Tackling the HIV taboo

28 Nov 2013
POSTED BY Y Magazine

As the globe prepares to mark World AIDS day on Dec 1, Y looks at what life is like in Oman for people living with the disease



Husbands are putting their wives and unborn children at risk of contracting HIV by unwittingly passing on the virus through risky practices.

Last year, 127 Omani women became infected through partners, according to the Ministry of Health. This was out of 435 women in total who tested positive for the disease.

Many only find out the truth when they are pregnant and have an HIV test as part of routine antenatal checks carried out on mothers-to-be.

Because of the stigma still surrounding HIV in Oman, many people are reluctant to be tested or keep their HIV-positive status a secret from family, friends and colleagues.

“It can be a shock for wives who test positive, of course,” says Dr Mohammed Redha Moosa al Lawati, consultant physician and head of the National AIDS Control Program at the Ministry of Health.

“They did not know that they had contracted it from their husbands. Sometimes the husband would have become infected before marriage.

“The husband and children will be tested for HIV and offered counselling.”

Women with HIV infection have around a 30 per cent chance of giving birth to a baby who will also be infected with HIV, according to the Ministry of Health.

Most babies infected with the virus will die before they are three years old.

If the mother’s condition is found early in pregnancy, medication can be given immediately, dramatically reducing the infant’s chance of contracting the virus.

HIV tests are available to couples in all regions of Oman who are concerned that one or both of them might be infected.

But Dr al Lawati admits that the challenges facing the Ministry is to get information about HIV out into the community and engage people in the sensitive subject, which still remains largely taboo.

HIV-positive people often have to leave their jobs if co-workers find out about their status.

“It is difficult because of the stigma,” says Dr al Lawati.

“We need help to get the information out there and educate people about the disease.”

With World Aids Day approaching (Dec 1), the Ministry is stepping up public awareness of the disease with a series of events and advice on prevention.

This includes a three day workshop, pilot programme of anonymous voluntary HIV testing and reactivation of a hotline, where anyone worried they might be infected can call for advice.

“The message we want to give out to people is that if you have been involved in high risk practices, then get a test done,” says Dr al Lawati.

“If you are positive, there is support and treatment available.”

Last year, a similar voluntary testing scheme was run but was not, admits the doctor, a great success with people reluctant to attend one of the named HIV centres for fear of stigmatisation. The Ministry has learnt its lesson and this time round, an appointment booking system will be employed.

UNICEF has classified Oman as having a ‘low prevalence’ of HIV infection and the Sultanate topped the MENA region list for testing pregnant women, with 94 per cent of women expecting a baby receiving an HIV test.

All expatriates seeking residency in Oman are mandatorily screened for HIV as part of the comprehensive medical. Anyone testing positive is automatically expelled from the country.

hiv-gender

Since July 2009, HIV testing and counselling services were introduced for all pregnant women. All donated blood has been routinely tested since 1988.

It was back in 1984 that the first case of HIV  was reported in Oman.  Times have changed considerably in the intervening years and the country – and treatment of the disease – has come a long way.

As of the end of last year, there were 1,454 people living with HIV in the Sultanate, a rise from 1,366 the previous year. The majority of cases are contained in Muscat, North Batinah and Buraimi.

More than half of these cases are aged between 15-35. “We do have a few cases of young teenagers,” says Dr al Lawati.

The main routes of transmission are heterosexual (50.2 per cent), homosexual or bisexual (14.1 per cent), mother to child (5.5 per cent), injecting drug users (4.2 per cent) and blood transfusion (3.3 per cent).

This is according to the Sultanate of Oman – Global AIDS Response Progress Report 2012 by the United Nations, which used information supplied by Oman in March last year.

Statistics from the Oman government’s National HIV/AIDS Prevention and Control Program (NAP) website OmanAids.org, from 2008 show that the top three risk factors were heterosexual activity, followed by unknown, and then homosexual behaviour.

The UN report stated: “While limited research has been done among most-at-risk populations, including homosexuality and injecting drug users (IDUs), available data and information from focus group discussions and key informants show that these MARP (Most-At-Risk Populations) are all present in Oman and face considerable HIV risks.”

While praising Oman’s national response to HIV, the report also noted that ‘changing sexual norms and practices and drug use, as well as international travel and increased exposure to other cultures may place young people at special risk of HIV.”

It further said that expatriate workers in Oman might also face ‘special vulnerabilities.’

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According to the UN, anecdotal evidence from ‘peer informants’ revealed that ‘high-risk sexual practices are increasingly common among young Omani people, in particular young men.’

Precautionary measures, such as condom use, were said to be ‘very low’ among high-risk sex groups, said the UN.

The UN also said that an Oman study of 113 men who engage in homosexuality was made in 2011. Full results were not available at the time the information was submitted (March 2012). Just over half of the men interviewed were single, with one-third (36 per cent) married while 13 per cent were divorced or widowed. Most had extensive contacts, said the report. Unprotected behaviour was a cause for concern.

With the means and opportunity to travel out of the region, the report said that ‘high-risk behaviours imply HIV-infection risks not only for themselves but also their (potential) spouses and children.”

Work has been done in Oman to tackle the rates of HIV infections through drug use, such as sharing dirty needles.

The UN noted a program of distributing clean needles in the Muscat area to discourage the practice of sharing dirty needles.

