The women tackling HIV and violence in Egypt
“I still had the scars from the latest beating 60 days after he died,” says Maha, from Alexandria, Egypt.
“The first time he hit me was on my wedding day, before it was made official. I was feeling faint and didn’t see a car coming. He hit me for being ‘stupid’. Marriage was a way for me to escape the control of my father so I didn’t dare tell anyone, and I went ahead and completed the ceremony.”
“The next time he hit me was ‘because’ I made the tea wrong. He wanted half milk and half water.
After that there were repeated beatings. He attacked me with a knife and he raped me.”
My HIV test results came back after his death. I can’t tell anyone I am living with HIV.
I come from ‘a good family’. If anyone outside the family finds out my status it will bring disgrace on all of us.”
Simone Salem from UNAIDS in Egypt says while the linkages between HIV and gender-based violence (GBV) are the same in Egypt as around the world, the impact can be amplified “because HIV stigma is much higher [similar to many other countries in the MENA region], plus there is extreme gender inequality for Egyptian women and girls, particularly in rural areas. Their vulnerability to HIV is increased as they are often put in positions where they are unable to protect themselves”.
Frontline AIDS partnered with UNAIDS in the Middle East and North Africa (MENA) and MENA-Rosa, the first association in the region supporting women living with HIV, on a programme called LEARN, to continue developing female leaders in the region to support other women facing these interrelated issues.
The connection between HIV and violence
The evidence shows that women are more at risk, both of becoming victims of violence and of contracting HIV, when they are not treated as equals. The women interviewed for this story had to ask for permission from their husband or mother-in-law to leave the house signaling a distinct lack of independence.
Gender inequality means that women have less control over their sexual and reproductive health and rights, including condom negotiation, are more likely to be subject to early and/or forced marriage, and are less likely to feel able to report violence, especially when it becomes ‘accepted’ or even expected.
I wouldn’t say it’s ‘normal’ for men to hit their wives, but it is typical.Maha
Her friend, Amany, describes how her ex-husband beat her because she is living with HIV. “He knew my status when we married,” says Amany. “I took him to my support group and the doctor to learn about transmission and prevention, but he still viewed me as ‘less than’ him. I was already less than a man, and now I’m even less than people without the virus.”
Even if they were willing to, girls and women whose birth wasn’t registered can’t report a crime. “They don’t exist” explains Simone. “There’s no name to file a complaint against. When men know this it makes the women even more vulnerable, we are working to ensure every woman is a visible person.” In practical terms this means helping women to obtain identification.
While not all women affected by HIV are living in abusive relationships, or vice versa, the women who are experiencing violence have additional, specific challenges and needs. Certain men are also more at risk of HIV. This includes those who inject drugs and men who have sex with men (MSM) whose risk is increased not because of their drug use or sexuality but because of punitive laws and restrictive cultural norms. “And many of these men have wives,” says Simone. This includes MSM as they are unlikely to be living openly as gay in their conservative communities. When drug use is a factor in a marriage, it can also have a knock-on effect on employment and income, or lack of, which can lead to wives taking up sex work, and this in turn increases their risk of being subject to violence.
The risks of going it alone
For women who are in an abusive relationship, like Maha, the death of a husband can present a ‘way out’. While on paper women can request a divorce, the pressure of family and societal expectations is one barrier that prevents women from exercising this right.
Amany cut her own face to trigger a divorce request from her husband. “I used a knife,” she says pointing to a scar on her cheek.
I wanted to look ugly so he would divorce me. It worked, he didn’t want to stay married after that.Amany
However, the escape isn’t always welcome. In a UNAIDS/MENA-Rosa report it states: “Even more risky than being dependent on men is not having them at all.” It may seem like a startling concept, that a woman being abused might be better off staying with her husband – this comes from testimonies from women like Maha and Amany who have lived on both sides. The lack of financial independence and economic opportunity for women can leave them “in dire straits”. Of course, some women would have options, but for the ones that can’t return home, selling sex can be the only route, or risk living on the street with their children and being abused by more than one man.
Samia, also a friend of Maha and Amany, spent two years selling sex after the death of her husband, “so I could afford baby formula”. Like Maha, she tested for HIV because her husband was dying. “My daughter was born a month before he died. I was too scared to breastfeed her, so even when a client was violent during sex, I thought, ‘I don’t care so long as he gives me the money to buy my baby food’.”
Sex workers are a key focus of support for Al Shehab, an organization providing key services to sex workers in Egypt. They provide shelters for homeless sex workers. “Sometimes a girl just needs a place to sleep and that in itself can push her to sell sex. She may have five clients in one night. That’s placing herself at risk five times, when all the girl wants is a place to sleep,” says Reda Shukry, Al Shehab’s founder.
“I believe HIV activism is what can change the situation”
The feeling of “nowhere to turn” is a frequently voiced concern, and that’s what LEARN was designed to provide. “People don’t want to go to government facilities” says Fatema, the MENA-Rosa focal point in Cairo. “At our support groups women can meet people in the same position, with no judgement.”
With so many women having to rely on men, it is not possible to address women’s needs in isolation, i.e. they also need to work with partners. Although MENA-Rosa focuses on providing support for women, one of its strategies is to visit men in hospital, as an access point to women and children, and to assess the whole family’s needs. Al Shehab provides support to all people affected by HIV and encourages testing and ‘partner notification’. Through its work, Al Shehab has observed that domestic violence increases when there are financial pressures in the home and so it sits with families to look at what benefits or opportunities there are.
People supported by both NGOs have gone onto work for them, providing employment opportunities and building up a team of strong female leadership, based on experience.
“I’m an optimist,” says Simone. “I believe the HIV activism is what can change the situation. These community leaders are addressing and integrating all other different needs of vulnerable women, whether it’s gender-based violence, hepatitis C or cervical cancer. Activists who have been trained by MENA-Rosa and Al Shehab are great examples. They go on TV, albeit with their faces hidden at this point in time, but they can say ‘we are here, you need to include us’. Communities need to keep demanding their rights in this way, not as a ‘key population’, but as a man, woman or child – and ask where is the right to health you have promised me.”
Frontline AIDS partnered with UNAIDS in the Middle East and North Africa (MENA) and MENA-Rosa, the first association in the region supporting women living with HIV, on a programme called LEARN which develops female leaders in the region to support other women living with violence and HIV. It was supported by USAID.