A discarded nurseThe double suffering of AIDS patients in Yemen [Archives:2006/972/Health]

By: Amel Al-Ariqi
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Adel never suspected how much his family life was about to change when he received a telephone call five months ago from Aden's Al-Jumhury Hospital telling him his brother, Khalid, was sick.

One word shaped that conversation and is shaping Khalid's life now – AIDS.

“I was shocked to the extent that I couldn't say a word,” Adel said, still trying to hide his emotions.

Shortly thereafter, Khalid's wife and 2-year-old daughter tested positive for HIV. “In the beginning, Khalid's wife collapsed emotionally. She cried and shouted, not believing that she, her daughter and even the baby in her womb, as she was pregnant, all were infected with this fatal disease,” Adel related, “But she later realized she must face her fate and she consented to remain with her husband.”

According to Adel, Khalid has volunteered at Al-Jumhury Hospital for 13 years. “He began working at the hospital in 1994 as a nurse. During that time, he worked in many departments such as the emergency room, surgery and the labs.”

Khalid married at the end of 2004 and his daughter Naseem arrived a year later. “Shortly after Naseem's birth, Khalid wasn't feeling well. He suffered stomachaches and lost weight. Doctors at the hospital diagnosed his state as a pancreatic tumor and asked him to undergo an operation to remove this tumor,” Adel explained.

Khalid had many routine pre-operative tests, one of which was an HIV test. He wondered about the unexplained delay in his operation, so he decided to look at his test results, discovering for himself his own disease. He emotionally collapsed, escaping to a room in the hospital, closing the door and refusing to talk to anyone.

One of his colleagues called Adel, informing him that Khalid was sick.

Khalid's suffering didn't end with discovering his AIDS infection; rather, it was just the beginning. According to Adel, Khalid was fired from the hospital when administration learned about his infection, but luckily, his colleagues arranged a strike against this decision, asking administration to act responsibly toward Khalid, who was an active member of the hospital medical staff.

Besides that, the medical syndicate and the Aden medical office forced hospital administration to help Khalid. Under this pressure, the administration agreed to give him his YR 19,000 monthly salary, as well as a medical clearance so he could travel to India for more medical tests. However, Khalid's journey to India was short because he couldn't cover the $2,000 weekly costs.

Adel stresses that his brother became infected with the HIV virus while working at the hospital. “My brother and his colleagues worked in very difficult circumstances. Hospital medical staff lacked basic protective means like gloves and masks. They dealt with patients without any protection, exposing themselves to infection.

Additionally, Khalid had hemorrhoid surgery at the end of 2005 at the hospital and donated blood the same year. At that time, nobody said Khalid had AIDS. For this reason, either Khalid's blood wasn't tested before these two procedures or he contracted AIDS afterward,” Adel concluded.

Al-Jumhury Hospital general manager Dr. Khalid Al-Jaradi denies firing Khalid, noting that the hospital offered what it could to support Khalid, even sending him to India to complete his testing. “He's one of our staff and we will support him as we can.”

Al-Jaradi confessed that the hospital didn't test the blood of hospital medical staff before Khalid's case, “However, we've learned a lesson from this and we now test medical staff yearly. Besides that, we've arranged many workshops providing medical staff with information about AIDS.”

However, he pointed out that many medical personnel ignore protection standards they must follow to avoid any type of infection. He didn't deny or confirm the possibility that Khalid was infected at the hospital.

Dr. Al-Khadher Nasar, director of the Ministry of Health and Population's medical office in Aden, believes Khalid was infected at the hospital, noting that AIDS can be transmitted in many ways.

Khalid's condition was so bad and in its last stage that Nasar believes he carried HIV at least five years ago. While admitting that medical facilities don't test medical staff, he agrees that such tests are important, particularly for medical staff in direct contact with patients.

Khalid refuses to speak to the media; however, his brother insists on telling his story. “I exposed this story, because I realized my brother isn't the only one suffering with AIDS but rather, he and many others suffer from governmental ignorance and social disgrace,” Adel says.

Khalid's case isn't unique. According to a Ministry of Health study from 1987 to 2006, the number of AIDS infections in Yemen has reached 1,821 cases, 437 of which are AIDS patients and others carrying the virus. The study indicated that 55 percent of patients are Yemeni nationals, 60 percent of whom are men, and also found 44 infections among children.

The National Strategic Framework for Controlling and Preventing HIV/AIDS reveals that most HIV-infected Yemenis are married with children and their needs and rights haven't been addressed. The study also addressed Khalid's situation, pointing out the potential for the spread of HIV through health care settings due to lack of infection control. For instance, the poor state of hospital waste management is a serious predisposing factor for rapid spread of blood-borne infections among health care providers as well as the community.

Dr. Fouzia Gharamah, executive manager of the National AIDS Program, commented that it's difficult to prove such infection really occurred at the hospital. She referred to the three ways HIV infections spread: sexual contact with an infected individual, contact with contaminated blood (for example, involving transfusions with infected blood or wounds from contaminated sharp instruments) and transmission from an infected mother to her child, either before or during birth or through breastfeeding.