Schoolchildren do learn about HIV and AIDs as part of the Peer Education Program in Years 10, 11 and 12.

“Young people should read about HIV and how it is transmitted and take sensible precautions to protect themselves,” says Dr al Lawati.

According to the UN report, Oman spent USD 4.7 million (RO1.8 million) on AIDS prevention and treatment. RO531,299 of this goes towards treatment, care and support for HIV-positive people with almost a million rial dedicated for mandatory testing. The rest is spent on prevention such as blood donating testing.

hiv-modes

On World AIDS Day in 2005, UNICEF Oman and its partners launched the Unite For Children, Unite Against AIDS campaign, highlighting the importance of protecting children and helping young people infected or affected by the virus.

A telephone hotline manned by ten volunteers was initiated to answer calls from the public.

This time round, the focus will also be on smashing taboos surrounding the disease and ending discrimination. With only 0.64 per cent of the population diagnosed with HIV, it does not have the same high profile as disease such as breast cancer or diabetes.

“The challenge for the Ministry is to make it where a test result is not held against the person,” says Dr al Lawati.

“We need a lot of education with the business sector, particularly that the confidentiality of results should be maintained.

“There are young people out there who are HIV-positive working in banks, for instance, and nobody needs to know about their status.

“If their status or the results of a test becomes widely known, however, it becomes difficult. Often they cannot survive in that environment and stigma.”

Treatment and life expectancy has changed since the first dark days of HIV. With early intervention and free treatment available to nationals, the disease can be managed much like any other and, with care and appropriate precautions, HIV-positive people can live relatively normal lives.

“Things are much easier,” agrees Dr al Lawati.

“HIV is no longer the death sentence that it once was.”

Sisters Together – Living with HIV

In 1984 in a remote village in the mountains, a few hours drive west of Muscat, two young sisters and their family are about to be struck with the most devastating news.

The girls’ mother has just died of an unknown cause. The eldest sister is only five when they lose their mummy.

Shortly after, the girls are tested for a virus their family and most Omani doctors had yet to hear of: HIV. Both girls test positive.

Remarkably, 29 years later, both Raya and Lamia are doing well.

In an interview with The United Nations Children’s Fund (UNICEF) a few years ago, they spoke candidly of their lives with HIV and dealing with the stigma that goes with it – including rejection by their own brothers and being shunned for marriage.

Their mother contracted HIV from a blood transfusion in the early 1980s. Oman, at that time, was importing blood from Africa and Europe. The blood was not screened for HIV since the test had not been developed.

After their disease was confirmed, Raya and Lamia were ostracised by their family. Their stepbrothers rejected them.

“They thought us repulsive,” says Lamia. “And they refused to sit anywhere near us or share a meal.”

Outside the home, the girls kept their diagnosis a secret.

“We attended schools like all the other children. Our disease was never an issue,” says Raya.

Further education continued with college. While their friends began to get married and have children, the girls could only watch.

Both have been proposed to – but the shadow of HIV has prevented it going further. Raya’s suitor ended the engagement as soon as he discovered her status, while Lamia refused to accept an offer of marriage, even though her suitor accepted that she was HIV-positive.

Today both girls remain well and living their lives as best they can.

* Credit: UNICEF

Myths

There are many misconceptions about HIV and AIDS. The virus CANNOT be transmitted from:

  • shaking hands
  • hugging
  • casual kissing
  • sneezing
  • touching unbroken skin
  • using the same toilet
  • sharing towels
  • sharing cutlery
  • mouth-to-mouth resuscitation

HIV – The Lowdown

  • It was back in 1981 in the United States that the first cases of a strange new disease were reported. Patients were presenting with unusual symptoms, such as rare cancers, usually only seen in people with compromised immune systems. Two years later, researchers identified a retrovirus as the cause of infection. It was named HIV (Human Immunodeficiency Virus).
  • It is believed the virus, and its variant HIV-2, originated in primates in West-central Africa and transferred to humans. The earliest documented case of HIV in a human dates back to 1959 in the Congo.
  • AIDS (Acquired immune deficiency syndrome or acquired immunodeficiency syndrome) is the disease caused by HIV. The illness changes the immune system, making people more vulnerable to infections and diseases. It is possible to be infected with HIV without developing AIDS.
  • HIV is passed from one person to another through blood-to-blood and sexual contact. Infected women can pass HIV to their babies during pregnancy, delivery and through breast-feeding.
  • HIV can be transmitted through body fluids, blood transfusions and contaminated hypodermic needles.
  • Many HIV-positive people are unaware that they are infected with the virus.
  • Modern HIV testing is extremely accurate. A single screening test is correct more than 99 per cent of the time.
  • Many people with HIV have no symptoms for several years. Others develop symptoms similar to flu two to six weeks after catching the virus.
  • Symptoms of early HIV infection can include fever, chills, joint pain, sore throat, night sweats, enlarged glands, weight loss and a red rash.
  • It can be up to 10 years before any more symptoms occur without treatment.
  • There is currently no cure for HIV/AIDS. Treatments can slow the course of the disease – some infected people can live a long and relative healthy life.
  • Drugs slow the rate at which the virus replicates, delaying the onset of AIDS.
  • Antiretroviral treatment is free for all Omani nationals and support, including counselling, is offered at 15 treatment centres around the country.


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