The forgotten: Living with HIV in war-ravaged Yemen

Editor | January 21, 2019 | Middle East | No Comments

Patients’ names have been changed to protect their identity.

Sanaa, Yemen – With each breath he took, the red rashes on Ahmad’s cheeks appeared to get brighter and brighter.

The eight-year-old, limping and fatigued, had just made his way up the stairs of the al-Jumhurriya hospital in the Yemeni capital Sanaa, one of the few health centres in the war-ravaged country that provide free medical treatment to people living with HIV.

As he took his seat in the waiting room next to his ailing father, the sound of static from an old analogue TV appeared to startle the young boy, as he waited anxiety for doctors to call him in for his latest blood test.

Three years ago, Ahmad was healthy and playful, his father Zakariyya told Al Jazeera.

“When he became sick, we took him to the hospital and doctors carried out tests and told us he had problems with his immune system. They later told us it was HIV,” he said.

“My wife and I also took the tests and we also tested positive.”

An acronym for the human immunodeficiency virus, HIV attacks important cells that help the body fight off infections, disease, and other viruses.

When the infection goes untreated, it causes AIDS. This typically causes fever, weight loss, recurrent diarrhoeal infections and other symptoms.

While both are seen as treatable, a cure has yet to be found.

The government has zero funds allocated for HIV and AIDS

Taha al-Mutawakel, Minister for Health in the Houthi-run administration

‘I take a red pill every day’

Zakariyya said his family moved to Sanaa in 2016 for treatment when fighting engulfed his neighbourhood in the southwestern city of Taiz.

As Houthi fighters were being expelled from the city, air strikes and street clashes devastated Taiz and at least 37 of its 40 hospitals and medical institutions were forced to close.

According to local authorities, Doctors without Borders (MSF) was one of the few aid agencies that that continued providing free antiretroviral (ARV) treatment to around 600 people living with HIV/AIDS at the al-Jumhurriya hospital.

MSF said that there were reports some patients were rationing their medicines because of the difficulty associated with reaching hospitals and clinics.

Citing the case of one woman, MSF said she began taking half a tablet instead of one and even began taking them on alternate days so she didn’t have to completely stop her treatment.

Zakariyya said he and his family began receiving their intended doses and were among the fortunate ones.

“The doctors have given us medicine,” he said. “I don’t know its name, but it’s a red pill. I take one every day.”

Yemen’s health system is on the brink of collapse with thousands of medical staff and facilities affected by the conflict [Al Jazeera]

Thrown out of their homes

According to the World Health Organization, the first HIV case appeared in Yemen in 1987, and the number of the people living with it was estimated to be around 9,900.

While prevalence was estimated to be at only 0.2 percent of the population, most Yemenis living with either of the viruses faced stigma and discrimination, even from their families.

According to the most recent report by Stigma Index, the world’s largest social research project implemented by people living with HIV, most HIV-positive Yemenis had been thrown out of their homes by family members due to fears of infection.

The research said that all the people they interviewed experienced some form of stigma because of their HIV status, with one third saying they had to “change their residence or could not rent a place” because of their condition.

Ibrahim al-Babli, a doctor at the HIV/AIDS laboratory at the al-Jumhurriya hospital, said those patients were not the only forgotten victims of this war.

A staggering 1.2 million civil servants living in Houthi-held areas had not received their salaries after the Yemeni government stopped paying them in late 2017 in an effort to start a popular uprising.

The effects were devastating with health, education and sanitation services left without the people needed to run them.

Resources were stretched so thin, Babli said, that patients were lucky to enter a manned hospital.

“I haven’t received my salary in months, I get paid sporadically,” said Babli. “If doctors aren’t cared for, then that means there’s no care for the patients.”

‘Zero funds for HIV/AIDS’

The UN has repeatedly described Yemen’s humanitarian situation as “catastrophic” and, on Wednesday, Mark Lowcock, the under-secretary-general for Humanitarian Affairs, said the situation had worsened in the past year with “more than 24 million people now needing humanitarian assistance”.

Taha al-Mutawakel, the Minister for Health in the Houthi-run administration, told Al Jazeera that the government had allocated “zero funds for HIV and AIDS”.

“We’re currently operating with a grant of $800,000 provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria,” he said.

“Medicines are readily available and offered free of charge and distributed to each of the governorates. But the siege has had a major impact on patients seeking treatment.”

Saudi Arabia, which has been conducting an air campaign in Yemen since March 2015, intensified its embargo on the country in 2017, restricting both humanitarian aid and commercial goods from entering Houthi-held ports.

The kingdom said the blockade was a necessary precaution aimed at preventing weapons being smuggled into Yemen by Saudi Arabia’s regional rival, Iran.

The inadequacy of services … may increase the vulnerability to HIV/AIDS transmissions

Eltayeb Elamin, Regional Programme Adviser at UNAIDS Middle East

‘Race against time’

Eltayeb Elamin, the Regional Programme Adviser at UNAIDS Middle East said the blockade had greatly affected the movement of HIV and AIDS patients, with the “disruption to the supply system … leading to difficulties in the accessibility for available services”.

“The effect of the war on the health infrastructure is also greatly stressed with inadequate supplies hampering HIV/AIDS prevention efforts especially counselling and testing,” he said.

“The inadequacy of services … may increase the vulnerability to HIV/AIDS transmissions through lack of universal precautions and inadequacy of needed services.”

Zakariyya said while he was still in the dark about his son’s future, with doctors failing to tell him whether the virus would spread, he was confident that with some treatment, he could go on to live a full life.

“My son nearly died. But now, all praise to God, he is doing much better,” he said. “We believe in God and have faith that our lives and our fate are in his, not our, hands.”

Meritxell Relano, UNICEF’s resident representative in Yemen, said that with the fighting showing no signs of abating, aid agencies were in a “race against time” to save the country’s children.

“We urge for an end to the war on children, not tomorrow, but today,” she said. “Parties to the conflict must work to reach a negotiated political solution, prioritising and upholding the rights of the children.

“The longer this war continues, the more children are going to die on the world’s watch.”