Aids, and the fear that helps it to spread

Experts say nations ignore at-risk groups, while voluntary testing planned by the UAE may fail due to patients' fear of punishment.

Dr Tim Martineau, the director of programme effectiveness and country support for UNAids, talked about reducing the stigma of HIV at the InterContinental Hotel in Dubai.

DUBAI // The Aids epidemic will never be brought under control unless governments in the region stop ignoring the most at-risk populations, health experts warned yesterday. Delegates at the UNAids meeting in Dubai said authorities must stop denying the existence of HIV/Aids and those most at risk of spreading it. Khaled Naga, a Unicef Goodwill Ambassador, said a "vicious circle of fear" is having an impact on the battle against Aids in the region.

He spoke openly of the often-unnecessary fear that contributes to the spread of the disease. The UAE, among others, currently offers no voluntary testing scheme although plans are underway to establish this service. Foreign nationals living in the country are forced to undergo an HIV test when applying for a residency visa, changing jobs, getting married or undergoing surgery at a Government hospital. Those who test positive are deported.

"If you have 10 people who are too frightened to get tested, they will never be screened," he said. "Because of that, the next year there will be 20 people, the year after that there will be 40, and so on. "Fear is the main reason the virus is still spreading." The three "key populations" identified as most at risk are injecting drug users, prostitutes and homosexuals. In many Mena countries, these populations are subject to strict punishment under the law.

Due to legal issues, Mena countries were reluctant to invest in Aids prevention targeting at-risk groups. The UAE spends more than 80 per cent of its $17.6m HIV budget on involuntary testing. None of the remaining money is spent on prevention in at-risk populations. Syria, Saudi Arabia and Kuwait also spend nothing on preventing the spread among key groups. Oman and Morocco spend at least 10 per cent of their prevention budget on such groups.

Christian Kroll, of the UN Office on Drugs and Crime in Austria, said all countries must accept that these at-risk groups existed, legally or otherwise. "It's easy to speak about 'key populations'," he said. "It's difficult for some countries to talk about what's behind that. "Nobody talks about homosexuals, transgenders or prisoners." As long as prostitutes, homosexuals and drug users were sent to prison for their actions, countries would "never ever get HIV under control", he said. "If you say that sex work is illegal and does not happen, go to a bar here at 10pm and have a look," he said.

He urged governments to learn from other nations, particularly those who have taken steps to adjust their laws in response to a growing and changing population. Laith Abu-Raddad, the author of Characterising the HIV Epidemic in the Mena - Time for Strategic Action, said the solution could be to strengthen and expand the role of non-governmental organisations. "Here are two ends of the spectrum," he said. "On a country level they don't want to recognise that these people exist. And other non-governmental groups want political acknowledgement.

"We need to find a middle ground, allow others to do this work with support and funding from the Government." Homosexual men are the most hidden and stigmatised risk group in the Mena region, his report states, but are prevalent at levels comparable with other regions. The report acknowledges that commercial sex is prevalent all over the region, estimating that as many as one woman in 100 exchange sex for money or other commodities.

The report, a joint effort between the World Health Organisation, the World Bank and UNAids, stresses the importance of targeting those known as "potential bridging populations" between at-risk groups and the general population. This category includes clients of sex workers, truck drivers, fishermen and military personnel. Dr Jaouad Mahjour, the director of communicable disease control in the WHO's Eastern Mediterranean Region, said most people with HIV do not know they have the disease. "Wider access to voluntary and confidential testing is critical."

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