By Dan Driscoll
When one discusses the primary health issues of Yemen and the priorities of funding, HIV/AIDS almost always falls near the bottom of the list. This is clearly shown in the recent failure of Yemen to receive further HIV/AIDS funding in the Global Health Funds next round of funding – a significant portion of HIV/AIDS funding in Yemen.
The failure however, is not on the responsible organizations such as the UNDP, but a lack of sufficient prioritization of organizations such as the Global Health Fund. By overlooking the potential dangers of HIV/AIDS, the Yemen government and its international partners are gambling on the hopes that a potentially dangerous situation remains dormant.
It’s not difficult to see why the Global Health Fund declined further funding after a superficial glance at the statistics that are often cited to demonstrate the HIV/AIDS epidemic in Yemen.
Only 318 cases were recorded in 2009 — significantly less than in many other countries affected with HIV/AIDS. In some ways, which will be discussed, this is a striking number, yet it could easily be pointed out that ultimately this fact only contributes to prevalence rate of approximately between .14%-.2% of the total population.
This data grows increasingly pale in comparison with the staggering statistics of countries in Sub-Saharan Africa such as the 26% prevalence rate in Swaziland – the highest in the world. Yet the low official rates and differences of statistics between countries shouldn’t mislead the priorities of Yemen as it advances health in the 21st century.
What donors and public officials may not understand is that beneath the facade of these statistics looms a large danger that could create one more disastrous problem as Yemen develops.
The current conditions in Yemen represent a perfect breeding ground for the HIV/AIDS virus to grow exponentially as the population has little information regarding the virus as well as lack of surveillance and response mechanisms.
For example, in a recent study of a local secondary school many misconceptions were discovered among youth – an at risk group of HIV/AIDS. Notably, only 40% of students did not know that HIV/AIDS is currently untreatable, nor is there a vaccine readily available.
18.5% of students believed that HIV/AIDS could be transferred by mosquito bites, and 40% believed you could contract HIV/AIDS by wearing the clothes of infected people. Most worrying, 95% of the students surveyed believed that young people are not susceptible to HIV/AIDS.
The lack of awareness is severely compounded by the fact that there is a lack of surveillance that limits the amount we actually know about the virus in the country. With limited epidemiological data in Yemen, an accurate level of HIV cannot be clearly defined. This shows in discrepancies between confirmed cases and estimated cases.
From the first documented case of HIV/AIDS in Yemen in 1987 until 2003, there was a total of 2,883 HIV/AIDs cases confirmed. This is contrasted with a total of 24,000 cases estimated by the World Health Organization in 2003. One reason for this is that 75% of the country lives in rural areas, far from any source of medical center where the disease can be monitored and addressed.
The lack of data is also a result –and a cause of the spread of HIV/AIDS- of the lack monitoring even at blood transfusion centers found in urban areas. The centers may have guidelines to screen for HIV/AIDS but do not have the resources to do so always.
This results not only in a lack of knowledge, but also contributes to the spread of HIV/AIDS as blood transfusion accounts for 6% of HIV/AIDS cases in Yemen. Yemen even lacks proper data even on the main target groups that are most at risk such as sex workers, intravenous drug users, among others.
consequences of a lack of awareness and knowledge on HIV/AIDS is made clear in an analysis of confirmed HIV/AIDS cases in Yemen during the 1990’s . In 1995, it was documented that the male to female ratio of HIV AIDS was 4 to 1, respectively.
This statistic was not surprising as many males began to travel to outside countries for work during this time and put them at risk of contracting the virus. However, the statistic changed in an alarming way. In 1996, this ratio morphed into a 2 to 1 ratio, and by 1999, it was 1 to 1.
This may suggest just how quickly the virus was passed from males who had HIV and passed it on to their wives and sexual partners. Yemen – despite its conservative culture – is not immune to a rapid spread and increase of the HIV/AIDS virus.
