In Saudi Arabia, AIDS still a stigma despite government, activist actions

The 35-year-old mother of six flinched when asked if she has told her children that she and her husband were diagnosed with AIDS four months ago. She never will, she said. "Can you imagine what their reaction will be? We'll be treated like pariahs," said Umm Muhammad, a Jiddah, Saudi Arabia, resident who declined to use her full name to protect her privacy.

Saudi Arabia's government has become more open about AIDS in recent years, publishing statistics about the number of infected Saudis, providing them with free medical care, and urging compassion. But in this deeply conservative kingdom, strong social stigma is still attached to the disease, which most people link, correctly or not, to acts forbidden by their religion and sometimes punishable by death: homosexuality, premarital sex, and adultery.

That complicates the work of health workers and activists who advocate spreading full awareness about protective measures. They ask, How can an activist educate people about safe sex in a culture that demands men and women abstain from premarital sex?

The dilemma is that many Saudis, mostly men, do have sex before marriage as well as extramarital affairs, especially while on trips to Arab or Western countries, activists say. Some contract the disease and then infect their wives.

According to Health Ministry statistics, 78% of HIV/AIDS cases in the kingdom are a result of sexual contact. "If we were to say 'Use condoms' to everybody, it's like giving them carte blanche to go out and have sex," said Rami al-Harithi, a 30-year-old activist who contracted HIV during a blood transfusion when he was 8.

Al-Harithi, from the holy city of Mecca, is one of the first Saudi HIV-positive patients to come out in the open and says people are sympathetic to him because of how he contracted the disease. Later this week, he says, he will speak frankly at a seminar to mark World AIDS Day that male high school students have been invited to attend.

"I will tell them, 'You should abstain from sex. But if you travel and cannot hold yourself, there's something called a condom that you should use,'" said al-Harithi. "I'm sure some people will be upset at this kind of language, but I don't care," he added. "My aim is to protect people."

But many Saudis disagree with al-Harithi, saying recommendations for safe sex among married couples, such as one posted on the Health Ministry site, are as far as activists or the government should go.The site says: "There are simple and effective ways to protect against the disease and the most important one, which is more important than any vaccine that may one day be discovered, is clinging to moral, social, and religious values that ban dangerous sexual conduct and that limit sex to marriage."

Of the 10,120 people who have tested positive for HIV in the kingdom since the first case was identified in 1984, 2,316 were Saudis, according to figures released by the Health Ministry in August, the Arab News reported. That figure is up from 7,804 in 2005, the paper quoted Tarek Madani, adviser to the health minister and consultant for contagious diseases, as saying.

Almost 80% of AIDS cases in the kingdom are in the age group, 15–49, while the percentage among children is 6.4%, the report said. The government sponsors public awareness campaigns, such as one it plans for this week to mark Friday's World AIDS Day that includes lectures, 500,000 phone text messages, billboards, and other activities under the slogan "Together for the sake of children. Together against AIDS."

The government also treats Saudi AIDS patients for free, at a cost of $2,700 a month. Expatriates are sent back home after an initial treatment. A few AIDS societies—the first ever—also are being set up and awaiting government permit, including the Al-Husna Society. One of its members, Laila Taha al-Dulaymi, said the group plans to financially help AIDS patients and their families and tackle issues like joblessness among AIDS patients who are often fired once their employers know they are HIV-positive.

That is a problem that Jiddah resident Jibril Ahmed, a 31-year-old guard, faced when, in 2004, he told his boss he was diagnosed with AIDS. Ahmed had no clue he had the virus until his seven-month-pregnant wife and the fetus died. A test determined the three were HIV-positive.

Ahmed says he guessed he became infected eight years ago, but he would not say how. "Everyone makes mistakes," he said. Because of his wife's death, his family learned of Ahmed's infection, including his two daughters, who are HIV-negative. Ahmed said family members at first were worried about catching the disease and would not touch the plates, cups, and cutlery he used. But now they have come to terms with it.

His daughters, 8 and 14 years old, know their dad is sick but don't know the details. "I hope they will eventually understand I didn't mean for this to happen," said Ahmed.

Umm Muhammad also contracted the disease from her husband, she says. "At first, I was very upset and yelled at my husband and asked how the disease has penetrated our home," she said. "But I'm certain he hasn't done anything bad. That's why I'm still with him and I support him."

But she draws the line when it comes to telling her family. "When my 12-year-old daughter asked me recently what AIDS is, I changed the subject," said Umm Muhammad. "It's hard for me to tell her, even though I know exactly what it is." (Donna Abu-Nasr, AP)