HIV and AIDS epidemic status in Egypt

Till the end of 2010, a total of 4,313 HIV cumulative cases were detected in Egypt, of which 3,328 were Egyptians.

 

In 2010, most transmissions occurred sexually (66.8%). Out of the total detected cases 46.2% are heterosexual transmission and 20.6% are homosexual transmission. Transmission through Injecting drug use represents around 28.3%. Among detected cases in 2010, 14 (4.9%) were children of various ages denoting probable mother to child transmission (Situation analysis 2010).

 

Egypt has a low HIV prevalence among the general population (below 0.02 %) with a concentrated epidemic among men having sex with men (MSM) and injecting drug users (IDU) in some governorates as detected by the latest biological/behavioral surveillance survey. Nevertheless, risk behaviors suggest that a wider epidemic may be emerging especially among most at risk populations (MARPs) and bridging groups (BBSS 2010).

Despite a low prevalence of HIV in the general population (<0.1%), a population based survey was never conducted in Egypt. Additionally, risk determinants for a wider epidemic exist due to a large population of young people age 15-24 with very low knowledge of HIV (4.8% and 18.3% of females and males respectively have comprehensive knowledge of HIV); poverty (20% of population under poverty line), the continued presence of illiteracy in the general population, high rates of risk behaviors and very low condom use.

There is emerging evidence of HIV epidemic among most at risk populations (MARPs) including injecting drug users (IDUs), female sex workers (FSWs) and men who have sex with men (MSM) who are mostly hidden due to stigma but are very much engaged in risk behavior.

HIV and Women in Egypt

UNAIDS/WHO estimates that there are 5,200 [3,000-8,600] women of 15 years and over living with HIV till the end of 2008 (UNAIDS, 2009). There is a special vulnerability for women and girls due to lower socioeconomic status, higher illiteracy rates (38 %), as well as weak access to prevention and services. Fewer women present for voluntary counseling and testing than men (23.3% of all VCCT visitors are females).

Very few women present for voluntary counseling and testing. Coverage of services for preventing mother to child transmission is estimated to be 21% in Egypt

There are gaps in women’s knowledge regarding HIV and AIDS. According to the Demographic and Health Survey only 7.1% of women age 15-59; and 4.8% of 15-24 years old women were found to have comprehensive knowledge of HIV. This coupled with weak access to services, presence of violence and low condom use places women at risk. Condom use rate is very low in the general population (2.5% among ever married women 15-49 years). A recent study conducted in 2007 on condom use among 2,309 males (age group 15-49) reveals that only 23.9% had ever used condoms (Kabbash et al, 2007).

HIV and Children in Egypt

According to UNICEF, the number of street children in Egyptian cities is estimated to be between 600,000 and 1 million. In a recent Behavioral Survey among street children in Greater Cairo and Alexandria it was found that about 67% of study participants 15–17 years old have ever had sex with someone of the opposite sex. Among those who had sex during the last 12 months, 54% had sex with more than one partner, and 25% reported using condoms. About 26% of street girls in Greater Cairo and 58% in Alexandria reported participating in commercial sex (this is less common among street boys). Around 28% of street boys reported having had sex with boys, frequently under the influence of drugs, and in many instances as part of group rape; 53% had more than one partner. Unfortunately, due to lack of proper education, the above behaviors are coupled with poor knowledge of HIV and AIDS. While 79% had heard of AIDS before, 16% did not know how to avoid contracting the infection.

HIV and Youth in Egypt

Knowledge among the general population is low as documented in the latest Demographics and Health Survey where only 7.1% of women age 15-59 and 18.1% of males in the same age group had comprehensive knowledge about HIV and AIDS. This level of knowledge is compromised at the younger age brackets of 15-24, especially for women, where 4.8% have comprehensive knowledge versus 18.3% of men.

National Response

In 1987 The National AIDS Programme (NAP)was established by ministerial decree in order to lead the National response against HIV and AIDS. Since then the NAP has implemented two 5-year National Strategic Plans (NSP), 1995-2000 and 2001-2005 and it’s currently implementing a third NSP (2007-2011). The last NSP was developed with inputs from several key government sectors, namely Ministry of Interior, Ministry of Information and National Youth Council, in addition to Civil Society (The Egypt Business Coalition on HIV, the Egyptian NGO Network against AIDS, people living with HIV and other national and international agencies).

Expenditures on HIV and AIDS in Egypt from national and international resources mounted to EGP 35,154,654 million and EGP 42,086,833 million in 2007 and 2008 respectively. Expenditures from Government resources represent 53.4% and 49.5% of total expenditures in 2007 and 2008 respectively. Resources allocated to HIV are strengthening health and other social systems.

Civil Society Organizations are supported by the UN, Global Fund and to a lesser extent by other donors, to implement peer-education programmes on HIV for vulnerable groups (street children, refugees, prisoners), and several outreach and prevention programmes for most-at-risk populations (injecting drug users, men having sex with men and sex workers).

Medical care is the responsibility of the NAP and is conducted through free provision of ARVs for people who need it, follow-up, and counseling and treatment of opportunistic infections. A home-based care program for PLHIV is in place in Alex and will be soon launched Cairo providing home visits to HIV affected people and trainings for PLHIV and their families raising awareness and clarifying misconceptions. In addition, as part of the home based care initiative, the group has been working with health care providers to improve treatment and care for PLHIV.

Access to Antiretroviral Treatment has improved due to procurement of a variety of antiretroviral medications supported by the global fund and national resources. Currently 264 adults and 27 children are on first line treatment, while 68 adults only  are on second line. The NAP has activated a process of decentralization of ARVs distribution system as a result PLHIV are now able to access ARVs through 6 distribution points located in  5 governorates (Cairo, Giza, Gharbia, Alexandria and Menia) while initially ARVs were available only in Cairo. Although ARV drugs are available for patients in Egypt the selection of ARVs distributed is still limited and especially for those who develop resistance