As a result, Yemen and the international community must be concerned with how such a rapid change in statistics plays out with a population of 24 million people. Current research can provide some insight into the potential growth of AIDS in Yemen as it was observed in many African countries that once a critical mass is hit, the virus spreads rapidly, increasing ten-fold in as little as 5 years.
As a result, Yemen sits upon an increasingly wobbly fence between containment of the disease or an increase that could spiral out of control. It cannot be denied that growth is already taking place; in 2000, there were 111 new cases of HIV/AIDS documented, followed by 318 in 2009 (Figure 1).
The increase is worrying as it comes with the recent UNAIDS announcement in its Global Report for 2010 that the global health community is actually beginning to slow down and even turn the epidemic around. The report found that new global HIV infections have been reduced by nearly 20% in the past 10 years. Yemen is a complete reversal of that trend.
This information should prompt action and not complacency in dealing with HIV/AIDS. The one thing that is certain with HIV/AIDS Yemen is that it is in the beginning stages of its spread. As such, an unprecedented opportunity exists as it makes knowledge not only the most powerful weapon against HIV/AIDS, but the cheapest.
It must be asked among government officials and the international donor community if it is better to currently invest in cost-effective awareness campaigns and better surveillance now or the exorbitant costs attributed to an explosion in HIV/AIDS in our country later?
Fortunately, the Yemen Government has demonstrated tremendous foresight and has demonstrated high levels of political will in addressing the virus. This political commitment has prompted many workshops for political and religious leaders in all Yemeni governorates, mandated institutions to treat people living with HIV/AIDS as any other patient, the encouragement of participation by ministers in HIV/AIDS specific events, issues of legal opinions from the Ministry of Guidance and Endowment supporting the rights of people with AIDS and much more.
Additionally, the Yemen Government’s Ministry of Heath and Population has created lasting relationships with international partners to achieve impressive accomplishments in dealing with HIV/AIDS.
These efforts have created 5 anti-retroviral treatment centers in sites throughout Yemen. Furthermore, 17 clinics have been opened throughout the country that provide HIV/AIDS screening as well as advice and support for infected individuals.
Despite these accomplishments, it is not enough and many challenges remain that must be addressed. One of the largest challenges that remains is the stigma associated with the disease.
Many, particularly in rural areas claim that increased awareness of HIV/AIDS will serve as a catalyst of promiscuity and refuse to acknowledge it. Stigma is not only confined to rural areas, when the first HIV/AIDS organization started work in Yemen, angry mobs threw rocks at the buildings for weeks on end. Changing the stigma of HIV/AIDS won’t happen on its own.
Additionally, the health infrastructure is very weak and unequipped to deal with issues of HIV/AIDs. Furthermore, the budget of the Yemeni government often does not match its will and rhetoric in stopping the disease.
The government’s financial support is as critical as ever as in order to navigate the dearth of funding suddenly imposed on the country’s HIV/AIDS efforts as a result of the Global Health Fund’s decision. The continuation of successful HIV/AIDS projects will be threatened if the government cannot follow through with its commitments.
As such, the Yemeni Government, and international organizations and donors, must renew their commitment to fighting HIV/AIDS. Responsible officials must take this the current opportunity and work together to effectively combat and prevent the spread of HIV/AIDS in Yemen. Given the environment it is necessary that we prioritize our efforts on cost-effective surveillance.
This will allow donors more up to date and vital information that will inform them of the real problem as programs such as the National AIDS Program moves forward in implementing needed awareness and response projects where they are needed most.
While greatly enhancing the assessments of the current status of HIV/AIDS it will allow these projects to effectively and easily prevent the spread of the disease. Lastly, we must increase our support to patients with HIV/AIDS through cost effective means such as training patients with the virus to console others.
By implementing these ideas and ensuring a long-term commitment to them, the Yemeni government and international community can take make an already low rate of prevalence of HIV/AIDS in Yemen even lower.
The current rates in Yemen should not be a call for contentment, but a call for action. If HIV/AIDS isn’t acted on now, a scarce window of opportunity will surely close.