The last time Mustafa Abdel Rahman, an Egyptian living with HIV, visited a hospital in Cairo, he was treated so shoddily by the medical personnel that eight years on he refuses to go back.
During the three months Abdel Rahman spent in hospital in 2003, the doctor never came into his room; he sent a nurse in once a day to give him his medication. Throughout his stay his room was never cleaned, forcing him to clean it himself, and when his temperature rose dramatically one night and he went to a doctor's office for help, he was thrown out and ordered never to leave his room.
"I saw for myself how people like me are detested, held in contempt, and given the severest psychological pain," Abdel Rahman, a lawyer, told IRIN/PlusNews. "Our medical workers do not just understand that people living with HIV and AIDS are human beings too."
According to a 2011 report on HIV-related stigma in Egypt, the healthcare sector was consistently identified by people living with HIV as a major source of stigma and discrimination. A study quoted in the report found that denial of care, breach of confidentiality, non-consensual testing, poor quality of care, gossip and blame were all frequent features of Egypt's healthcare setting. Many of the 11,000 Egyptians living with HIV would rather suffer minor health problems than attempt to obtain health care.
"HIV/AIDS related stigma and discrimination are the most serious challenges to putting the lid on infections in this country," said Ahmed Awadallah, the manager of the youth reproductive and sexual health programme at local NGO the Family Planning and Development Association. "This trend must change because it has its own adverse effects."
Amany Masoud, deputy director of the Right to Health Programme at local NGO the Egyptian Initiative for Personal Rights, told IRIN/PlusNews she knew of a pregnant HIV-positive woman who was denied permission to give birth in many of the country's main hospitals before eventually being offered a room specially for HIV-positive people at a hospital in Cairo.
Awadallah noted that discrimination was particularly bad for men who have sex with men (MSM).
"Egyptians in general tend to perceive HIV as a punishment from God and the personal responsibility of the infected party," he said. "Most people, including the medical staff themselves, look down on the patients because they see them as having pursued unorthodox or abnormal lifestyles, or as being homosexuals."
According to the Ministry of Health, 49.5 percent of HIV infections in Egypt are through heterosexual transmission, while homosexual transmission accounts for 22 percent of infections.
"Homosexual patients are in for the worst treatment inside the hospitals," said Abdel Rahman. "They suffer most of the scorn in fact."
A systematic review of data on MSM in the Middle East and North Africa (published in August 2011) found that HIV epidemics appeared to be emerging among MSM in at least a few countries in the region and could already be in a concentrated state among several MSM groups. Unless issues around stigma and discrimination are addressed, experts say the epidemics will continue to grow.
"Prevention of male-to-male HIV transmission must be set as a top priority for HIV/AIDS strategies in MENA [Middle East and North Africa], and obstacles must be addressed for the provision of comprehensive sexual health care for MSM," the authors recommended.
As a result of the high levels of discrimination, many HIV-positive people do not tell healthcare workers they are infected with the virus, something that officials say is risky. Abdel Rahman gets his life-prolonging antiretroviral drugs from the Health Ministry every three months, but when he feels very ill, he goes to private clinics but does not disclose his status.
"When I catch severe flu, for example, I go to a private clinic, but I never mention AIDS," he said. "I am sure that if I mention it, I will be kicked out of the clinic."
"You cannot imagine how dangerous this is. In the absence of standard infection prevention measures in our hospitals, this can be really catastrophic," said Masoud.
The stigma report found that physicians and nurses were often reluctant to provide people living with HIV health services due to their lack of knowledge about infection prevention; doubts as to the effectiveness of prevention measures; moral stigma against “illegitimate sex”; fears of being stigmatized by the community; misconceptions about care and treatment of people living with HIV/AIDS; and the generally negative connotations associated with HIV/AIDS.
Medical ethics training
The authors recommended, among other things, improved infection control programmes and training on medical ethics with the aim of establishing effective anti-stigma policies, as well as education for health workers on health services for HIV-positive patients.
"The problem is that most doctors are not aware of infection prevention measures," said Zeen Al Abdeen Al Taher, an HIV/AIDS expert and the former director of the state-run National AIDS Programme (NAP).
Al Taher says in 2007, NAP created the first network of medical specialists with experience in dealing with HIV patients, including homosexual cases. It also specified units in the nation's hospitals for the treatment of HIV patients.
"We also gave training to medical students on how to deal with HIV patients," he said. "But... doctors are part of society and the culture of this society needs to change."
Abdel Rahman and several hundred HIV-positive people have founded a group, the Friends of Life Society, which aims to make people living with HIV more aware of their right to health care; they meet on a regular basis and give each other ideas on how to counter stigma, share experiences, and give each other tips on how to get their medical rights.
"As a patient, I have a right to healthcare," Abdel Rahman said. "The doctor treating me does not have the right to ask me where I got the infection from."