As this diagram llustrates not too much yet is publicly known about Saudi Arabia and HIV/AIDS. This is a topic which continues to be opened up slowly. Not only does a large stigma exist on simply the subject of HIV/AIDS but in many cases, Saudis who have been diagnosed with AIDS are literally banished. There are several well guarded secure facilities in Saudi Arabia where AIDS patients are taken and admitted. These patients are admitted as a number and not by a name to further protect the identify of the patient and the family. If one is tested positive for HIV/AIDS at a hospital, he or she will probably not even be permitted to leave the hospital and return to the privacy of their own home. The patient will be placed in some form of isolation.
SAUDI ARABIA
|
Population, 2007 |
27,600,000 |
|
People living with HIV/AIDS, 2005 |
No Data |
|
Women (aged 15+) with HIV/AIDS, 2005 |
No Data |
|
Children with HIV/AIDS, 2005 |
No Data |
|
Adult HIV prevalence (%), 2005 |
No Data |
|
New HIV infections, 2005 |
No Data |
|
AIDS deaths, 2005 |
No Data |
*Source: Population Reference Bureau & UNAIDS
Now according to this August 2006 article from the International Herald Tribune it indicates that a greater awareness and understanding of HIV/AIDS is taking place in the Kingdom. It is true that more conferences and seminars about the disease are taking place now. But in my view the stigma still remains with those who have been identified and diagnosed as HIV/AIDS positive whether infected due to homosexuality, STD or blood transfusion.
Filed under: Health, Saudi culture
Saudi Arabia, a country in denial of reality.
Great post! Thank you for the information on stigma and statistics (more stats were available in the article), including the graphic representation and your personal impression or stigma.
Did you come across this abstract “Epidemiology of the human immunodeficiency virus in Saudi
Arabia; 18-year surveillance results and prevention from an Islamic perspective” http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102284257.html; and, the full article
http://www.biomedcentral.com/content/pdf/1471-2334-4-25.pdf of the same from the Department of Medicine, King Abdulaziz University, Jeddah and the Ministry of Health, Riyadh, Saudi Arabia? Though it dates from 2004 it has interesting information and hypotheses; and all epidemiological data are divided into Saudi or expat.
It emphasizes hetersexual transmission as the primary mode, although homosexual transmission is more prevalent among Saudis than expats (surprised me!–but on second thought makes sense), and it does acknowledge IV drug abuse. The causes and solutions are discussed from an Saudi Islamic perspective, with an emphasis on the need to encourage marital sex, and to keep the Kingdom free from the “sex trade, prostitution, and drug smuggling and to implement the Islamic penalties on those involved in such illegal acts. ”
It does acknowledge there is no research proof of the efficacy of Islamic preventative strategies.
The role of zakat in preventing poverty and thus prostitution and drugs was a new hypothesis for me; as well as the recommendation to create charitable institutions to cover marriage costs to encourage marital sex as a preventive strategy. In this context allowing young (sometimes very young) marriages is seen as a positive.
I am very impressed that Saudi protects Saudi patients’ privacy, and right to work, and provides free meds as well as health care. Canada does not cover the cost of medication, and as you know health care costs are a major issue in the USA.
Stigma and illicit sex, and stigma and homosexual sex go together unfortunately well for the sufferers.
In the denial department, South Africa seems to have Saudi beat, since the diagnosis is not acknowledged or recorded (people have other type of blood ills instead), and the head of government advocates herbal remedies, and vitamins. Fortunately Mandela has been open about his son’s death from Aids.
Once again, great post, sorry to be long-winded
.
That’s what I thought. Many rulers of countries in the Middle East are in denial that such problems exist in their country. Yet, I think it’s important to know about something like this, rather than find out later, if you know what I mean.
I don’t think though putting a person in isolation in necessarily the right treatment. If anything, the person will end up with mental problems.
Saudi Arabia should find a way to educate people, especially the younger generation, about these issues, the right preventive measures, and if someone does have a health issue like such, what he or she needs for proper treatment, if treatable.
