Abstract standers of freedom, equity and zero hunger, violence

Abstract

 

In September 2000 Millenium
Development Goals (MDGs) were originated from the Millennium Declaration they
include eight global development goals to be achieved by 2015. each goal had
set of targets, Goals four, five and six were
related to health development. Goal six had two targets on was to halt and to
stop the spread of HIV/AIDS by 2015. Egypt is facing an increase in the
prevelance of HIV/AIDS despite being lower in prevelance compared to other
Middle East and African countries. Stigmatization, discrimination and lack of
finance are having an upper hand of obstructing the national health system to
overcome the rising prevelance of HIV/AIDS in Egypt. National AIDS Program (NAP) works in
partnership with UN agencies like UNICEF and UNAIDS for the aim of lowering HIV
prevelance in Egypt.

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Introduction

 

In September 2000 world leaders
gathered at the United Nations headquarters in New York, to discuss different
global issues and the role of the United Nations in the 21st century.

Following Millennium summit the United Nations General Assembly signed the
United Nations Millennium Declaration that declared that every individual has
dignity and has the right to live a life with basic standers of freedom, equity
and zero hunger, violence and intimidation. The Millenium Development Goals
(MDGs) were originated from the Millennium Declaration they include eight
global development goals to be achieved by 2015. each goal had set of targets, Goals four, five and six were related to
health development. Goal six had two targets on was to halt and to stop the
spread of HIV/AIDS by 2015 and the other one was to guarantee access to
treatment to all individuals who need it by 2010.UN General Assembly high level
meeting on ending AIDS was held in 2016 in New York, UN Member States have
devoted to establishing an agenda to end AIDS/HIV by 2013 and set specific time
bound targets that must be achieved by 2020 under the structure of Sustainable
Development Goals. In this essay we are going to discuss how and to what extent
HIV/AIDS prevention and treatment has been progressed in Egypt, In addition to
providing case studies that give a realistic picture about the challenges
facing the country towards achieving lower prevelance of HIV/AIDS and identify
challenges facing healthcare workers in providing health services for patients
with HIV/AIDS, furthermore, this essay will outline the role of national and
international programs and policies addressing HIV/AIDS and their outcomes.

 

 

 

Challenges on lowering HIV
prevelance illustrated by Case Studies

 

Egypt is facing an increase
in the prevelance of HIV/AIDS however, it is considered to have a low epidemic
level compared to other Middle East and Africa countries. 1 71%
of HIV transmission in Egypt is occurred through unprotected sexual behaviours
and half of detected cases were through heterosexual transmission. Egypt
possess several national and international programs aiming at decreasing the
prevelance of HIV/AIDS however, the country is facing many challenges to
achieve this goal. These challenges are mainly caused by poor the national
health system leading to a weak surveillance and prevention system beside the
insufficient access to sexually transmitted disease information. In addition to,
many Egyptians who are HIV-positive don’t seek for treatment or medical services
due to social taboos regarding sexual transmitted diseases and fearing from
discrimination. The main barrier for the national health system to overcome the
raising levels in HIV/AIDS is the insufficient capacity of stakeholders that is
linked to the dramatic economic environment in Egypt which affects the
salaries, training and incentives for healthcare workers leading to their poor
performance. Although the principles that The World Bank had identified for a
proper public financing for health are very effective in many countries, it is
very difficult to apply them in Egypt due to some obstacles including taxation
policy, national budget distribution and political conflicts.

 

 

As mentioned previously,
stigmatization and discrimination are having an upper hand of obstructing the
national health system to overcome the raising levels of HIV/AIDS in Egypt. 2A
case study was conducted by the National AIDS program and approved by the
Ministry of Health in 2010 in a public hospital in Giza governorate in Egypt,
the study aimed at identifying reasons for neglecting health care for patients
with HIV and to find solutions to deal with this problem. Data collection was
obtained through interviews with healthcare workers in the hospital and those
who are responsible for the medical care for the patients living with HIV/AIDS.

The study showed main reasons behind the lack of care for HIV patients among
hospital staff which includes their fear of infection with HIV and being stigmatized
by the community, misconceptions regarding treatment of HIV as they thought
that it has no cure and there is no need for medical care, staff don’t trust
infection control measures of the hospital, and other reasons related to
negative beliefs such as judging HIV patients of having improper sexual
behaviors that they don’t deserve treatment  that and they want to pass infection to
others. Fear of infection was the main obstacle among heath staff, this can be
handled by providing them with proper infection control trainings and skills
beside applying good infection control measures resulting in increased
confidence of health workers to deal with HIV-patients. Egyptian health
authorities carry the burden of changing stigmatizing behaviours among health workers
against HIV-patients and developing policies for hospitals ensuring optimum
standards of infection control facilities for all healthcare workers. The
feedback of this study was giving valuable information about the barriers of
providing health care for HIV-patients in Egypt which can help stakeholders to
establish HIV-patient friendly hospitals.

