March 2010 - Egypt Report - New report warns of HIV epidemic

Egypt Report

New report warns of HIV epidemic

A new report says Egypt is moving towards a “concentrated HIV epidemic”, as an increasing number of HIV patients are being recorded.

The report by the Information and Decision Support Centre, the research arm of the Egyptian Cabinet, was published on 29 December. It states that at the end of 2008 the number of people living with HIV in Egypt was 3,735, including 963 (25.8%) who had developed AIDS.

Local NGOs dealing with HIV/AIDS and the UN Joint Programme on HIV/AIDS (UNAIDS) say this figure could be far higher.

While the number of HIV/AIDS cases in Egypt is low compared to many other countries, the report’s findings have come as a shock to many of those asked in this predominantly conservative Muslim society where extramarital sex is banned.

“Risky sexual activities can’t be controlled,” Magdy Badran, a leading Egyptian immunologist, told IRIN. “Also, there’s a real expansion of drug addiction in this country. These are things that can spread the disease dramatically.” The report, the first of its kind to be produced by such a highlevel body, said HIV cases had increased six-fold between 1994 and 2008. It said HIV cases could be found in all Egyptian governorates with the exception of northern and southern areas of the Sinai Peninsula. However, the country’s two most populous cities, Cairo and Alexandria, had most cases.

The report said around 75% of Egyptians living with HIV were aged 25-49, the most productive segment of society.

Sex education

The authors of the report said one reason for the rise in cases might be the lack of sex education in schools.

“Our schools must offer proper health and sex education about HIV transmission,” Badran said. “We must work hard to fight drug addiction, encourage marriage and put an end to the presence of children on the streets.”

Some NGOs estimate the number of street children in Egypt to be more than three million, although the government disputes that number. The report said these children are the most vulnerable in terms of contracting HIV/AIDS.

It added that the steady increase in the number of detected HIV cases was a warning for the whole population. -- IRIN

End of free health care hits poor hardest

Hesham Gohary says he has been coming to the Health Ministry in central Cairo for weeks in the hope of getting free kidney dialysis treatment, but always leaves empty-handed.

The 54-year-old farmer is one of 35,000 lowincome kidney failure patients whose collective US$118 million health bill used to be footed by the government, until it recently declared its coffers empty. “I badly need the dialysis,” Gohary told IRIN.

“But it seems so difficult to get free treatment in this country these days.” Around 35 million of the country’s 80 million people are in the state health insurance system, according to the Health Ministry, and most of the rest are supposed to get free health care.

Those seeking free treatment must make their case at a Health Ministry office and, if successful, receive an official letter authorizing public hospitals to treat them for free.

The hospitals then reclaim payment from the ministry. Last year, the government gave free treatment to 2.2 million poor Egyptians, including kidney failure, cancer, diabetes and high blood pressure patients, according to Mohamed Abdeen, chairman of the Specialized Medical Councils, the part of the Health Ministry which determines whether a patient qualifies for free treatment or not.

A problem of money

But the government has incurred debts of US$219 million to hospitals and is no longer able to pay its health bills, and since mid-December 2009 hospitals have stopped treating the patients it sends to them.

“This is a problem of money,” Abdeen told IRIN. “The hospitals can’t do anything else. If they don’t get money, they won’t be able to offer treatment or medicine for these people.” Gohary used to receive kidney dialysis treatment 12 hours a week at a cost to the government of $3,302 a year – a small fortune for him.

“I really can’t pay for my treatment. And it’s hard for me to work because repeated dialyses have made my body frail,” he said.

The Health Ministry says around 700,000 high blood pressure and diabetes patients used to receive free health care at an annual cost of $183 million; and around 25,000 cancer patients cost the government $51 million annually. Egypt’s economy grew by 7.1% in 2007, 7.2% in 2008 but just 4% in 2009, according to the government.

Independent analysts say the loss to the economy because of the global financial crisis is bigger than the government is willing to admit.

Meanwhile, individuals like Gohary are facing the consequences: “I suffer bleeding every time I undergo the dialysis. This costs me 300 pounds [$55] in medication every month. This money and the cost of the dialysis are too big for my sons to be able to pay.” -- IRIN

Controversial organ transplant bill
welcomed by WHO

A controversial organ transplant bill which is expected to become law this year could regulate organ transplants and curb Egypt’s booming illicit trade in human organs.

Hundreds and possibly thousands of poor Egyptians sell their kidneys and livers every year to pay off debts and buy food, making the country a regional “hub” for organ trafficking, according to the World Health Organisation (WHO).

The bill, which is causing controversy among medics, clerics and rights activists, says organs donated from live donors will be restricted to “family members of the fourth degree”, and that the removal of organs without official authorisation would be considered first-degree murder and be punishable by death, according to IRIN. However, a WHO report says “individuals who remove or implant human organs shall be penalised by life imprisonment and a fine ranging from 100,000 to 300,000 Egyptian pounds (about US$18,000 to $55,000).

Official authorisation for organ removal will come from a three-person panel to be established by the Higher Committee for Organ Transplants, a Ministry of Health-affiliated body. For dead patients, the law stipulates that the panel reach consensus on whether or not the potential donor is dead – an issue on which there is much contention.

Dead or alive?

The consensus in the medical profession is that if a person’s entire brain is dead, the person is dead, even though their heart may continue to beat for a short time. This provides an opportunity to obtain organs while they are still in good condition for transplantation.

Some Muslim clerics and MPs say a person’s heart must stop before he or she can be pronounced dead. Mohamed Awadeen, a professor of Islamic law at Al- Azhar University in Cairo, said: “Apart from this, the law is totally against Islamic law, because man doesn‘t have the right to donate his or her body, which is God’s after all.

“The advocates of the new law are lying. [Live] Organ donors won’t lead a normal life later on. A man needs kidneys to live normally.” However, Mohamed Sayed Tantawi, Grand Sheikh of al- Azhar, Sunni Islam’s most respected institution, has previously endorsed a brain dead standard.

Law for the wealthy?

Some rights activists have said the new law could exacerbate organ trafficking and turn Egypt into a global market for the organ trade.

“This would only benefit the rich,” said Hafez Abu Saeda, secretary-general of the Egyptian Organization for Human Rights, Egypt’s leading human rights organisation. He said by offering legal cover for organ transplants, the government was turning the poor into sources for human spare parts and offering the rich – in Egypt and beyond – a well stocked market for organs.

Statistics for organ sales and transplants in Egypt do not exist because they are mostly performed clandestinely, but Abu Saeda said his own research suggested hundreds of unlicensed transplants happen every year.

He said some of the richer recipients who did not trust the skills of local doctors took donors with them to China to have transplants. “Rich people from the Gulf also come here to buy organs. A law like this can be a great affliction in such a poor country,” Abu Saeda said in a recent discussion in Cairo on the law.

Positive development

Hussein Gezairy, WHO regional director for the Eastern Mediterranean, said: “The approval of this law is a wonderful step that creates hope for thousands of patients who have been waiting a long time for life-saving transplant operations. It is also a significant step towards ending illegal organ trafficking, which usually results in operations conducted under unsafe conditions and harms both donor and patient.” WHO estimates there are 42,000 people in Egypt in need of transplants.

According to a WHO report, transplant procedures for low-income patients will be financed by the State, according to the new law.

Date of upload: 20th April 2010