Begins to Face Hidden
AIDS Problem
By HASSAN M. FATTAH,
NYTimes on the Web, August 8, 2006
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Tamara Abdul Hadi for The New York Times
Rami al-Harithi,
infected with H.I.V. in surgery, is a public advocate in ways that
homosexuals cannot be. |
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RIYADH, Saudi Arabia —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 H.I.V.-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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