 

Another reason for the
insufficient medical care of patients living with HIV in Egypt is related to
their adherence to Anti-retroviral therapy ART due to obstacles preventing them
to comply with medication. 3A
study was conducted at a place run by “Support for Development Foundation” for
people living with HIV (PLHIV) in 2015, in Alexandria
Governorate, Egypt, the purpose of
the study was to give a picture of PLHIV with national healthcare system in
addition to their adherence to Anti-retroviral therapy. The study design was
qualitative study using focus group discussion (FGD), participants were
subjected to different questions regarding various dimension of their access to
ART and dealing with health care services. Participants stated that they were
subjected to rejection from the private hospitals and clinics to provide them
with HIV healthcare services and there is only one public hospital ‘Fever
Hospital’ in the governorate that provides HIV services “Centralization”
leading to discouraging of some patients to receive therapy due to long
distance , although they were satisfied by the services provided by the
hospital some of them don’t adhere to ART because the hospital asks for their
full name leading to confidentiality conflicts and that ART is not available
all the time “evening dose”, futhermore, some of them don’t adhere to ART due
to its side effects.

Stigmatization and
discrimination were also reported regarding other health services for example
some of them faced bad attitude from doctors when asking for dental care or
family planning and delivery services. PLHIV suggested some ideas to overcome
obstacles and improve the provided health services some of them were related to
health system and others were related to ART, suggestions included providing
health awareness sessions to PLHIV and to health workers as well to remove
misconceptions and stigmatization, others were about better dispensing of ART
doses. The study recommended implementation of strategies to remove
stigmatization by increasing the awareness of the community about HIV beside providing
more public hospitals that provide HIV services to avoid centralization and
facilitate aces to HIV care services to all PLHIV.

 

 

Governmental Policies and
Role of National and International programs

 

Egyptian
National AIDS Program (NAP) is the official governmental program accountable
for the treatment and the prevention of HIV/AIDS, it was established by the
Ministry of Health in 1986 to establish policies and plans for the aim of
lowering the prevelance of HIV in the country including strengthening HIV
surveillance system under the National Surveillance plan that established 4 HIV/AIDS
Biological Behavioral Surveillance Survey Bio-BSS Egypt in 2006 that is
repeated every five years, its goal was to implement a 2nd
generation HIV surveillance system for high risk population and tracking their
behavioral data. NAP other goals included the provision of free
Anti-retroviral therapy for PLHIV, raising community awareness about HIV/AIDS,
improving capacity of healthcare workers, establishing long-term programs for
population at risk of HIV infection and enhancing the quality of life of PLHIV.

NAP works in partnership with UN agencies like UNICEF and UNAIDS. UNICEF mainly
supports HIV prevention among children especially those at risk like ‘street
children’ in addition to preventing mother-to-child HIV transmission and
assisting vulnerable women in Egypt living with HIV. UNAIDS regulates a joint
program to support the National Strategic Plan on fighting HIV aiming at
supporting the country to achieve MDGs. Egypt also has many other NGOs like
Caritas and others that assists in raising the awareness of the Egyptian
community against HIV through media campaigns that is without doubt having a
crucial role in removing stigmatization and social taboos.

 

 

 

Conclusion

 

Despite the national and
international efforts to lower the prevelance of HIV Egypt there are still gaps
that obstacle achieving this goal, poverty and ignorance are the main barriers,
public hospitals don’t obey the least measures of infection control due to the
lack of funds to import sterilization materials leading to increasing number of
infections. Awareness campaigns are mainly targeting educated people and don’t
reach the rural and vulnerable communities thus stockholders should increase
the capacity of awareness programs to reach all levels of the community and
design strategies targeting most vulnerable groups that cover wider geographical
areas furthermore, enhancing outreach programs to accesses children living in
streets to provide them with information to avoid themselves from being
infected with HIV. 5SDGs focused on gender
equity and empowering women though Government should support 6women
living with HIV as they are the most stigmatized group in the community and
provide special delivery rooms for them in hospitals in order to avoid being
rejected from doctors and decrease the chances of infection as they seek to
deliver by maid wives in unsterilized places because hospitals refuse to
deliver them. Moreover, centralization prevents a lot of PLHIV to reach
medication, Government have to increase the number of health facilities, hospitals
and clinics that provide HIV services so that PLHIV can adhere to therapy
easily. ART delivery should be also modified to avoid missing doses and ensure
proper adherence to medications beside being available all the time for adults
and children. National programs aiming at advocating for the rights of PLHIV
should be implemented to protect them from violation and discrimination to 7promote
Justice, and Peace among the society. Achieving SDGs will have a positive
impact on HIV in Egypt, if we apply SDGs concepts in causes of increasing prevelance
of HIV in the country.

1 National AIDS Programme Egypt, UNGASS Country Progress Report,
2010.

Abdelrahman,
I., Lohiniva A.L., Kandeel, A., Benkirane, M., Atta, H., Saleh, H., El Sayed,
N., Talaat, M., 2015. Learning about barriers to care for people living with
HIV in Egypt: A Qualitative exploratory study. Journal of the International
Association of Providers of AIDS Care 14 (2), 141-7.

 

3 IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 5, Issue 3 Ver. IV (May. – Jun.

2016), PP 35-42 Available at: http://www.iosrjournals.org/iosr-jnhs/papers/vol5-issue3/Version-4/F0503043542.pdf

 

4 Ministry of Public Health and Family Health International.

Integrated Bio-Behavioural Surveillance Surveys, Round two, Egypt. 2010,.

Country progress report, Egypt. 2010

 

 

5 SDG#4 Achieving Gender Equality, Empower Women and
Girls

6 Abdeldaim.

A.H. A., 2015. Challenges facing women living with HIV in upper Egypt. Master
Thesis, the American University in Cairo School of Global Affairs and Public
Policy.

 

7 SDG#16 Promote Just, Peaceful and Inclusive Societies