Regional Outlook : Arabs Waking Up to AIDS : Spread of virus alarms regional health officials, but it remains a disease of fear and shame.

In a radio spot played all over Cairo the last few weeks, a young Egyptian man traveling abroad spots an attractive European woman in a bar. “A walking rocket!” he exclaims to himself as he sits down and buys her a drink.

Little did he know how right he was. Within moments, the stern voice of his father is heard warning that women like that may look nice, but they carry acquired immune deficiency syndrome, or AIDS. Then, an even sterner voice is heard reading an unsettling verse from the Koran. “Don’t go to hell on your own legs,” the voice commands.

Two messages are clear: AIDS often comes in the guise of a shapely foreigner. And Allah is the best ammunition for fighting the disease.

Both assumptions may be partly to blame for an AIDS caseload in the Arab world that has more than quintupled in the last two years. The disease that feeds on the promiscuity and drug abuse so rampant in the West is settling into the Muslim societies of the Middle East, where it remains a disease of fear and, worse, of shame.

Several Arab countries for some time refused even to report their AIDS cases to international authorities, and underreporting, or misreporting, is still thought to be widespread. Egyptian authorities publicly claim every Egyptian AIDS case was contracted through contaminated blood transfusions received abroad, though many of the same authorities admit privately they know better. To tell the truth, they say, would be to bring public disgrace to the victims’ families.

In Egypt, an AIDS patient quarantined at a local hospital was shot to death by a security guard a few years ago when he threatened the hospital director in a bid to escape. An AIDS patient at the same hospital had to have her baby delivered by her mother because the physicians and nurses at the facility refused to touch her.

Treatment for AIDS depends on where you are. Basically only the oil-rich Persian Gulf states offer costly drugs such as AZT. Most of the other countries of the region treat only AIDS-related complications such as tuberculosis.

“In Middle Eastern countries, you have to keep everything at a very low tone. Everything happens, but you have to be very sensitive to other people’s sensibilities,” said an Arab physician who works for an international relief organization. “If somebody here is stamped as having contracted AIDS through illicit sex, they’ll be goners. Society will never support them, and they need all the support they can get.”

In fact, AIDS has been slow to arrive in the Middle East despite the region’s proximity to AIDS-ridden Africa. Strict religious and societal taboos against extramarital sex and homosexuality are probably responsible, health officials say.

Only 208 AIDS cases had been reported by 1989 throughout the Arab world, including countries such as the Sudan, Djibouti and Somalia, which straddle the Sahara. But the cumulative total grew to 1,082 last year. Health officials throughout the region have become alarmed enough that many, for the first time, are adopting widespread AIDS education programs.

The North African countries of Morocco, Tunisia and Algeria, which have seen the disease appear both from the south, in Africa, and among the large numbers of single young men who frequently travel back and forth to Europe, convened their first regional AIDS conference earlier this year.

In Sudan, whose 476 reported cases are the highest of any Arab country, a huge billboard warning of the dangers of AIDS confronts travelers driving into downtown Khartoum. In Egypt, the widespread radio, television and brochure campaign that started this year is thought to be unprecedented.

But how do you fight AIDS in a region where homosexuality isn’t supposed to exist, and you’re not supposed to even talk about sex?

Even more difficult, how do you advise people who engage in sex outside marriage to use condoms when the sheiks of one of the most revered Islamic institutions in the world, Cairo’s Al Azhar University, have declared that the principles of the Koran are enough to protect people?

For months, physicians at the Egyptian Health Ministry battled with the religious establishment for permission to talk about condoms. Finally, one television spot was allowed to mention the “C” word.

The commercial shows a verse from the Koran prohibiting illicit sex, then cuts to a drawing of the globe. “Abroad, people use condoms to prevent AIDS,” the narrator says. “But our youth, if they maintain their religious principles and morals, will not suffer any danger.”

Gamal Shanan, who produced the spot for the Health Ministry, laughed gleefully as he rewound the commercial. “At least it gives them the idea, even if we can’t come out and say it,” he said.

The condom controversy escalated late last year when it was disclosed that a large number of the 4 million condoms distributed for family-planning purposes were being sold as balloons. It was a simple question of economics, said AIDS program director Nasser Mohammed Sayed. Balloons can cost 30 piasters (about 9 cents); condoms are only 5 piasters.

World Health Organization officials say the Arab world has had two factors on its side in the relatively low level of AIDS detected so far. First, the disease was introduced into the region in the mid-1980s after health officials knew how to detect it and how to help protect people against it.

For the most part, they say, AIDS seems to have originated in the Persian Gulf region from contaminated blood imported from the United States and other areas where AIDS was prevalent before blood screening became routine in 1986.

“Another reason (for the relatively low rate) is that there are factors present in the region, particularly the sociocultural religious patterns, that would work against the rapid spread,” said Mohammed Wahdan, who heads the World Health Organization’s regional AIDS program in Alexandria, Egypt.

The pattern of infection found in the West doesn’t match that of the Middle East. In a recent survey of 110 men arrested for homosexual activity in Egypt, only one tested positive for the HIV virus. A 1987 survey of 385 female prostitutes there produced no positive test results. About half the HIV-positive cases in Egypt are foreigners, 80% of them from Africa.

The result of this history is a perception in many Arab countries that AIDS is an imported disease that comes mainly from foreigners.

The Egyptian opposition press regularly carries reports, never authenticated, that Israel is secretly exporting prostitutes with AIDS into Egypt to contaminate the population. In a recent popular play about inter-Arab relations, Israel was depicted as a lovely foreign woman in an evening gown who had AIDS. An Israeli Arab woman arrested last month on spying charges was widely reported to have AIDS until the Interior Ministry publicly denied it. The foreign connection is also stressed in the approach to fighting the disease. Young Saudis traveling to Bangkok for sex vacations are discreetly warned of the AIDS outbreak there, and Egyptians are handed brochures about AIDS at the Cairo airport.

But health officials admit that they can no longer rely on closing the drawbridges to fight the disease. The World Health Organization now estimates that 70% of new cases in the Arab world are sexually transmitted, more than half of them through heterosexual contact.

“The idea that it’s all coming from outside is going to change now,” says the Egyptian Health Ministry’s Sayed. “AIDS is no longer an imported disease.”

Expanding Threat

Reported AIDS cases as of 1991 in the Arab world: Sudan: 476 Tunisia: 105 Djibouti: 104 Morocco: 98 Algeria: 92 Saudi Arabia: 35 Egypt: 34 Qatar: 31 Lebanon: 29 Oman: 24 Jordan: 13 Somalia: 13 Syria: 11 United Arab Emirates: 8 Iraq: 7 Kuwait: 1 Libya: 1 Bahrain: 0 Yemen: 0 TOTAL: 1,082

Source: World Health Organization, Egy, and the Association to Fight AIDS in the Maghreb.