ERBIL, Kurdistan Region - Iraqi Kurdistan is seeing the beginning of an AIDS epidemic that already affects the region, says Tristan Troby, coordinator of the AIDS program for the Kurdish Ministry of Health and Kurdistan Save the Children.
The Kurdistan government has asked the Swede to start working on controlling the spread of the disease by setting up a system to spread information about the illness, such as how it is transmitted and how to avoid infection.
“The Kurdistan Region of Iraq has 19 official cases of HIV and AIDS,” he says. “But probably more people are infected without knowing so, because not much testing is done under the local community.”
It is mainly foreigners asking for permanent residence in the region who are tested for HIV, under an Iraqi law that dates back to Saddam Hussein’s time.
Neighboring countries are known to have much larger numbers of infected people, and Iraqi borders have been open since 2003. At the moment, the fastest spread of the virus is happening in the Middle East and North Africa (MENA) region, which includes Iraqi Kurdistan.
Troby points out that in 10 years, from 2001-2011, HIV has increased in the MENA region by 35 percent. AIDS-related deaths have increased by 17 percent. There are about 300,000 people living with HIV or AIDS in these countries, with about 32,000 new people infected annually.
“Globally, most of the affected are under 30 years of age. The deaths of these young and productive people have a devastating effect on whole societies, especially in parts of Africa,” Troby explains.
For years, Kurdistan did not see HIV as a local problem and expected that, as long as the threat from abroad was checked by testing foreigners, things would remain under control. That policy seems to have changed.
“The Kurdish Minister of Health is determined that this threat should be dealt with in a proper way,” Troby says.
That is why he started six months ago to set up an information network about AIDS that starts at the bottom, with so-called district focal points -- local men and women who can provide information to the communities. There are also three governmental commissions with different members of society to follow-up, facilitate and make suggestions.
A national AIDS Council, chaired by the minister of health, brings together representatives from other ministries and independent organizations. A seat reserved for a group to organize people with HIV/AIDS is vacant for lack of such an organization in Kurdistan.
Troby is in the process of training the “focal points,” “because when they understand the subject, they will feel more free to discuss it.”
As HIV is transmitted mainly through sex, the subject is hard to address in the conservative Kurdish culture, where high school biology teachers still skip the chapter on reproduction.
To give people the possibility to talk about it anonymously, three hotlines will be opened soon. “The staff will be very explicit in describing how the illness is transmitted. Anyone who then thinks he or she might have run a risk to contract the virus can then go to a clinic to be tested,” Troby explains.
Eventually, part of the project is to train journalists, leading possibly to radio- and TV programs on the subject.
Troby wants to avoid creating stigmas. “It is important people understand that they cannot catch HIV from touching the clothes of someone that they think is ill.”
Nor can one catch it from kissing a person who lives with HIV or AIDS, or using that person’s cutlery, Troby adds.
Most people (60-80 percent) infected with HIV get the virus from unprotected sexual intercourse, with 95 percent of infections through heterosexual contact and five percent through homosexual.
People may also get HIV from sharing needles when using drugs. About 35 million people live with HIV or AIDS in the world, of whom half do not know they are infected.
Since 1996, being infected with HIV does not have to lead to AIDS, or to death. With a cocktail of medicines, the virus can be controlled. Globally, eight million people are treated with this Anti-Retroviral Therapy (ART).
To make that possible in Kurdistan, a special “CD4-machine” has to be brought in to count the affected blood cells and determine which mix of medicines would work best for every individual case. Through a Swedish-Kurdish cooperation, Troby is working to bring in machines and medication.
“But here, also the Kurdish conflict with Baghdad is having its effect,” Troby says, referring to Baghdad’s decision to freeze the Kurdistan Region from the national budget over an oil row. “We have to wait till that is solved,” he adds.
Until then, those infected in Kurdistan will have to travel to Iran or Turkey for the tests necessary for ART.
“The doctors in the Kurdish governorates are doing all they can to get the best treatment available,” Troby maintains. Yet, since ART is not yet locally available, that will often only be the treatment of symptoms, without stopping the growth of the virus, he admits.
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