Refugees see HIV as pass to treatment
There is one group in Cairo that is dealing more openly with HIV than others -- refugees from Sudan and other troubled African nations.
And for some of them, being diagnosed with the infection might not seem all bad.
If asylum-seekers who are accepted by the United Nations's refugee office test positive for HIV, they and their families stand an excellent chance of being quickly resettled in a western country, usually the United States, where the infection will be treated.
Some people even approach Baraka Kabaya, a staffer with the agency Refuge Egypt, hoping they will test positive because "it speeds their processing to go to America," he said. "They will get everything there."
Sudan, ripped apart by ethnic warfare and now afflicted with hunger and disease, has generated a flood of refugees crossing the border into Egypt in the hopes that it will be a stopover on their way to the West.
All told, there are an estimated 50,000 African asylum-seekers in Egypt. About 19,000 of them have been recognized as refugees by UNHCR, the U.N. refugee office. The remainder are still being considered or their cases have been closed, meaning they have been rejected as official U.N. refugees.
And while those who test positive for HIV may count it as a blessing if they have refugee status, it can be the worst of all worlds if they don't.
"If you have a closed file and are diagnosed with HIV, then you are in a real tragedy," said Refuge Egypt's medical director, Dr. Eman Kamel. "Closed files, this is a big problem."
Refuge Egypt, a faith-based agency that runs health clinics and a craft shop in All Saints' Cathedral in Cairo, is bustling most weekdays.
On some mornings, expectant mothers, and a few fathers, listen to lectures about pregnancy and childbirth while little ones run around and teens rehearse plays they might perform during lunchtime.
Pregnant women who attend the prenatal clinic or seek advice about family planning, as well as those who are newly diagnosed with tuberculosis, are offered the chance to be checked for HIV.
Kabaya performs all the counseling and tests.
The patient sits down with him in an office with the door closed.
Do you know what HIV is? Kabaya asks in Sudanese Arabic. Do you know how it is transmitted? Tell me what you know.
He tries to correct misperceptions and educate. Then he tells them about the HIV test. As far as he can remember, only one woman refused, and that was because she wanted to talk to her husband about it first.
With the patient's consent, Kabaya lays out his equipment: a sterile disposable needle, a plastic test card, chemical bottles. He puts on gloves and grasps the patient's thumb with one hand while readying the needle in the other.
Some watch calmly while others flinch and look away. A quick jab, a squeeze and a drop of crimson appears. Kabaya uses a short, slender pipette to transfer the blood droplet to the card, to which he adds the chemicals. Then he and the patient wait for the result.
If it's positive, the patient will go to a Cairo hospital to have confirmatory tests performed.
Kamel, the medical director, said that in a little more than a year, Refuge Egypt has tested about 900 people. About 23 of them, or 2.6 percent, were positive for HIV. That approximates the 2.3 percent infection rate that the United Nations estimates for adults in Sudan.
If a woman who is pregnant tests positive for HIV, she gets a dose of medicine and will deliver by Cesarean section to reduce the risk of her blood infecting her baby. She is also warned not to breast feed.
But HIV-positive people whose U.N. refugee cases have been closed do not get any AIDS drugs or other assistance. Technically, they are illegally residing in Egypt.
Kamel, a Coptic Christian, is concerned that the larger Egyptian community is not sufficiently aware of the AIDS threat.
he noted that Cairo has an estimated 300 Sudanese sex workers, and their clientele is not limited to other Sudanese. Condom use is not popular.
Some male refugees tell Kabaya, "If you are going to use a condom, the lady will refuse you. Why are you using a condom if you are not sick?"
But some community members, particularly women's groups, are recognizing the need to learn about HIV and have asked Refuge Egypt experts to give talks about the disease.
That's encouraging, Kamel said. Just because Egypt has a low prevalence of HIV now does not mean it will stay that way indefinitely.
"We need to raise awareness in the schools, in the churches, in the mosque, everywhere," she said. "Good Muslims, good Christians. Yes, our religion says no and no and no. But are we sure everyone is committed?"
HIV doesn't come to us, she likes to say. We go to HIV.
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