The Security Threat

You’re in: AIDS at 25 Coverage / 25 Years Later: Conflict

Credit: David Vaaknin

—Jericho, West Bank

A decade ago, after 13 years of working and living in the glitzy Persian Gulf city of Dubai, Hussam returned to his hometown with a secret that he’s kept since then. He tested positive for HIV at a time when AIDS was still virtually unknown in the Middle East. He remained largely symptom-free until the first day of 2005, when he awoke from a New Year’s Eve party to find himself blind in his right eye from viral retinitis, an opportunistic infection that signaled the progression of his disease. Now, in this West Bank city of just under 40,000 residents, he co­­pes with medication shortages and security clearances for hospital visits—a set of circumstances perhaps unique to this time and place. Such is the life of a Palestinian with AIDS.

“I feel when I enter Hadassah hospital [in Jerusalem] like I’m crossing a border,” said the thin-framed, 46-year-old former stonemason and vegetable seller, whose carefully groomed beard does not quite hide a lesion on his cheek. He agreed to be interviewed only on condition of anonymity; he still keeps his HIV-positive status a secret, even from his two sisters and one of his brothers.

With the election of Hamas—classified by much of the West as a terrorist organization—
to the Palestinian Legislative Council, the government lost most of its foreign aid this spring, leaving its budget decimated, doctors and nurses unpaid for months and hospitals’ medicinal stocks drastically depleted. For Palestinians living with HIV/AIDS, that means their government-supplied medication—hard to come by even in good times—is falling far down the list of their nation’s priorities.

Dr. Assad Ramlawi, the Palestinian director of public health, says that with international help his ministry conducts basic public testing and blood-donor screening, and has taught many of its doctors and nurses how to handle an HIV-positive patient. Some Christian and Muslim leaders, in an effort to overcome the terrible stigma that persists, now preach that people with HIV are as deserving of compassion as a victim of cancer. And while under-reporting of infection is still a serious problem—medical officials say the actual number of cases could be three to four times the officially registered 78 cases in the West Bank, Gaza and east Jerusalem—the prevalence, in a population of an estimated 3.8 million, is still low.

But the nearest specialized clinics that offer testing and treatment are in Israeli hospitals. To access those clinics, Arabs need permission to cross checkpoints into Israel—and both the permit process and the checkpoints themselves have become infinitely more strict since the beginning of the second intifada in 2000. While Israeli authorities have issued more than 20,000 permits for general hospital visits to West Bank and Gaza residents this year, a small number of patients are not allowed to travel unless they are accompanied to the hospital by armed security; another 600-odd patients from Gaza, a more volatile region and more of a Hamas stronghold, have been refused entry outright.

The Israeli branch of Physicians for Human Rights has taken up two such cases involving AIDS patients this year: a man from Hebron too ill to work who was told he must hire private security, at the prohibitive cost of about $450 per trip; and one from Gaza who was refused entirely, despite a Supreme Court appeal.

“[Security] is most important,” said Tal Manor, the group’s intervention coordinator. “The judges say [that the Gaza patient] is so dangerous that they will not allow him to pass thro­ugh Israel. So dangerous? I don’t know. He’s about to die.”

“It’s not possible to provide AIDS drugs where you have shortages in drugs for chronic diseases that affect a majority of the population,” Dr. Ramlawi said. Less than half of Palestinian HIV/AIDS patients were getting medication even before Hamas took over.

Hussam’s own triple cocktail therapy has already been interrupted once this year, during which time he developed threatening symptoms. His hopes for the future, he says, now rest on God, and on his doctors’ continued ability to wrangle medication and travel permits. “You can die today or tomorrow. The most important thing is to have quality of life,” he said.

Carolynne Wheeler is a Canadian freelance journalist based in Jerusalem.

Originally published August 13, 2006

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