Its all a matter of saving face…to admit such things exist within society means admitting that sex exists…and of course…sex is still the number one taboo in the Arab/Muslim world….ironic considering the Prophet was very open about sexual matters and didnt hesitate to discuss or answer questions dealing with it in all its forms. Yup…the Arab world has come along way in 1400 plus years….NOT!!!
All – thank you very much for the interesting comments!
I agree that isolation is not always the best solution yet privacy is so guarded here in Saudi Arabia it is not a surprise.
[...] There are several well guarded secure facilities in Saudi Arabia where AIDS patients are taken and admitted.” Posted by Ayesha Saldanha Print version Share [...]
Salaams Carol:
You wrote:
“If one is tested positive for HIV/AIDS at a hospital, he or she will probably not even be permitted to leave the hospital and return to the privacy of their own home. The patient will be placed in some form of isolation.”
“probably” is the key word here. Are you serious? Once tested, they cannot return home? OMG!
Bedu, I hope this situation is not accurate. HIV patients can live AIDS free for an indefinite time with the proper treatment. This amounts to a life prison sentence.
This information is not new. I remember my Saudi neighbors telling me of such back in 1991 when I was still an undergrad.
However, in all fairness, the kingdom, out of fear of the spread of the disease, isolates these patients. This is what I’m guessing.
Honestly, when you think about it, it carries a stigma no matter what country you’re in.
I will investigate further but I did have a discussion with a medical practitioner on this topic and was advised positive HIV/AIDS patients are basically sequestered and isolated. You’re right, Saudi in US, it does equate to a prison sentence.
Isolation, to me has two meanings–medical isolation of highly infectious patients with highly communicable diseases (eg. tuberculosis) ,and of immuno-suppressed patients to protect them from others; and, social isolation. The former is rarely necessary except in specific circumstances, and the latter never serves anyone well especially the longer it lasts. It can be used as part of the treatment of manic patients to decrease stimulation but is short term until they recover sufficiently (eg. they stay in their own regular hospital room and don’t socialize with other patients for a few days ).
I would hope initially diagnosed Saudi HIV patients are only isolated until it is established they have no highly communicable diseases. It seems from the articles that expats with HIV are imprisoned and deported.
Stigma is present everywhere but to differing degrees, and those degrees can make a world of difference. I would imagine HIV/AIDS patients are doubly stigmatized since the usual (often false) assumption is that they are homosexual, or engaged in illicit behaviors whereas some are infected by transfusion, marital sex with an unfaithful partner, or neonatal transmission. All of course, deserve care and compassion. The rare HIV infected man who deliberately infects other women begs for seclusion, isolation, imprisonment, castrations (chemical or otherwise), etc.
My understanding is that social isolation is very common with HIV/AIDS positive patients. Ironically I was talking with a few nurses (expats) who were interested in working with HIV/AIDS patients and the private hospitals are so well protected that they did not even know the hospitals existed. They confirmed that at the large hospitals, any HIV/AIDS patients are kept isolated.
Adding to the above comment, I think that it is fortunate that at least in regards to the large hospitals, the nursing (and to an extent physicians) are expats who are probably more tolerant and compassionate to HIV/AIDS patients.
Social isolation
Compassionate health care workers–expat or other
My guess is the rates are higher than nonexistant, as the Saudi government would like to pretend. As most people throughout the Arab world know, the Saudi’s are particularly known for bieng sex tourists to other Arab countries–where the rates of AIDS are still low, but rising. (Of course it does’t mean that all Saudi’s are sex tourists, but those who are have given the Saudi’s a bad reputation all the way across North Africa….)
Expat21
“Expat Abroad”
expat21.wordpress.com
I wonder what would happen to healthcare providers who are exposed to HIV/AIDS via needle pricks- here we have procedures to follow so that a provider is tested and given medication from the moment the incident happens- personally I have had to sign off on quite a few cases of providers who are accidently exposed.
Would then in KSA these providers find themselves without a job instantly, through no fault of their own?
