COUNTRY SITUATION ANALYSIS

There are troubling indicators of risk behaviours in Egypt  —  for example, rates of condom use are very low in the general population and among people whose behaviour puts them most at risk, with only 24% of men in one study reported every having used a condom (Kabbash, et al., 2005). HIV testing rates are very low (for example 99% of drug users never had a HIV test) (UNAIDS/UNODC, 2004).

The majority of people who are tested HIV positive in Egypt are men; reported HIV cases are four times more likely among men than women. This could be because more men than women are tested for HIV, because as most of the tests in Egypt are on male migrants applying for a ‘disease free’ certificate to work in the Gulf countries. According to the 2005 Demographic Health Survey, only 6% of women have comprehensive knowledge of HIV. Outreach to women who are most likely to be exposed to HIV, such as sex workers, women in poverty and injecting drug users, has been initiated, but coverage remains limited.

Other people likely to be exposed to HIV in Egypt include street children, prisoners and refugees. HIV prevention and care services to these people have been started, but remain limited in scope and coverage. The Ministry of Health and Population is the lead government body for the AIDS response.

Hepatitis C is one of the main health concerns in Egypt and has a high prevalence. Increasingly, HIV and hepatitis C prevention efforts are addressed collectively. This is believed to help counter the very strong stigma associated with HIV in Egypt. Efforts are under way to engage other key government partners, especially the Ministry of Interior and Ministry of Information, and the National Youth Council. Civil society engagement has increased over the recent past. An Egyptian nongovernmental organization Network against AIDS works to build the capacity of nongovernmental organizations. The Egypt Business Coalition on HIV/AIDS is under formation, and people living with HIV are planning to establish an independent association.

The bulk of HIV spending comes from the national budget. The main donors for HIV-related activities are United States Agency for International Development, United Nations (UN), the Ford Foundation and most recently the Global Fund to fight AIDS, Tuberculosis and Malaria. Donor coordination is ensured through the Expanded UN Theme Group on HIV/AIDS.

Challenges and emerging issues for 2007

Focusing national efforts on addressing issues related to men who have sex with men, injecting drug users and sex workers is an urgent priority. Current efforts have proved successful in reaching sex workers and injecting drug users, delivering key services in a participatory manner and decreasing risk behaviour. Nevertheless, these programmes remain limited in coverage and must be urgently scaled up if they are to have an impact on the epidemic. Strategies to address men who have sex with men, especially the most impoverished among them, must be a key priority during 2007 and beyond. Greater involvement of key non-health sectors such as the Ministry of Interior will be required. Capacity building of nongovernmental organizations to enable them to undertake these programmes is pertinent.

While the availability of HIV medication free of charge from the government is strongly applauded, medical care and follow-up of people living with HIV on treatment is in need of strengthening, for many reasons, such as to reduce the probability of drug resistance. Efforts are underway to procure a second-line treatment.

Addressing the special needs of women and girls has, to date, not been a specific focus of the national response. The gender gap remains wide in Egypt and data show that women tend to have less knowledge of HIV, experience higher rates of illiteracy and unemployment, are increasingly becoming infected with HIV, and when infected with HIV have access to less social support. 

  HIV AND AIDS ESTIMATES