Sunday, January 20, 2008

Hiding In Vulnerability, H.I.V.

It is nothing new to us to turn a blind eye to behaviors that we deem immoral and we even attest that those are not present in our cultures or societies and they are by-product of western and Zionist corruption of our youth and digressions from our holy religion of Islam that offers the solution to all these problems are the cause of all those problems.

From that it follows that we don't have extra marital sex relationships, sex workers are non existent, injection drug users are not our children, brothers or sisters, and we surely don't have men who have sex with men for that is a western thing you know.

The sad thing is that ignorance towards those behaviors and others converge in aiding the prevalence of HIV/AIDS. So its only natural that we consider HIV/AIDS prevention to be a fringe issue, and we even have the statistics to back this up. For according to the ministry of health, as of 2004, there have been 361 recorded cases of which 136 cases of Jordanians contracting the virus. Looking at those numbers you would think that they are doing a splendid job in prevention !

While major strides have been taken in the campaigns under taken since 2002 in this field, the major problems faced by those campaign are still the same. Some of the good things that they have implemented were mandatory testing of foreigners staying in the country for longer than a month, this has helped to limit the exposure of the increased traffic that crosses the country and limit the exposure to the virus through that means. The testing of blood donators and blood bank supplies to ensure that they are contamination free.
Also the establishment of the HIV/AIDS hotline does help in answering any questions or concerns that people might have.

Now these are all fine, but taking a look at their site I couldn't happen but to notice a few issues; for starters the website is out of date, its naming not the previous health minister but the one before him. The data on there is more than 3 years old, plus they tend to preach morally when it comes to the issue which is not the best way to go about it( men having sex with men, sex workers, prisoners and injection drug users aren't even mentioned) .

There might be an explosion of HIV cases because its seen that there is no need to do the preventive work and encourage people to do voluntary testing. There is a higher percentage of people who test out only because symptoms appeared which might take anywhere from a year to 10 to appear. That means that through that period they have been able to infect others along the way.

So one of the main things that should be established is to try to reach out to those high risk communities, to get their trust enough for them to be educated about preventive methods.
One thing that they have done to achieve this is through peer education program. There isn't any statistics to measure the success or failure of such programs but I can't truly understand how a program that preaches the moral high ground as a preventive method would be hugely popular among sex workers for instance.

The preventive methods suggested by the ministry of health are as follows (by the way, they are not even mentioned in the English version of the website) ;
  • Abstaining from pre-marital and extra-marital sex and being committed to one uninfected partner (they do indicate its a sin from the religious point of view)
  • Using a condom correctly (whats the point if i did your previous step ? )
  • Verifying that blood transfusions are free of the virus (is there any indication to tell whether the blood has been tested or not ? especially in heamophelia cases ?)
  • Using disposable needles (Do they provide any free needles ?)
  • Disinfecting medical equipment in the proper manner (to layman like me how am i supposed to know if they are doing it or not ? )

Based on the preaching embedded here it is highly unlikely that the campaign had any meaningful penetration of high risk groups.
Some of the solutions that come to mind are as follows;
  • Establishing true anonymous testing (i.e. random number are taken and no follow up from any governmental arms, yes they do that now invading all ethics of patient confidentiality) . preferably this initiative to be removed from the ministry of health.
  • Provide pre-test and after-test counseling and sexual education to high risk groups and students, either through seminars or through providing materials to interested individuals to help reach out to high risk groups that is void of moral preaching since that will do more harm than good.
  • Abstinence approach to sexual education has been proved to be impotent, leave that to religious leaders and teachers rather than health educators.
  • establish support groups and family education to HIV positive individuals, for they are mostly having to suffer on their own. while currently they are forced to suffer alone in silence atleast some support of a fund and legislation against discrimination at the work place will help to provide better living standards to those who fell ill.
  • The hotline should have regular advertisement and emphasis should be noted that none of the calls are monitored to insure that the people who need it the most, they are mostly the groups that are ostracized and persecuted, are able to reach it paranoia free.
  • Testing of prisoners to limit the prevalence of the disease in prisons. Also to educate them.
  • Educating the health staff to deal with cases confidentially and humanely, rather than stigmatize a patient who came to them looking for aid.

