive Faces.

It has been 30 years since a grassroots movement of activists mobilized in response to HIV that was impacting their communities. They had no money and even less recognition from the world but with courage and strong belief in their cause they made, and continue to make, a difference for people infected with and affected by HIV. Now, a photo exhibition brings together two movements led by anonymous individuals and communities that share a call for equity and justice.

The exhibition, co-organized by UNAIDS and Sawy Cultural Wheel, opened on 11 May and will run until 21 May at the Cultural Centre in central Cairo. It borrows from the spirit of the Egyptian revolution to extend dignity and freedom to people living with HIV and affected communities.

The launch event included a discussion forum with panellists Menna Shalabi, UNAIDS National Goodwill Ambassador for Egypt; the photographer Mr Monir El Shazly; and Dr Mohamed Slalah, President of the International Federation of Medical Students Association in Egypt.

While Dr Slalah underlined the role of art in communicating messages to promote social justice and human rights, Ms Shalaby drew from her personal engagement with people living with HIV to emphasize that people can get trapped by feelings of disempowerment. “I hope that people living with HIV in the country realize they have the power to make a difference, to help themselves and others by speaking up for their rights,” she said.

Mr Shazly, who is a professional photographer of note, commented that the photographs were so expressive and profound that they communicated to both the heart and mind. In his opinion, the sense of solidarity around a common cause is what drove the popular uprising and revolution in Egypt. “The HIV response needs to solicit the same sense of unity and people living with HIV should realize they have the power to make that happen,” he said.

Wessam El Beih, UNAIDS Country Officer Egypt explains that the idea to combine photographs was, “to emphasize that overcoming the fear and silence barrier is key to galvanize action that brings about change and the realization of rights.”

Three winners of the 2010 HIV photo contest were presented with digital cameras sponsored by Canon during the launch. The first prize winner, Dina Ezzat, explained that her child was the inspiration behind her photograph. According to Ms Ezzat, the image of a baby wrapped in a red ribbon symbolizes that the future can be bright and free from HIV, and that there is an obligation for society to protect that future through an effective AIDS response.

“I am keeping my HIV status a secret from my family and friends. I am burdened by the disease and by my secret. I feel guilty, but I fear if I were to tell, that I would be rejected,” says Ali, a 25 year old man living with HIV.

This sense of isolation and low self esteem is all too common for many people living with HIV in Egypt. To date, not a single person living with HIV in the country has publically disclosed their status. So for the majority of Egyptians AIDS remains without a personal face which contributes to misconceptions and fear about the disease.

The world over, media plays a huge role in shaping public opinion about social issues and bringing to life the human impact and complexities of difficult themes. According to UNAIDS Country Officer in Egypt, Wessam El Beih, Egyptian media, especially the film industry, has propagated misinformation and portrayed biased views about people living with HIV, “leading to prejudice and discrimination.”

Over the past several years, UNAIDS in Egypt has advocated with scriptwriters and film producers to create feature films that could bring a human face to HIV by creating characters that people could identify with. The inspiration behind this idea came from people living with HIV who hoped that social views would be more compassionate if their real experiences were shown in a drama.

In 2007, a young scriptwriter and director Amr Salama accepted the challenge after attending a meeting convened by UNAIDS with a group of people living with HIV. He listened to their stories and was touched by their experiences. Salama spent a full year, collaborating with UNAIDS, on several versions of a script featuring the true story of a woman who lived with HIV and died of injustice. He was anxious to convey the same emotional intensity that he had experienced when he heard people’s stories.

“This film was a tremendous journey of exploration. I wanted it to reflect the anger I felt for the injustices I have seen,” said Mr Salama. “I was angry, not just for the people I met who lived with HIV, but rather at the silence and injustice that were close to becoming norms in our society.” Mr Salama’s movie script is entitled Asmaa—a woman’s name which means “names” in Arabic.

Overcoming fear to speak out

The next big challenge for the project was grabbing the interest of a producer. Mohamed Hefzy, a young producer who had worked on social issues such as street children and autism, took an interest in bringing the film to life. Mr Hefzy’s conviction of the role of media in addressing human rights issues led him to believe this project was worth investing in.

“It's ironic that this film, about a woman who decides to break the fear barrier to demand her basic rights for health care, was made before the Egyptian revolution. After all, the revolution was only made possible by Egyptians overcoming their fear to speak out. I hope that the film, like the revolution, will empower people living with HIV to do the same and that society's perception will change irreversibly as a result," says Mr Hefzy.

People living with HIV have been involved in many of the steps in creating this movie, some even acted on screen, and their experiences have inspired and informed the views of the cast.

The film has been given star endorsement. Tunisian celebrity actress Hind Sabry, who lives in Egypt, plays the leading role in the film of the character Asmaa. This is the story of a woman who bravely overcomes her own fears as well as social rejection to claim her rights.

