Country Situation Analysis

There are troubling indicators of risk behaviours in Egypt. For example, condom usage is very low in the general population and particularly among people whose behaviour puts them most at risk (such as men who engage in sex with men and commercial sex workers.). One study suggests that only 24% of men in one study reported every having used a condom (Kabbash, et al., 2005). Additionally, HIV testing rates are very low (for example, 99% of drug users never had a HIV test) (UNAIDS/UNODC, 2004).

The majority of people who are tested HIV positive in Egypt are men; reported HIV cases are four times more likely among men than women. This could be because more men than women are tested for HIV; most of the tests in Egypt are performed on male migrants applying for a ‘disease free’ certificate to work in the Gulf countries.

According to the 2005 Demographic Health Survey, only 6% of women have comprehensive knowledge of HIV. Outreach to women who are most likely to be exposed to HIV, such as sex workers, women in poverty, and injecting drug users, has begun, but coverage remains limited.

Other people likely to be exposed to HIV in Egypt include street children, prisoners and refugees. HIV prevention and care services to these people have been started, but remain limited in scope and coverage. The Ministry of Health and Population is the lead government body for the HIV/AIDS response.

Hepatitis C is one of the main health concerns in Egypt and has a high prevalence among the population. Increasingly, HIV/AIDS and Hepatitis C prevention efforts are addressed collectively. This is believed to help counter the very strong stigma associated with HIV in Egypt. Efforts are under way to engage other key government partners, especially the Ministry of Interior and Ministry of Information, and the National Youth Council. Civil society engagement has increased in recent years. An Egyptian non-governmental organization, “Network Against AIDS,” works to build the capacity of non-governmental organizations. The Egypt Business Coalition on HIV/AIDS is under formation, and people living with HIV (PLHIV) are planning to establish an independent association.

The bulk of HIV/AIDS spending comes from the national budget. The main donors for HIV-related activities are United States Agency for International Development (USAID), United Nations (UN), the Ford Foundation and, most recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Donor coordination is ensured through the Expanded UN Theme Group on HIV/AIDS.

Challenges and Emerging Issues for 2007

Focusing national efforts on addressing issues related to men who have sex with men, injecting drug users and sex workers is an urgent priority. Current efforts have proved successful in reaching sex workers and injecting drug users, delivering key services in a participatory manner and decreasing risk behaviour. Nevertheless, these programmes remain limited in coverage and must be scaled up urgently if they are to have an impact on the epidemic. Strategies to address men who have sex with men, especially the most impoverished among them, must be a key priority during 2007 and beyond. Greater involvement of key non-health sectors, such as the Ministry of Interior, is imperative. It is also important to focus on building the capacity non-governmental organizations in order to enable them to undertake the necessary programmes.

While it is commendable that the government has made the availability of HIV/AIDS medication free of charge, medical care and follow-up on those living with HIV must be improved.

Addressing the special needs of women and girls has, to date, not been a specific focus of the national response. The gender gap remains wide in Egypt and data show that women tend to have less knowledge of HIV/AIDS, experience higher rates of illiteracy and unemployment, are increasingly becoming infected with HIV, and, when infected with HIV/AIDS, have access to less social support.

The HIV/AIDS Epidemic in Egypt

Since 1986, there have been approximately 1,740 reported cases of HIV/AIDS in Egypt. More than 5,000,000 HIV tests conducted. However, preconditions for a wider epidemic exist. Risk determinants (factors that can help the virus spread faster and make it more difficult to control) include overpopulation, a large population of young people aged 15-24 (the group where over 50% of new HIV infections in the world take place), poverty (20% of population under poverty line), and the continued presence of illiteracy in the general population (38%) and especially among women.