I wish they would establish a free anonymous testing days in order for people of those high risk groups to voluntarily go and get tested, and establish the habit of ongoing bi-annual testing in order to reduce the chances of any insurgence in HIV cases.
While the efforts of the ministry of health are commendable and admirable, the national stigma of the disease is far from overcome and treatment of HIV positives is far from what it is hoped to be.
Although they are provided with free access to anti biotic cocktails they don't have access to the latest and more effective drugs which help to keep the symptoms under control. Also due to moral objections & cost, access to medications such as PEP and PREP is not available. So we still have a lot more work to do as a community.

To get more information about testing and information regarding AIDS/HIV:
  • Jordan Red Crescent: Safety first AIDS/HIV program

    Telephone: 06-4765660 Email:
  • Ministry of health: National AIDS prevention program
    Telephone: Amman 06 - 5697933
    06 - 5673436
    05 - 3936060
    05 - 3243008
    02 - 6353545
    05 - 3550752

ps. One thing to note, there is a high correlation between economic booms and prevalence of HIV cases due to the fact that travelers tend to be one group that spreads the virus and these are usually that come over for periods shorter than a month. They are the ones that are not getting screened and it is highly likely that they would engage in sexual acts, or drug related activities with the locals. I already made this incoherent article long enough even though i have alot more to talk about, hopefully i'll do that on another occasion.

pps. the pics either include the source on them or they are from ACT UP paris campaigns which i especially like.

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  • Thanks you for this excellent post. Many Jordanians are infected by HIV but they won't know it until the disease becomes very advanced because neither them nor their doctors would suspect it, it's one of the last diagnoses any doctor in Jordan would suspect. There's more prostitution in Jordan, there are more men having sex with men in Jordan and more people having sex in general, and to many people even the educated ones they don't understand that it doesn't have to be vaginal sex to get the virus transmitted. Also there are a lot of Jordanians who temporarily live abroad and they might get infected as well because of their high-risk behaviors. There are fewer than ten HIV specilaists in infectious diseases in Jordan, and the science of HIV keeps changing quickly and nobody stays updated with it.
    I don't think HIV will become a major killer in Jordan but it definitely can become a big problem soon.

    By Blogger Hareega, At 20/1/08 18:41  

  • Good job, Bambam.

    As a foreigner who used to have to get AIDS tests yearly in order to live here, it used to amaze me that somehow I was a greater risk of bringing AIDS in than a Jordanian traveler who went to San Fransisco or Thailand several times a year.

    By Anonymous kinzi, At 20/1/08 21:28  

  • hareega thanks for dropping by, since preventive methods are much cheaper that post infection care i think its the way to go for jordan, but since you are a doctor is there anything you would like to add ? maybe reference to some doctors who specialize in the area ?

    kinzi hmm technically kinzi all foreigners are at a higher risk of being carriers or infected with HIV than locals, statistics wise. So although its mostly involuntary i think its one of the good things. either way i think if the option is available, to get tested discreetly and privately, for those people who travel a lot and like to mingle (based on ur choice of cities & countries there) then that will limit the spread of the disease and they would be able to recognize their infections early on and deal with it.

    one last thing, i remember you mentioning that Spike kid had to do it for the first time this year, so how was it ? did they provide any orientation ? did they act cordially ? am curious to know .

    By Blogger No_Angel, At 20/1/08 21:52  

  • This is awesome! We definitely should do our best to raise awareness to these issues.

    Hat tip to you for this post

    By Anonymous Qwaider قويدر, At 20/1/08 23:00  

  • That is an excellent post BamBam, eventhough it is too long :)

    We are in disperate need for sexual education. I am happy for the work done by the red crescent in Jordan. We need more awarnace campaigns.

    By Blogger The Observer, At 21/1/08 12:08  

  • Thanks for remembering my son, Bambam. He actually just had a cursory glance by the Doctor, but at 15 will have to have an AIDS test and full physical. :)

    By Anonymous kinzi, At 21/1/08 20:43  

  • qwaider thanks brov, and i'll try to do my part

    observer thanks for bearing with it brov, and yes they did a good job (altho it was better with the mammograms) but there needs to be more done with the help of society

    kinzi you are welcome, well so atleast it wasn't for this year.

    By Anonymous bambam, At 21/1/08 21:50  

  • ya3ni if anyone wanted to be checked for HIV now, he she can call these number but they will have to take full information about them and if the result was positive, what would the natural procedure with HIV patients?

    By Blogger Thunder, At 22/1/08 18:25  

  • actually those numbers will not ask you for information (but at the other hand there is nothing that says the calls aren't logged)
    when you do a testing you will be asked for your information and if the result is positive there will be further questions asked ...

    By Blogger No_Angel, At 23/1/08 13:07  

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