Ms Sabry has personally committed to advocating for the rights of people living with HIV for several years. She has participated in TV public service announcements and been a voice for people living with HIV in several forums. To prepare her for this role, UNAIDS facilitated meetings between the actress and women living with HIV.

“I believe the movie may come under criticism because it tackles thorny issues, but Asmaa is an artistic and humanitarian experience,” said Ms Sabry.

The next phase of the project is around the corner as the film will be launched later this year after touring several world film festivals. Many people—in Egypt and further afield—eagerly await the release of the production and carry a lot of hope for positive social change.

In 2010 UNAIDS and the Senghor University of Alexandria signed an agreement of cooperation to include a 25 hour module specific to AIDS into the university’s Master’s degree in International Health programme.

The opening session of this new module, co-organized by Senghor University and UNAIDS, was held on 17 April 2011. Twenty-two students from across sub-Saharan Africa, the Maghreb and Egypt took part in the five-day training.

In attendance at the course opening was Jean-Elie Malkin, special advisor to UNAIDS Executive Director, whom he represented on this occasion. He was joined by other senior UNAIDS staff including the Director of UNAIDS Regional Support Team for West and Central Africa Meskerem Grunitzky-Bekele; and Director of UNAIDS Regional Support Team for Middle East and North Africa, Hind Khatib-Othman. Dr Christian MÉsenge who is the Director of the Health Department at Senghor University of Alexandria represented the University’s President Albert Lourde.

UNAIDS and the Senghor University of Alexandria signed an agreement of cooperation to include a 25 hour module specific to AIDS in the university’s curriculum of their Master’s degree on Health.

The memorandum of understanding was signed in Geneva on 21 October 2010 by UNAIDS Executive Director, Michel Sidibé and Mr Albert Lourde, Rector of the Senghor University.

The agreement also established that a selected group of students cursing the second year of the master’s degree will have the opportunity to undertake their mandatory 3 months internship in several UNAIDS country offices located in West and Central Africa as well as the Middle East and North Africa regions.

UNAIDS will also certify the continuing education courses organized by the University throughout the francophone Africa when such courses are related to AIDS.

This initiative is a consequence of the broader cooperation agreement between UNAIDS and the International Organisation of La Francophonie (IOF) signed in December 2009 focusing on institutional dialogue between governments, partners, stakeholders in the field and civil society. The IOF and UNAIDS strengthened their collaboration for the benefit of the peoples of the French-speaking world, specifically the most vulnerable.

The main areas of cooperation, which were identified with the Operating agencies of La Francophonie, could thus be embodied in new tailor-made agreements built around the themes of democracy and human rights, including legislative aspects of HIV, and education and research, in conjunction with the University Agency of La Francophonie (AUF) and the Senghor University of Alexandria.

This new agreement signed with Senghor University embodies the ties between UNAIDS and La Francophonie by building the capacity of the francophone countries in terms of human resources as well as raising awareness of the AIDS epidemic and UNAIDS work.

Dawn has just broken in Cairo, Egypt, but Ahmed is already out on the street. But unlike other children Ahmed is not on his way to school. Ahmed is 12 years old and left home when he was just six because his father in law didn’t want him in the house. After wandering from one house to another, he found that it was easier for him to live on the streets. At that time he didn’t realise that it was far more dangerous too. When the social workers of Hope Village found him, he had been beaten up, robbed many times and raped twice. Hope Village provided him with a safe place to stay and offered him much needed shelter, care and support. “We also enrolled him in an HIV session where he learned how HIV is transmitted,” said Nawara a sociologist at the Hope Village. “After what’s happened to him he is very worried that he could be positive himself,” she added.

 

Hope Village Society was initially created to provide shelter and support to orphaned children from one of Cairo’s poorer neighbourhoods. However, a fter two years, they realized that the local street children also needed a safe place to go where they could receive care and support so they opened a day care center. The inauguration of this centre in the Shubra district of Cairo was soon followed by many others including one in the district of Sayeda Zeinab where Ahmed and other young boys come to seek refuge and comfort when the streets of Cairo become too much for them.

 

Twenty three year old Nawara has been working at Hope Village for about a year. She said that although her job is very tough it is also very rewarding, “these boys really need our help” she said. “The most difficult case I encountered, she recalled, was one of an 11 year old boy whose father threw him off the window because he was being too loud. I go with the kids when they have their medical examinations and I am shocked by what I see on their bodies–– bruises, cuts, infected wounds––It’s difficult to imagine what these kids go through,” she said.

Khalid Dawoud has been working with Hope Village for the past 17 years. He set up the Sayeda Zeinab day care centre. “I know the story inside out and I know what those kids are subjected to,” he said. 

