In the summer, when thousands of young Gulf Arab men flee heat and boredom in their native land, airport posters warn them of a life-threatening danger lurking abroad, symbolized by a skeleton and four red letters: AIDS. Radio talk shows urge Gulf tourists to be chaste when they visit foreign cities portrayed as infested with the disease, especially in the West. Religious scholars tell audiences at Friday prayer meetings and at the AIDS conferences now held regularly in the region that only the teachings of Allah can save believers from the modern-day scourge knocking at the Middle East’s door.
Cases of Acquired Immune Deficiency Syndrome are still relatively few in the Middle East — 366 have been reported either to the World Health Organization (WHO) or in local media as of April 1989, out of a world total of nearly 150,000. But the true number of cases is undoubtedly higher, and bound to grow. The corresponding figure for April 1988 was 196, showing an increase of 87 percent in just one year.
In some Gulf countries where extensive blood tests have been carried out for the HIV virus believed to cause AIDS, the infection rate is surprisingly high. In Qatar, for example, WHO lists 21 cases in a country of only 257,000 people.
Sudan borders the central African AIDS belt, believed to have the highest density of cases in the world, and has reported 88 cases, the highest in the region. Israel, with close demographic ties to the United States, has reported 76. The North African states — Morocco, Algeria and Tunisia — also have relatively high totals, which could reflect the presence of large numbers of European tourists.
Arab authorities for a long time ignored the AIDS threat on the grounds that its main means of transmission in the West — homosexual sex and drug use with shared hypodermic needles — did not exist in Muslim societies, or were very marginal. The fact that the first Arab cases were linked to transfusions of imported contaminated blood only reinforced the fallacy that AIDS was a disease of Westerners, or perhaps Africans, and that Arabs were largely immune. But as the number of cases grew, many through sexual transmission, governments from Rabat to Bahrain have been forced to adopt a preventive public policy.
Health, information and religious authorities are now battling the disease with a mixture of cautious publicity, blood screening and fire-and-brimstone warnings in the mosque. Islam often sets the boundaries of debate about AIDS and the sexual practices that spread it, especially in the conservative Gulf. Religious leaders and some governments portray AIDS as divine retribution for Western decadence, and urge strict adherence to Islam as the only means of prevention. A health official in Kuwait, Ibrahim al-Sayyad, gave police cadets at an AIDS conference in February 1988 a lurid description of gay bars in New York before quoting the Prophet Muhammad: “When obscenity flourished among them, even in public, a plague appeared that their forefathers never knew.”
A pamphlet published by the Kuwait Ministry of Health urges: “This disease spreads basically through sexual contact with an infected person. Therefore the most important preventive measure is abstinence, avoiding obscene acts and abiding by what Allah ordained.” To suggest the use of condoms or other &ldquosafe sex” practices could appear to sanction illicit sex — a step very few Muslim governments are willing or able to take. One exception is Tunisia, which has recommended the use of condoms for recreational sex in a pamphlet aimed at students.
Nations have historically tended to blame the outbreak of a new disease on others, especially those who pose some kind of social or cultural threat. The bubonic plague in Europe was once called the “Oriental&rdauo; plague, as Susan Sontag notes in Aids and its Metaphors. Thus Gulf Arab states are spending millions of dollars on HIV blood tests for their large foreign worker populations with only limited scrutiny of their own citizens.
Deep-seated fears of cultural penetration by the West, of immigrant labor forces (in the Gulf) and even of Israel are widely reflected in debates about AIDS. An Egyptian opposition weekly, in a report widely quoted in the Gulf, once claimed that Israel had sent HIV-infected prostitutes to Cairo — a favorite sexual recreation spot for Gulf Arab men — to spread AIDS in the Arab world. In Dubai, where immigrant workers make up three-quarters of the population, authorities in 1985 banned Ugandan women from entry on the grounds many were prostitutes and potential HIV carriers, according to press reports in Kampala. Saudi Arabia, the United Arab Emirates (UAE) and Kuwait carry out, at great expense, mandatory HIV blood tests on foreigners who apply for residency. Those who test positive are summarily expelled.
There is no mandatory testing of citizens except in Iraq, where the most draconian test laws in the world require all people arriving in the country, including Iraqis, to undergo an HIV test within five days. Iraq has not reported any cases. (In fact, few Iraqis are tested because few travel abroad except on official missions, and they are probably exempt. Even with foreigners the law is not applied systematically.) In Gulf states, citizens who test HIV positive but have no symptoms — tests are sometimes carried out on hospital patients and in prisons — are kept under close surveillance, but calls for quarantine laws have been rejected so far. The 1988 Kuwait conference, which brought together representatives from 20 countries of WHO’s Eastern Mediterranean region, urged member states not to discriminate against AIDS carriers and to balance their individual rights with those of society at large.
The spread of AIDS in the Middle East, as in the rest of Asia, began later than in the West or in Africa and appears to have different characteristics. Most cases have been traced to transfusions of infected blood imported from the West or sexual contact (both homosexual and heterosexual) with infected persons. The high number of cases in the UAE and Qatar, for example, has been attributed to their heavy dependence on imported blood which was unscreened for HIV until 1985. Iran, which has five reported cases, has tested 3,198 known hemophiliacs and found 450 HIV positive. Jordan and Lebanon have both reported cases of single young men who lived a long time abroad and returned to fall sick at home. Kuwait’s one reported AIDS death was a hemophiliac child. Tunisia has reported cases traced to sexual contact with foreign tourists. Doctors in the UAE cite cases of sick African residents, including women.
In short, although the facts are scarce (particularly about sexually-related cases) it appears that as yet no single means of transmission dominates the region. As HIV screening of blood banks becomes the norm in the Middle East (although very poor countries like Sudan are still unable to afford proper equipment) the number of transfusion-related cases can be expected to stabilize, as it has elsewhere.
But WHO experts have warned that unless governments frankly confront the extent of the problem and properly educate their people, the number of other cases could explode in coming years. Due to the long and unpredictable incubation of the virus someone may test negative one day and positive the next. WHO stresses that education — not mass blood screening, quarantine or border restrictions — is the most effective means of prevention.
Saudi Arabia and the United Arab Emirates still refuse to give WHO official data on their AIDS cases. Governments have begun to admit that “Western” decadence may not be so uniquely Western, and that their own sexually active populations engage in high-risk behavior that could spread the disease. But in some countries the emphasis remains on screening foreigners rather than educating citizens. A big obstacle is that AIDS education requires discussion of sex, so governments have to tread carefully.