In our facility we are tested annually- and in cases of specific areas- every six months for all types of contagious diseases…that alone puts stress; let alone knowing that you might be isolated “permanently” for being positive…
Even in the USA any patient is referred by their MR# for HIPAA regulations on privacy- and only direct patient care providers have access to a patient’s info- and that is also strictly regulated- meaning MR#, DOB, M/F- all other characteristics are not to be mixed with these because it singles a person out- our Virology clinic is enormous- yet all patients come and go- precautions are taken and people have awareness- though of course social stigma; and the individual prejudices will never disappear… But prison like isolation serves only to break up that person’s tenuous hold on life and the will to survive…
From the International Herald article:
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 commit “sexual deviancy.”
Now the government is changing its policy on AIDS. In June, the Ministry of Health announced that more than 10,000 people in Saudi Arabia were infected with the virus, HIV, or had AIDS, including nearly 600 children. The numbers appear to show a sharp 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 country 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.
The article I referenced of an 18 year survey by Saudis:
from 1984 through 2001, a total of 6046 HIV infections were diagnosed; 1285 (21.3%) cases were Saudi and 4761 (78.7%) cases were expatriates. The infection was most common in the age group 20-40 years (74.6%) and predominantly affected men (71.6%). The modes of transmission among Saudi citizens and expatriates, respectively, were as follows: heterosexual contact, 487 (37.9%) and 1352 (28.4%) cases; blood transfusion, 322 (25.0%) and 186 (3.9%) cases; perinatal transmission, 83 (6.5%) and 19 (0.4%) cases; homosexual contact, 32 (2.5%) and 38 (0.8%) cases; intravenous drug use, 17 (1.3%) and 33 (0.7%) cases; bisexual contact, 10 (0.8%) and 14 (0.3%) cases; unknown, 334 (26.0%) and 3119 (65.5%) cases. The number of HIV infections transmitted by blood or blood products transfusion declined to zero by year 2001 [due to screening].
Based on these articles, even the higher total numbers are still low compared to others worldwide. It is an improvement to acknowledge the existence of the problem even if it is minimized and stigmatized.
Inal–one of the most cruel patient-nurse interchanges I have witnessed was a psychiatric patient’s refusal to reveal his HIV status after a nurse had been contaminated while helping to restrain him. As a result she, a wife and mother, had to wait weeks for the test result on her (both were negative). Fortunately testing is faster now, and even most psychiatric patients would reveal their status in such a situation.
expat21 – I actually wrote an earlier post about Saudis and sex holidays.
Inal – I will have to ask about medical staff and exposure…what happens, what is the policy.
HIV/AIDS is getting growing attention in KSA but is still viewed as a big stigma.
Last year we piloted an HIV rapid test and we ask all patients if they want testing that includes counseling; it was also instituted for our employees in cases of accidental exposure- the results are interesting and we have been able to “treat/counsel” people earlier if they are positive- we go before the Board in a few months to give the results of the pilot so they can give us permission to implement it hospital-wide.
Please let me know Bedu, I am curious on the policy over there.
That sounds great Inal and I am confident there is nothing similar yet in KSA.
This is one of the saddest articles you had on your blog Carol. Not everyone who contracts HIV is engaged in risky behaviors. Some women contract the disease from husbands that engage in sex tourism for instance and others contract it through blood transfusion. The fact that a country with the resources of Saudi can treat these patients and have them live a normal life instead of warehousing them in institutions. The risk of spreading the disease is minimal, since HIV does not transmit through normal every day contact.
The government is engaging in an inhumane treatment of patients that deserve compassion and care. What is worse is the religious leaders are fueling this stigma by labeling it as a punishment from god. Nothing could be more un-Islamic than having such lack of compassion for follow humans. I want also to note that we have not heard from any of their mouth pieces, that comment here regularly. They will spend days arguing the simplest issues like saying Salam to non Muslims or listening to music, but condemning people to a life long sentence in a hospital seems to be OK in their book I assume.
Saudi in US, oh but God specifically condemns those activities that the mouthpieces defend. How dare you criticise them! :O
I agree with you Saudi in US that this is a sad state indeed.
Interesting post Bedu…
Also interesting to note that the same is said about North Korea and there statistics or lack there of of HIV/AIDS cases…. with the North Koreans refusing to even acknowledge that there would be any cases in there country…
Coincidence……
I have a feeling that is NOT a coincidence at all regarding North Korea!
