Dr Khadija Mualla, HIV/Aids Practice Leader and Regional Coordinator for Arab States, United Nations Development Programme (UNDP), works tirelessly to check the epidemic in the region. However, it’s not just HIV and Aids awareness that’s a problem, but the stigma surrounding the disease, acceptance in communities and gender barriers.
Gulf News spoke to the woman who is trying to change the mindset of a region under threat.
GULF NEWS: At a conference held in Cairo in 2006 it was announced that an HIV infection occurs every 10 minutes in the Arab world and in 2007 it was estimated that there were half a million Arabs living with HIV. What is the situation today?
DR KHADIJA: That’s an estimate, the WHO (World Health Organisation) is estimating that 460,000 people are living with HIV, but it’s an estimate, not cases, so the governments usually know precisely the people who went and got tested, but generally we don’t really know. So this is why the WHO will generally tell you that behind each person there are 10 more people.
So it depends on the country and on the surveillance, especially the second generation surveillance, meaning that we do surveillance among most at-risk populations such as paid sex, or injecting drug users, who might be sharing syringes or men having sex with men. Once you go into these groups you have a better chance of knowing the reality in any country.
So it’s too difficult to say what the situation is today?
Basically today the situation differs from country to country … depending, in some countries we know more, in some countries we know let’s say the numbers are quite high in Sudan for instance, the percentage is high in Djibouti. It’s all about the countries and whatever they would like to report or not, whether they know or not. But usually it’s between governments and the WHO, this is the agency that is in charge of all these numbers and statistics.
As far as you know at the moment, how widespread is HIV/Aids among women and girls in the Arab world?
It seems that we have kind of a 50:50 per cent between men and women, which is quite high for women. Women are extremely vulnerable in our region, because they don’t necessarily know: whether they’ve never heard about Aids, even if they know they cannot negotiate safe sex with their husband, and unfortunately, 80 per cent of them that are infected are infected within the bond of marriage, so they have a tendency to think that marriage is protecting them, sometimes it’s not, sometimes it is.
So it’s a lot about this vulnerability and the ability to negotiate, you know what you don’t have your rights, it’s very hard to negotiate if you’re being threatened of being divorced or being thrown out of home.
In most cases, women discover their infection after their husband has died. And this is where they are being told by the medical doctor that this is how he died, now why don’t you do the test and then they discover and the whole story starts then.
How can people get to the root of problem and stop HIV/Aids from spreading if it’s a social/cultural problem?
By tackling stigma, this is what we do in the United Nations Development Programme, we work a lot on the stigma part by working with religious leaders and media people, because they are the ones who are opinion-shapers; they are the ones who can convince people to stop stigmatising the others, and to see people living with HIV as normal people, like you and me and anybody, so tackling stigma is the first priority for us.
Secondly, discrimination which means working on the law side, working with parliamentarians to enact laws that are protecting the rights of people living with HIV or at least work on the human rights side of guaranteeing that whoever is infected will continue living a life with dignity, with having all his rights protected. This is something that we very much work towards making sure that it is there, and this is why we are leading as a UN agency with 10 other UN agencies — you can imagine that many UN agencies synergising with government and also with civil society organisations and the private sector. We need all these collective efforts to really stop this epidemic if you want to meet the MDG — the Millennium Development Goals — in 2015.
The summit just finished in New York last week and we had all these Governments committing to making sure that for the last stint of five years we will work really collectively to at least meet six if not all eight of the goals, but definitely each one.
How much of a part, then, does gender empowerment play in protecting women against HIV and Aids?
Definitely we need to protect women’s rights and we need to protect women. Gender is about the power relationship between men and women. So we need to work on that to shift this power imbalance and make it equal and this is the only way that we can tackle Aids and protect women’s rights. If we continue accepting that women don’t enjoy their full international human rights then it won’t make a difference and we will be just doing some talk.
We need to give women the power over their body, over their freedom, to be able to protect themselves. Actually we are not protecting them unfortunately, because they do not enjoy their rights. So it is very much linked, rights and [gender].
