When my father was growing up in Cairo in the 1940s, he got hooked on Sherlock Holmes—thanks to monthly instalments of Reader's Digest. One of his favourite exchanges was the famous "curious incident of the dog in the night-time" from "Silver Blaze." The dog, of course, did nothing, which was what was so curious.
I was reminded of my father and Holmes when looking at statistics on the global Aids epidemic. This year marks the 25th anniversary of the discovery of HIV, the virus which causes Aids. According to UNAids, there are an estimated 40m people infected with HIV around the world, and almost 3m died of Aids last year. Epidemics on this scale transcend medicine, spilling over into international politics and economics. At the end of May, the UN will hold a special assembly on Aids, dissecting progress to date and pondering what sort of prescription will halt the spread of the disease by 2015—one of its millennium development goals.
In a world awash with HIV, there is, however, the curious incident of the middle east, which seems strangely untouched by the disease. According to UNAids, there are more than 400,000 people living with HIV in the middle east and north Africa—0.2 per cent of the population. But compare that to south of the Sahara, where, on average, 6 per cent of the population—around 25m people—are infected with HIV.
So what is going on? Are Arabs somehow immune to Aids? Many in the region think so. They argue that Aids will never be an Arab problem because Islam takes a hard line on practices which spread the virus—homosexuality, prostitution, intravenous drug use. And when Aids does rear its head at home, they tend to blame foreigners for it—most famously in Libya, which in 2004 sentenced six Bulgarian and Palestinian healthcare workers to death for allegedly infecting more than 400 children at a hospital in Benghazi. (The sentences have since been overturned, and the foreigners face retrial.)
The notion that religion or culture can serve as a vaccine against Aids is not unique to the Arab world. There are plenty of other countries—India and China among them—which once argued that their culture and traditional values could protect them from Aids—and which now find themselves struggling with the epidemic. Nor are Islamic societies uniquely protected—just look at Indonesia, the world's most populous Muslim country, where infection rates have soared in recent years.
The trouble is, of course, that official statistics on Aids in the middle east do not tell the whole story. They largely reflect Aids cases which turn up in hospitals, or migrant workers who have been tested for their visa applications. To get a picture of the real state of HIV in the middle east, you need to test those at highest risk, but such surveys are rare. Not only does stigma prevent people with risky behaviour from volunteering, but in many Arab countries their practices are illegal—hardly an incentive to step forward. Poor availability of confidential counselling and testing does not help; nor does the prospect of deportation by some Gulf states if foreigners are found to be infected. And with a scarcity of antiretroviral drugs, there is little interest in being tested if there is little hope of being treated. So those who claim that HIV is not a middle eastern problem are simply shouting in the dark.
To be sure, there are many features of Arab societies which may have slowed the spread of Aids in the past, such as strong family networks and practices such as circumcision. But the Arab world is changing in ways that make it vulnerable to HIV. UNAids notes there were more than 60,000 new infections of HIV in the region in 2005, about the same as North America or western and central Europe.
As economies liberalise, migration and trade are opening new avenues for Aids in the middle east. Conflict makes it easier for HIV to spread. Sudan, long plagued by violence, has seen its epidemic move from high-risk groups to the population at large, and there are concerns that the war in Iraq is making inroads for HIV. The relative youth of Arab societies also puts them at risk. Almost three fifths of middle easterners are under 25, ripe for the sort of sexual experimentation they see on satellite television and the internet. Young people are delaying marriage—in part because they cannot afford it—but their sexual needs are not so easily put off. Yet schools provide little education about sex or protective measures, such as condoms. And although many middle easterners are reluctant to admit it, prostitution and homosexuality are long-established facts of life.
But it is not all bad news. There is a dawning recognition in the Arab world that Aids is now a home-grown problem. There are attempts to promote awareness, prevention and treatment—the UN, for example, is training hundreds of imams and priests across the region to spread the word about HIV.
Moreover, the Arab world has a once in a lifetime opportunity to tackle HIV early enough in the epidemic to stop it in its tracks. People are literally dying all over the world for such a chance; now is the time for the middle east to lift the veil on Aids.
