“I fell sick just after getting married. It was back in 2006, and I was working in Saudi Arabia. I went to the hospital and I found out I was HIV-positive there. At first I was shocked, I had no information about the disease and I thought that everybody would avoid me. I thought I would die in a week and I was worried for my mother and my wife, who was five months pregnant. My wife took it well. She got tested to find out whether she was infected or not. I was planning to give her the choice to stay with me or leave if she was negative, but she said that we would live or die together.”
Abo-Mohaned* is 35 and lives in Sana’a, the capital of Yemen. HIV is not a major epidemic in Yemen; prevalence is estimated at about 0.2 per cent of the population. However, people living with HIV face stigma and discrimination almost everywhere, even in some health facilities. Abo-Mohaned has witnessed it first-hand: “When the time came to give birth, we went to two hospitals and both refused to assist my wife. The only solution was to take her to a third hospital, and hide her HIV status.”
Dr Abdul Fattah works at the HIV/AIDS treatment clinic at Al-Gumhuri hospital, the only place in Sana’a providing antiretroviral (ARV) treatment, and where about 445 people are currently receiving treatment. He decided to devote himself to fighting the disease while he was studying medicine, after a friend died alone, at home, without any medical care whatsoever. “After that, I had a reason to start reading about HIV. And when I finished my medical studies, I heard there was this clinic, so I came and started working here.”
“Fighting discrimination is a major challenge,” says Dr Abdul Fattah. “At first, people with HIV were being refused admission to hospital. After a lot of pressure and training of medical staff, the situation has improved a bit. Yet there are still many doctors, respected doctors, who panic at the mere mention of HIV.”
Besides the clinic, there are five centres in Sana’a where people who want to know their HIV status can get testing, diagnosis and pre and post-test counselling. However, the supply of tests to diagnose HIV has run out in the last few months. The Global Fund to Fight AIDS, Tuberculosis and Malaria will finance activities in Yemen until 2014, but these funds are only to ensure lifesaving HIV medicines to people who have already started treatment. “For care and treatment, we have enough financial support, but for other activities, especially awareness-raising, we need more. We lack resources for counselling and diagnosis, and particularly for the prevention of HIV transmission from mother to child, and these are services that we need to scale up,” explains Dr Adbulhameed, Director of the National AIDS Programme in Yemen.
First MSF HIV/AIDS-specific project in an Arab country
Since the beginning of the year, MSF has been working in Sana’a to help reduce the stigma faced by people living with HIV and improve their access to quality healthcare. “The strong discrimination against people living with HIV results in poor access to health facilities – people can be afraid of how they will be treated and, at times, their concerns are warranted,” says Sue Petrie, coordinator of the HIV programme run by Médecins Sans Frontières (MSF) in Sana’a. “Our aim is to work hand in hand with the National AIDS Programme, supporting their activities and improving the situation for people living with HIV.”
“I found out I was HIV-positive after my husband died,” says 35-year-old Um Abdul Rahman*. “I faced discrimination from a very close person: my own father. He disappointed me. He told me that I had to leave and go to the place where I had caught the virus. He abandoned me.”
Um Abdul Rahman has found that being a woman has made it even more difficult to cope: “Because I am a woman it has been really tough. When I found out I was HIV positive, I had no means to support my daughters. If I had been a man, I could have found a job, any job.”
According to official data, there are more HIV cases among men than women. However, Dr Abdulhameed cautions that these data may not be a true reflection of the number of cases among women: “Women may not have access to the available services for a number of reasons, related to stigmatisation and discrimination, or to violence against women. We need to scale up our services in order to trace the cases of HIV among women.”
Thankfully, Um Abdul Rahman found support at one of the associations working to help people living with HIV in Yemen: “I married again. Now I am married and have four daughters and a son.”
Associations such as the AID Association or No Stigma Foundation, struggle to support people living with HIV and advocate for their rights. “Our association was founded in 2007 by a group of young volunteers concerned about AIDS,” says Abdulhafed Al-Ward, Secretary General of the AID Association. “We believed that the affected people were stigmatised and deprived of many things in their daily life: medically, socially and legally.” The AID Association promotes awareness of the disease among the community and helps people with HIV to earn a living by providing microloans and organising training courses.
“These kinds of initiatives are helping to improve the situation for those most affected by HIV/AIDS,” says Petrie. “MSF wants to work with these associations because our impression is that they are a committed group of people who want to raise the profile of issues for people living with HIV, and reduce stigma and discrimination. This is also one of the main objectives of our work here: to raise awareness of the disease, reduce stigma and discrimination, and improve access and acceptance. Ultimately, we want to improve the services provided to this patient group.”
* The patients’ names have been changed to protect their privacy.