Basically empowerment means giving choices and the choices the first one is to protect ourselves, so we need to make sure that our girls are not getting infected the first night of their wedding, that the family continue protecting their daughters, even when they are married after the marriage, and that once they get infected to still continue protecting them, because some husbands will unfortunately just divorce them or leave them alone, will leave them sometimes pregnant and here the family has a huge role to play.
I don’t want the family to just forget about their daughter because she got married. She’s still part of the family, and this protection that started when she was born should continue, by making sure that she has her rights, she can protect herself. This is exactly what we want to achieve.
That’s quite a big task to try and change a whole mindset. How will you go about doing that?
This is why we work with religious leaders — absolutely they should be part of the solution and they have the solution. This is why we invest a lot of time, energy and funding by working with them. Because they have this power to give people the right messaging when it comes to men living with HIV. And actually we have the beautiful Cairo declaration where they are giving this compassionate message.
We have even the same beautiful declaration which is the Tripoli one, in which 80 high-strength women religious leaders pulled together and really advocated their rights not to get infected, so we are on the right track when it comes to the powerful players in our region, and we want them to be part of the solution and they want to be.
Which is why I’m so extremely proud that those religious leaders didn’t decide to wait – like in sub-Saharan Africa – to have such an epidemic to move or to speak. They already spoke, things have been moving and since 2004 we have been working with them, and we are continuing more than ever. So I think the hope will come from them, a progressive one.
Do you think much resistance to changing the mindset actually comes from the women themselves?
Of course, of course. This is why we need to empower women, because some of the women because of the education they receive from the time they are born and from the school and from the media, means that some women themselves are perpetuators of violations of other women’s rights. The one who takes the daughters to have the female genital mutilation, to have their genitals cut, are mothers. Usually it’s not the father. Or sometimes it’s the grandmother or the mother-in-law, and this is a huge problem, because women can violate other people’s rights, and even violate the rights of their housekeepers or anybody.
So when we talk about this is the cultural shift that needs to happen among women themselves, but they need to also be advocating human rights, and rights of all, and that they also shouldn’t accept to violate anybody else’s rights if they don’t accept violation of their own rights.
Female genital mutilation was a problem only in four countries in our region, and not only we didn’t succeed to stop it, but it’s spreading to some other countries, which is scary for me. Here the mothers have a huge role to play, but also the men. I want to see champions in our region, I want them to say “I will never get married to a woman who has been so subjected to so horrible a tradition”, which has nothing to do with religion.
Here again the religious leaders took a real stand, by saying that it has nothing to do with our religion, because if it was, how do you explain that both religions are doing it, Muslim and Christian are doing it in our region, how do you explain that only four countries are doing it and not the others? Are we telling the others that they are not Muslim? So it’s a big thing that we need, women, need to take a firm stance against. There are other practices that we need to take a stance against — early marriage because it makes our teenagers very vulnerable.
We really need to respect that a teenager cannot be a mother, she cannot be a wife, let her just enjoy her childhood and then she will have plenty of time to get married. She needs to get education first. So it’s a whole mindset that needs to be changed in our region.
Dubai Dr Khadija Mualla is the United Nations Development Programme (UNDP) Regional Coordinator for the HIV/Aids Regional Programme in the Arab States.
Based in Egypt, she coordinates a number of Aids initiatives in order to sensitise and mobilise religious and political leaders, artists, and members of the media, non-governmental organisations (NGOs) and the private sector.
Prior to this, she taught law at the University of Law in Tunis and continued her practice at a private law firm. At the same time, she volunteered in an Aids NGO in Tunis and was a United Nations consultant on HIV/Aids rights issues for more than ten years in sub-Saharan Africa.
Workshops
Dr Khadija has spoken on this issue and conducted numerous workshops in more than 40 countries, and has a special interest in women’s rights and developing leadership programmes in the Arab region.
She is one of the six global advisers on HIV/Aids for the UNDP/BDP Group, and has participated in formulation of HIV/Aids policy with the Arab League, the World Economic Forum and other prominent global bodies.
Source: Dubai School of Government