San Francisco Chronicle - November 24, 2005
James Palmer, Chronicle Foreign Service

Today, Shanin is 31 and living on the outskirts of Baghdad, in a large hospital room she shares with her 5-year-old son, Mustafa, who she says is not HIV-positive. Her parents and her in-laws have rejected them, she says. She visits her sister in western Iraq once every three months but prefers to stay in the hospital, where she has access to some HIV medications, but not the ones most likely to stave off full-blown AIDS and prolong her life.

"My sister's husband fears their five children may catch the virus," Shanin said through an interpreter. "If anyone in their village knew about my illness, they would not allow me to stay there."

Iraq is struggling to cope with HIV-AIDS as it seeks to rebuild its health care network. It faces shortages of medications to treat HIV, and the stigma surrounding AIDS limits dissemination of information about transmission and prevention.

Physicians say the virus entered Iraq through tainted blood imported in 1986 from Merieux, a French pharmaceutical company now known as Aventis Pasteur, and it was detected the following year in scores of hemophiliacs in Baghdad. Saddam Hussein's government filed a $33 million suit against Merieux, but the case was dismissed in France because of the international sanctions then in effect.

HIV prevalence rates remain low in Iraq -- officials at Baghdad's AIDS Research Center (ARC) said they have identified 448 cases since 1987, and 21 new cases since April 2003.

But physicians treating HIV-AIDS patients here expressed concerns that the primary route of transmission has shifted from blood transfusions, which are more tightly monitored now, to sexual intercourse, a topic not openly discussed in Iraq.

"The disease is definitely going to be transmitted more through sexual activity in the future," said Dr. Fadhel Alwan, who treats HIV-positive patients at Ibn Zuhur hospital in Tuwaitha, just outside Baghdad.

Dr. Wadah Hamed, director of ARC, says Iraq has difficulty getting pharmaceutical companies to provide affordable HIV-AIDS medication because of the low caseload.

"Large drug companies don't want to bother with us because there's too little demand," said Hamed, who is also Iraq's national AIDS prevention program manager. He said the new Iraqi government was considering pursuing new efforts against the French firm that supplied the tainted blood.

The drug companies say they are working to meet Iraqi government needs.

"It is my understanding that GlaxoSmithKline has filled Iraq government requests for anti-AIDs medicines as ordered," said Mary Anne Rhyne, director of U.S. media relations for GlaxoSmithKline. Bristol-Myers Squibb spokesman Brian Henry said in an e-mail that the company was "certainly open to accommodating requests for our products, including HIV-AIDS medicines. But to our knowledge, we have not received requests in Iraq for our HIV-AIDS medicines through the third-party organizations we work with."

But Alwan says he cannot prescribe the most effective treatment -- the so-called drug-cocktail therapy involving three or more antiretroviral drugs. "We are forced to use secondary drugs that are not as effective as other anti-retrovirals available," he said.

Medical personnel say most HIV-positive patients conceal their illness to nearly everyone.

Zainub Mohamed Hassan is among the 35 people who visit the Ibn Zuhur hospital once a month for medication and counseling. Hassan says she does not know how she contracted the virus.

"It is very difficult to live with the virus here," she said. "I can't tell my family."

Open discussions in Iraq about HIV-AIDS are rare, and awareness is spreading slowly, even to the most vulnerable.

Hanan Ali, a 21-year-old prostitute in Baghdad, says she always makes her customers use a condom to prevent pregnancy, but she learned only recently from a colleague about its use to protect against HIV.

"I find discussions about these things embarrassing," Ali said through an interpreter. "If I get pregnant, my family will kill me faster than any disease."

Dr. Wisan Shaker, 47, who has worked in the HIV-AIDS unit at Baghdad's Infectious Disease Control Center since 2001, says the Health Ministry is setting up awareness programs in Iraqi schools. But a United Nations Children's Fund survey earlier this year reported that roughly 70 percent of a sample group of young Iraqis said they had never heard of HIV or AIDS and did not know how the disease was transmitted.

Hussein Jassan, 15, who sells cigarettes and soda after school at his father's stall along a dusty side street in Baghdad, admitted he knows little about HIV-AIDS except its fatal consequences, and no information about the virus is provided at his school.

"I think you can get AIDS if someone with the disease sneezes around you, or if you swim in the same water with them," Jassan said. "We learn about the body in school, but nothing about AIDS."

"It is going to be difficult to get people to talk about it," Dr. Kareem Bahal Nadh, the director of Ibn Zuhur hospital, said during a recent interview in his office. "Iraq is the land of the forbidden."

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