 

During his experience with Hope Village, Khalid noted how interested the children were in knowing more about HIV because of the dangers they face, from sexual assaults to drugs, violence and prostitution. Sex, both forced and voluntary often takes place at and other deserted places. The girls are usually more at risk because they are abused by the older street boys, by the police and others. Some girls accept to have sex for a sandwich, others do it to ensure protection in return. “It’s critical…” said Khalid “…that they know how to protect themselves from HIV. When we announced that we would open a testing centre soon, all of the kids wanted to be tested to make sure they are not infected with HIV.”

With help from UNICEF and other sponsors, the Hope Village Society undertakes a wide range of activities from providing boys and girls with care and shelter to offering them psychological support, training and behavorial skills to help them reintergrate into society.

 

“Working with such initiatives is one of our priorities in Egypt,” said Maha Aon, UNAIDS Country Coordinator in Egypt. “We know how important and effective it is to focus interventions on people who are most likely to be exposed to HIV infection. One of the ways to protect street children is to help them understand where the risks are and how they can protect themselves in a way that they understand and which helps them care for and respect themselves.”

UNICEF, in collaboration with UNAIDS provides training on AIDS issues for the social workers at Hope Village . Nawara, who did the course in March said that the information she received and the methods of participatory teaching helped her a lot with the children. “We learned to use games to communicate information about HIV and about the dangers of life on the street, from an HIV perspective,” she said. AIDS awareness has become an integral part of the work carried out by Hope Village to help the children.

Dr Erma Manoncourt, Chair of the expanded Theme Group on HIV and UNICEF representative in Cairo said, “We need to mainstream HIV into existing programmes and develop programmes and interventions which focus on reducing the vulnerability of marginalized groups, including HIV prevention and impact mitigation,” she added. “We are reaching out to the private sector and other civil society entities and working with NGOs and community-based organisations, and at the same time, we collaborate with and support the Government. All these efforts are needed to make a difference for those who have no one else to care about them,” she concluded.

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All photo credits: UNAIDS/P.Virot

Links:
Hope Village Society (Egypt)

Empowerment of women and promotion of gender equality were underlined as critical to reducing vulnerability to HIV in the Middle East and North Africa [MENA] at a recent gathering of experts from the region.

Specialists working in the areas of HIV and gender joined at a think tank meeting on “Gender and HIV in the Middle East and North Africa”, organized by the UNAIDS Regional Support Team MENA in Cairo, Egypt.

As the HIV epidemic in the MENA region continues to spread, the number of women living with HIV is increasing and the gap in prevalence rates among men and women is narrowing. Participants at the meeting agreed that gender inequalities across the region help fuel vulnerability and increase exposure to HIV infection. “Gender inequalities is and must be at the core of our national AIDS responses ,” said Fouzia Abdallah, the National AIDS Programme manager of Yemen.

Traditions and the role of religion were widely discussed by participants. The Minister of Family

Affairs and Social Development in North West Somalia, Fadume Haji Adam, gave an opening address looking at specific cultural and religious traditions in the region that have an impact on women and girls in the context of HIV.

“In our traditions lie our challenges, and it is also there we will find the solutions,” she said.

Adapting strategies on gender and AIDS to fit the regional context was highlighted as fundamental to a successful response. Giving examples of how AIDS responses have failed to adequately address the situation of Muslim women, Dr Nafisa Mohamed Abdelkarim from Afhad University for Women in Sudan, called for a deeper understanding of the contexts in which many women and girls in the region find themselves“:

“ We cannot adopt an international agenda on gender and AIDS, we must develop our own agenda. We have to find our own solutions and strategies,” she said.

Often, our women do not make individual choices. They make their decisions within their social contexts. Our responses to AIDS have to address these contexts, and not only the individuals. We have to make AIDS our agenda, with a language and with interventions that speak to us and our situations ,” she added.

The meeting brought together people from some of the most conflict-affected areas in the world. A key concern of participants was how to keep gender and AIDS high on an already full political and media agenda. “ The agenda is already full of immediate and emergency-related issues. At the same time, we can see how conflict situations increase vulnerability to HIV,” said Laila Baker, Assistant Representative for UNFPA, Occupied Palestinian Territory.

Rather than putting all our efforts in an emergency mode, we have to keep an eye on gender and AIDS in conflict situations. We can not afford ignoring such a crucial development issue ,” she added.

Building on this Think Tank meeting, the group identified key activities for moving forward, including reviewing national responses to AIDS in the context of gender, building capacity among national partners to further strengthen a gender-sensitive response, and mobilizing key ministries and partners to address gender and AIDS in the region.

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Links:

More information on the Middle East and North Africa region

The Joint United Nations Programme on HIV/AIDS urges all parties concerned, including the media, to understand that HIV infection is a condition that requires appropriate treatment and care.