I was under the impression it was the expats who were held if they have a positive test for HIV not saudis. Saudis from what I understand are free to leave and hide it from their families. Their jobs are protected and their medical care is free.
I’m also under the impression some statistics are out there. And acknowledgement however small has been growing over the years. Here is a link to an article from 2006
http://www.nytimes.com/2006/08/08/world/middleeast/08saudi.html
I also must say that I applaud the government for requiring Saudis to have HIV testing in order to get married rather than just foriengers.
Foriegners on the other hand.. well that is a whole other bag of basmati ain’t it??
I know there can be distinctions between provinces, but I can say here in Nej’d there is a stigma. I know of an individual who had an infection with some similarities to HIV and this person was immediately admitted and isolated (after simply coming to a medical center on a routine matter). Thankfully the individual did not have HIV and was subsequently released once the findings were known.
Nzingha–my impressions are the same as yours; and the NY Times article is the same as the International Herald Tribune one, which does give stats and talks about stigma still being present.
American Bedu–I wonder if the person you know of was medically isolated until the findings could be known, rather than socially isolated for stigma reasons. Stigma continues despite increased openness (all relative of course) as you and other commenators have pointed out; however, the Saudi system for Saudis seems to have some real positives about privacy laws, work, and free medical care including medications. I still have to wonder whether the stigma has as much to do with perceived homosexuality as the illness itself and misunderstandings about communicability.
I can’t say Chiara. This same individual realized while at the clinic that he had left some documents in his car which were needed and the clinic personnel would not even let him exit to go get the documents and insisted someone else had to retrieve them. It seemed the fear stemmed that he would leave and not return and the clinic lost control.
Bedu- maybe that was just the clinic. I’m sure if dude pressed it hard enough he could have walked out. I’ve read of a hospital holding a newborn ransom because the parents couldn’t pay the bill so they wouldn’t release the baby. Not legal by any accounts but the hospital did it. Weird stuff.
Chiara- I would say the stigma is all about the disease and how it is associated as a “wrath from God” usually as a point to prove how peverse the west is. When you are taught this from religious leaders it is difficult to accept a person who has HIV as being nothing more than cursed from God for their peverse behavior. Even a wife will be blamed if her husband brings it home as it is something she has done to lead him astray. That is a tuff hurdle to get over.
Thank you American Bedu and Nzingha.
Here medical isolation is a legal requirement in some instances eg. for some types of tuberculosis until medication reduces the communicability, or for Sars ,and patients who don’t remain confined to their room in those circumstances will be brought back by hospital security or the police. The isolation (like a quarantine), is difficult psychologically. Where a patient is still contagious and is a repeat escapee a guard will be posted at the door. Normal medical isolation is a medical not a legal requirement of the patient, and they could sign out against medical advice.
I get the sense in the situation described the man was being held (legally, pseudo-legally, or only medically) to make sure he didn’t have one of the many communicable diseases (including tuberculosis) that immunosuppressed HIV patients get, and was released when he didn’t.
I was aware of the religious curse part but didn’t appreciate how far reaching the perception of deviant behaviour was in this context, nor how deep the stigma. Very difficult, indeed. Here the medical system contributed greatly to the reduction in stigma, by giving information about the true difficulty of contracting HIV casually, and the different modes of transmission.
Also, Canada is a generally nonreligious country, even compared with the US, where more people identify as religious, attend church more often, and there is a proliferation of protestant sects (some of the homosexuals and loose women are cursed variety). Where the US coin has “In God We Trust” we have “Elizabeth II D G Regina” but no official Church as in England, and Roman Catholicism which once dominated Quebec life is now light and liberal (my description, not the Vatican’s!).
Saudi Arabia needs to address this time bomb before it gets out of proportion! AIDS is a serious health issue specially in KSA knowing that most of the saudis are sex tourists to nearby countries and most of them do engage in a very risky sexual behaviour.
Worth of note is the fact that they are sexually deprived of the freedom to engage in sexual activities. Hence, they visit nearby mi-east countries say in the morning as sex tourists and get back to KSA i nthe evening to infect their spouses without knowing it.
I personally has close encounters of people engaging in such a risky sexual behaviour.
I condemn such promiscuity.