AIDS in Yemen A Concealed Menace ! [Archives:1997/50/Health]

December 15 1997

By: Yasin al-Qubati
Introduction: Sex is one of the essential desires for the continuation of life. In developing and under-developed countries it is still treated with suspicion and disgrace. In these countries, the only respectful way to practice this desire is through marriage, a process accompanying plenty of needs and expenses. This fulfillment of marriage becomes impossible for a lot of youngsters who revert to practice secret methods to satisfy this essential biological need.
These methods might be: – secret habits (masturbation) – promiscuity and prostitution – abuse of youngsters – homosexuality – others The hidden handling of sexual desire (blamable sex) would lead to hidden management of the consequences and outcomes. The result will be low reporting of STD infections. In Yemen and in many of the Eastern Mediterranean Region countries, the inadequate information system adds to the problem of invisible dangerous outcomes of the blamable sexual relationships. On the other hand strong social and religious beliefs help in controlling the transmission of STD.
SOURCE OF INFORMATION ON AIDS AND STD: Most of the cases diagnosed in Yemen are heterosexual and got the infection when they were outside the country either between surgical procedures or illegal sexual relationships. Most of the information collected about AIDS and STD prevalence are from the records of the central laboratories, where the equipment and instruments necessary for diagnosis are located. The records for AIDS infected persons in the central laboratories in the main cities of Yemen does not give the actual situation of AIDS in Yemen. There are backlog cases which could not be determined or even estimated due to the following factors:
ù inadequate information system ù bad health infrastructure ù high stigma ù the lowest priority given for health services as a general policy in the military ruled countries
RISK FACTORS: 1- Refugees and illegal immigrants: Yemen is the nearest Arab country to the African horn with easy access to known high prevalence countries of AIDS like Uganda, Tanzania, Eritrea, Ethiopia, Zaire, Zambia and Zimbabwe. The smugglers in their boats are used to carrying people from shores of Ethiopia, Somalia and Eritrea to Saudi Arabia or Yemen for job hunting. When they reach the coasts of Yemen, these smugglers deceive the travelers saying that they have reached Saudi Arabia. From the coasts of Yemen, some of these deceived travelers manage to get through to the big cities of Yemen, but some get caught and deported. Those who got into the country live illegally in the Yemeni community with their less restricted social and sexual attitudes and no medical or social support. Therefore, the chances for transmission of diseases, like AIDS and STD, through them is more likely to occur. Some of the unfortunate job seekers are caught and put in jails where they could transmit disease to other prisoners in jails with poor medical and hygienic conditions.
2- Poverty: Yemen is the most densely populated and poorest country in the Arabian peninsula. Poverty is increasing among the population as a result of the devaluation of the Yemeni currency since the beginning of 1980s. The second Gulf War and later the civil war worsened the economical conditions. So some of the despaired people, ignoring the normal, religious and social beliefs, try to find other sources for income. These attitudes increase the risk for STD transmission.
3- Political Commitment for Health: Poor economical resources put health services at the bottom of the priority list. Also, the inadequate planning and their implementation lead to more favorable conditions for the spread of communicable diseases including STD.
4- Industrial Developments: Industrial growth, transport, communication and social developments increase the need for laborers and the mingling of both sexes. If not accompanied by good education, this in turn may lead to illegal relationships and may endanger people to STDs.
5- Health Education for Travelers: Increased frequency of people traveling to more “open” societies for business, pleasure and medical treatment without enough health education about AIDS and with sexual suppression, endanger them to come back infected with AIDS. The people undergoing surgical procedures abroad especially in cheap centers, are more in danger of risking an AIDS infection.
EPIDEMIOLOGY OF AIDS AND STD IN YEMEN: Between 1987 and 1996 the cumulative number of registered cases of AIDS victims in Yemen reached to 208 persons. Out of them, 110 were Yemeni people and 98 were expatriates. During the period September 1996 to September 1997, 52 cases of AIDS and AIDS Related Complex were diagnosed. Thus, the total number of cumulated registered cases in Yemen since 1987 till now is 260 cases. Out of these cases, 82 have AIDS and 178 are asymptomatic HIV carriers.
AGE AND SEX DISTRIBUTION: Most of the AIDS cases were males in the age group of 30 – 39 years which is the age of sexual activity and financial capability.
RESULTS OF HIV TESTS: While searching in the records of the central laboratory of Ministry of Health, following data was found for the groups tested for AIDS since 1992 (Table 3). Out of the 1,112 tests done for high risk groups, 68 tests were confirmed as AIDS positive. In low risk groups, out of 20,136 persons tested, 28 were AIDS positive (Table 4). Thus between 1992 and 1997, out of 21,494 total serology tests, 96 persons are positive for HIV.
CONCLUSION: In Yemen it is difficult to determine the exact cause of most of the communicable diseases due to lack of an adequate information system. Moreover, in communities with a high stigma against STDs, AIDS remains a concealed menace until it bursts out to be epidemic and lead to serious consequences. This could be avoided if a proper planning for health education and surveillance system is adopted.