There are currently 866 living with HIV, according to reports from the National AIDS Programme (NAP). However, UNAIDS/WHO estimates that the actual number of people currently living with HIV/AIDS ranges from 2,900 to 13,000. These data regarding AIDS cases indicate the following: the population group most affected is adults in the age group 20 – 40 years. Additionally, the fact that the male / female ratio of those being tested is 4/1 is probably because more men get tested for HIV. Often, testing occurs among migrant workers seeking ‘virus free’ certificates to travel for work in the Gulf countries, which require testing for HIV, Hepatitis B & Hepatitis C). Most reported transmission occurs sexually (84%); heterosexual transmissions accounts for 58% while homosexual transmission accounts for the remaining 26%. Transmission through injecting drug use represents around 3%. Mother to child transmission is responsible for 1% of reported infections. Transmission through blood/blood products is 8%. In 4% of the total reported cases, the mode of transmission is unknown. To date, the overall prevalence of HIV in Egypt may range from 0.007% to 0.02% of the population.

There are three different types of HIV epidemics. The first is called a ”Generalized Epidemic” and occurs where HIV prevalence among the general population (as measured by women attending antenatal clinics) is 1% or higher. “Low Prevalence Epidemics” occur where HIV prevalence among the general population is less than 1%. “Concentrated Epidemics” occurswhere HIV prevalence in the general population is less than 1% and 5% or higher in any population group (for example, among sex workers).

There are numerous troubling indicators of risk behaviours that suggest that HIV may rapidly spread if interventions are not increased immediately. Condom use rates are very low, including among the populations that are most-at-risk. For example, 58% of injecting drug users in one study had never used a condom in their life (UNAIDS/UNDOC, 2004); in another study, only 6% of female sex workers reported regular condom usage (AbdelSattar et al., 2002). The majority of injecting drug users share injecting equipment (55%, UNAIDS/UNODC, 2004). Men who have sex with men are often married (73%, MOHP/FHI, 2006), suggesting that an epidemic among this group may easily spread to the general population.

National Response to HIV in Egypt

Egypt is a signatory to both the Millenium Development Goals (MDGs) and the Declaration of Commitment on HIV/AIDS. In accordance with these declarations, the National AIDS Programme (within the Ministry of Health and Population) and a range of national partners are working in collaboration with international agencies to increase awareness among and provide services to vulnerable populations. They are also working to provide counseling and care to those infected and affected with HIV and AIDS, and general HIV prevention. Several programmes are already in existence. These programmes include, but are not limited to, anonymous voluntary counselling and testing sites across the country, free antiretroviral medications for people living with HIV, several peer-education programmes on HIV, and several outreach programmes for most-at-risk populations, such as injecting drug users and sex workers.

The government is currently finalized a National Strategic Plan on HIV and AIDS. This multisectoral plan will be lead by the Ministry of Health and Population, but also includes several key government sectors, namely the Ministry of Interior, the Ministry of Information and the National Youth Council. Many civil society organizations are also aiding the efforts, namely the Egypt Business Coalition on HIV, the Egyptian NGO Network against AIDS, people living with HIV and others.

There is a strong need to strengthen the role of non-health sectors in the HIV/AIDS response. Key opinion leaders such as religious scholars and media artists must increase their advocacy on the issue. There must be more focus on scaling up outreach programmes to the populations that are most-at-risk through direct service delivery and education. Programmes targeting vulnerable populations, such as street children, refugees and prisoners, must be dramatically strengthened. Finally, treatment and care of people living with HIV/AIDS must be improved, including the procurement of a variety of antiretroviral medications and the capacity-building of public and private healthcare entities

An average of USD 11 million is spent on HIV/AIDS response in Egypt, USD 8 million of which comes from the Ministry of Health and Population. The main donors to HIV/AIDS efforts in Egypt are currently USAID, the UN and Ford Foundation. Therefore, Egypt is indire need for more donor support. This support is particularly critical now, given that HIV/AIDS remains somewhat contained in Egypt, but has begun to grip of some parts of the population. Egypt has a golden opportunity to curb the spread of HIV/AIDS.