“We must consider all of these ways when we talk about any AIDS infection. For instance, using contaminated shaving instruments may cause infection,” she explained.

However, this isn't the only place where ignorance about AIDS comes into play. Abdulrahman Al-Shamiri, coordinator of the AIDS awareness program, confirmed that many medical staff have wrong thoughts about AIDS. “For example, they don't know that there are differences between and HIV-carrier and an AIDS patient.”

HIV infection doesn't necessarily mean that an individual has AIDS. Some HIV-infected individuals may not develop any of the clinical illnesses defining full-blown AIDS for 10 or more years. According to Al-Shamiri, experts prefer using the term AIDS for cases involving a patient who has reached the final, life-threatening stage of HIV infection.

Regarding medical care that should be provided to both AIDS- and HIV-infected patients, the strategy mentioned that health care providers haven't yet been trained in AIDS care, neither in treating opportunistic infections nor in using Anti-Retroviral (ARV) drugs. Many harbor an exaggerated sense of personal risk of infection from their patients.

Gharamah stresses the importance of raising awareness among the public as well as medical staff. She confirmed that HIV-carriers can work, produce and perform their domestic and social duties, but AIDS patients require medical, social and domestic support.



“Yemeni society views HIV/AIDS patients as criminals, even by his or her family members, who may discard and isolate the patient, refusing to deal with him and assuming that the patient became infected due to sexual transgression,” she stated.

Wide-ranging misconceptions about the mode of transmission also share in creating such discordance, as many believe they could become infected by sharing a meal with an infected individual. Other misconceptions include the belief that HIV can be transmitted through touching a patient or his clothes and from mosquito bites. “So, many people begin to react against HIV-positive individuals, who experience stigma and discrimination,” Gharamah added.

Adel confirmed that his brother's family didn't receive any type of support. On the contrary, they were ostracized, both among their family and their friends. “They were afraid to visit or talk with them,” Adel recalled, “Therefore, we decided to hide the truth, even from our relatives. Khalid and his family decided to go to Sana'a to avoid meeting these relatives. He now is without a job, but living on a salary he receives from the hospital.”

Gharamah talked about the importance of counseling and psychological support for those with HIV and their families. “When we [in the program] are informed about HIV cases, we ask to meet the patients, first giving them information about the disease, the stages they'll go through and instructions to avoid any medical problems. For example, we ask them to care about their nutrition and to avoid smoking and coldness.

“We inform them about methods of transmission. For example, the HIV patient is supposed to inform the program or his doctor about his condition before any surgery. Additionally, he or she is forbidden from donating blood. We also address the family with the same information, educating them on how to deal with the patient. Such information educates the patient, the family and protects society,” she explained.

Although there's no cure for AIDS, new drugs are available that can prolong life spans and improve quality of life for infected individuals. In this regard, Yemen has received a grant from the Global Fund to Fight Malaria, TB and AIDS and the Ministry of Health and Population is committed to providing free drugs to AIDS patients. “Regarding HIV patients, we provide them with drugs according to World Health Organization (WHO) standards,” said Gharamah, who gave no further explanation.

“When my father learned about Khalid's condition, he had a stroke. He's now unable to leave the house,” said Adel, referring to how his brother's infection has affected the entire family. “Khalid's wife has cut her relationships with most of her family just to avoid any questions that may be asked,” he added, confirming that neither his brother nor anyone in the family received any psychological support enabling them to face “this disaster.”

He also confirmed that his brother is suffering dire financial straits due to expensive medication and testing to which he and his family must be subjected. “I'm wondering where are the policy guidelines and legislation to protect those with HIV and their families from discrimination? Where are their rights to all basic social services?” Adel asked.

For her part, Gharamah insisted that the Ministry of Health is committed to raising public awareness regarding AIDS. However, she called on all relevant authorities and organizations to contribute actively to insure such patients' rights.



Acquired Immunodeficiency Syndrome (AIDS), human viral disease that ravages the immune system, undermining the body's ability to defend itself from infection and disease. Caused by the human immunodeficiency virus (HIV), AIDS leaves an infected person vulnerable to opportunistic infections. Such infections are harmless in healthy people, but in those whose immune systems have been greatly weakened, they can prove fatal. Although there is no cure for AIDS, new drugs are available that can prolong the life spans and improve the quality of life of infected people. Infection with HIV does not necessarily mean that a person has AIDS. Some people who have HIV infection may not develop any of the clinical illnesses that define the full-blown disease of AIDS for ten years or more. Physicians prefer to use the term AIDS for cases where a person has reached the final, life-threatening stage of HIV infection.

By 2005 the United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimated that worldwide 40.3 million people were living with HIV infection or AIDS, an increase from an estimated 37.5 million in 2003. A joint report issued by the two agencies estimated that from 1981 to November 2005 more than 25 million people died as a result of AIDS. About 3.1 million people died in 2005 alone, and more than half (1,570,000) were children under the age of 15. About 5 million new cases of HIV infection were reported worldwide in 2005, according to the joint UNAIDS/WHO report.
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