BEIRUT: By the end of November 2018, the total number of people living with HIV/AIDS in Lebanon was estimated to be 2366 by the National AIDS Control Program (NAP) in Lebanon.
What do we need to know about HIV/AIDS exactly?
According to various scientific resources, HIV is a virus that targets and alters the body’s immune system, increasing the risk and impact of other infections and diseases. Without treatment, the infection might progress to an advanced disease stage called AIDS, characterized by a severe loss of the body's immunity, greatly lowering the resistance to infection and diseases.
“HIV can only be transmitted from one body to another in three ways: unprotected sex, the mutual using of sharp instruments (including needles), and from mother to infant,” Nour El Khazen, program manager for harm reduction and outreach at Skoun center for addiction treatment, told Annahar. The center is one of several centers that offer voluntary testing and counseling for HIV and other Sexually Transmitted Diseases (STDs). It has been active in this field for more than 10 years.
“The most common form of transmission [of HIV] is by sexual intercourse,” continues El Khazen.
Contrary to popular belief, HIV is not transmitted through handshakes (touching) or by using the same kitchen utensils or even sharing the same toilet.
However, the most common form of transmission in Lebanon comes from Men who have Sex with Men (MSM) and sex workers, who are considered a vulnerable population. A recent study conducted by the NAP showed a prevalence of 12 percent among Lebanese MSMs.
To emphasize this fact, 94.4 percent of all new 160 cases reported by NAP in 2018 were men, while only 5.6 percent were women. The fact that global gender distribution of AIDS cases in the world is around 50 percent gives us an idea of the disparity in numbers in Lebanon.
.“There is also the fact that the number of women who get tested [in Lebanon] is much less than that of men because women face so many obstacles in our society, in addition to the stigma and discrimination,” El Khazen said. “The fact that HIV is connected to sexual activity is a barrier to women in an oriental society that does not accept premarital sex. To give you an example, 226 people were tested in Skoun in 2018, out of which only 45 were women.”
Another isolated minority is foreigners who work in Lebanon, especially in the domestic housekeeping field. “Most of the campaigns target Arabic-speaking people despite the facts that migrant workers exist in Lebanon and are having sexual relationships,” El Khazen noted.
The problem with foreigners, she continues, is that, not only are they denied treatment from the ministry once it is proven they are carriers of HIV, but there is a high chance that they might get deported to their countries.
“There are a number of countries abroad that require HIV testing for the employee before bringing him/her to Lebanon,” social activist Rania Hashem told Annahar. “Most of them are African countries.”
Another demographic segment that could potentially contribute to the numbers is teenagers, since sexual education in public and private schools is still sketchy, inaccurate and biased to this day.
“Sexual education in Lebanese schools is not complete. It’s limited to educating students about the reproductive organs only,” says Noha Shehab, an English teacher at City International School (CIS). “At first, the parents’ consent must be taken. And we certainly don’t hand out condoms or explain anything further than that, because we respect the culture [of the parents].”
There are certain NGOs and organizations (like Skoun, Marsa Sexual Health Center and SIDC) that are trying to break the taboo around sexual health by raising awareness in schools and universities. “We hand out pamphlets to the people in the streets and inform them about our anonymous testing for HIV, hepatitis B and Hepatitis C,” El Khazen said.
Not only is testing completely anonymous, she says, but so is the registration process, where numbers are given instead of names. “The testing process takes 15 to 20 minutes during which we give the patient a general idea of STDs and how they are transmitted,” said El Khazen.
In case of positive testing for HIV, a confirmation test named ELISA has to be done (usually available at Marsa Sexual Health Center or Trad Hospital) after which the results are delivered to the National AIDS Program. The program then informs the corresponding NGO of the test results and procedures are taken accordingly.
“Many patients after starting treatment require counseling. We don’t offer post-test counseling for HIV,” said El Khazen when asked. “But what we do is that we refer the patient to a counselor.”
One center that does offer professional post-test counseling is Marsa Sexual Health Center. Located in Badaro, Beirut, Marsa has also been operating for about a decade, providing anonymous testing and counseling for almost all STDs, including HIV.
“We provide support, counseling and psychotherapy to people who have questions about their sexual orientation or people who have just discovered they have HIV.” Miled Abou Jaoude, psychotherapist at Marsa, told Annahar.
The first reaction of HIV positive individuals is, understandably, that of extreme shock and devastation. “They have the stereotype that people are still dying from AIDS which isn’t true anymore because we have good treatment today and, hopefully with good follow up, they can live long happy lives.” The important thing is to set an action plan for the patients whereby they have to head to the Ministry of Health to receive the right treatment, which makes the virus less active after a while.
It’s also important to give the patient accurate scientific information and make sure they don’t resort to the Web which can be tempting and harmful, says Miled.
How much time does it take for the individual to accept his/her condition?
“That depends on every case, if they work or study or have an income… each case is unique,” he answers.
There is, however, one fact that is disturbing to Miled: more and more teenagers are becoming sexually active and seeking Marsa’s help. “We’re talking 14, 15, 16 year-olds,” he said. “Their schools don’t educate them and they have no other source of information. We need to find a solution for this problem.”
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