Download History of Sexually Transmitted Infections in Egypt

12/7/2014
History of Sexually Transmitted
Infections in Egypt ; Historical
perspectives
Presented by
Dr Adel Botros Zaghloul
Consultant Dermatology and STI
Al Haud Al Marsoud Hospital
Consultant STI, WHO and FHI
EMRO, Genéve
Former Fellow at UTMB ,Galveston, TX, USA
American Academy of Dermatology Intl’ fellow
Ancient Egypt
 Egyptians developed one of the
world’s earliest civilisations
 Egyptian civilisation produce,Giza
pyramids, temples, tombs, and the
death mask of “ Tutankhamun”
 Egyptian developed the world’s first
first mythologically based religion ,
with an assurance of an after life
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Ma’at
 Egyptians cherished and
practiced what they
called Ma’at
 A sense of good order in
both the conduct of their
private affairs and their
political institutions
Ancient Egypt
 Ancient Egyptian society flourished
for more than 3,000 years
 In the last few hundred years BC ,
Greek influences became strong in
Egypt
 In 30 BC , Egypt became a province of
the “Roman Empire” this was followed
by the influence of Christianity
 Today and for more 1300 years the
Muslim faith has predominated
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Egypt Geography
 Natural defenses extensive
desert to the west and east
 Sea to the north and east
 Egypt’s geographical setting
favored long periods of peace
 Nile flood with the abundance
of sunshine made to harvest
two times per year
 Farmers went to work for the
Pharaoh in order to pay taxes
Egyptian Society
Political and Economic structure
 Egyptians believed their pharaohs
to be descendant of the sun god Ra
 Swings from poverty to prosperity,
well-recognized as determinants
of epidemic levels of sex infections
were non-existent in Ancient
Egypt
 The population of Egypt’s towns
was small
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Egyptian Society
social structure
 Families formed the strong fundamental
fabric of Egypt’s closely –knit society
 Girls trained in household affairs in the
home with their mothers
 Boys, often from the age of 8 became
apprentices with their fathers eg, potters
 Some boys aimed to follow their fathers
and become scribes
Family life
 The Nile River was the place
where most people went to
relax.
 The Nile was used for fishing,
boating, swimming, etc…
 Egyptians also loved music,
and they often had parties
and festivals with music and
dancing
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Marriage and Sexuality
 To marry and have children was seen
as a most welcome duty
 The majority of girls, married between
12-13 years and the boys at a year or
two older
 Menstruation began around 14 years
and marked the change from
childhood to womanhood
 Sex is a sacred, beautiful and
meaningful act

Sexual Life in Egypt
 Egyptian wife viewed herself and her
husband as a companions
 Divorce was not common
 In contradistinction to Greece and
India Egyptian temples were not used
to house prostitutes
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Sexual practices
 Premarital sexual activity is rarely
mentioned
 Prostitution was acceptable only as
behaviour of bachelors, soldiers, men
away from home for extended periods
 The towns of Abydos and Deir el
Medina adjacent to major building
projects had houses of prostitution
 Leca, mentioned the punishment for
rape was : “ l’amputation des organes
genitaux”
Sexually transmitted disease in
Ancient Egypt
 Hyksos invaders departure around 1557 BC,
many Egyptian soldiers returned back
home with urethral discharge
 Ebers papyrus ( 1555 BC) was found in a
temple at the city of Abydos, recommends
to treat leucorrhoea and burning
micturition with (Balanites aegyptiaco
with honey, copper and antimony)
 According to Ghalioungui PID, must have
thrived , among builders in Deir el Medina
and Abydos
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Primary prevention at the time of
Pharaoh
 Egypt’s social structure and the orderly
way it functioned favoured prevention
 Population in Ancient Egypt was static
 Early marriage without adolescent
period secured against STIs
 Stable hierarchical political structure
made for a near permanent state with
consistency and continuity for more
than 3,000 years
Exodus of Israelites from
Egypt
 The exodus of the Israelites 1280 BC
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from Egypt, to Sinai, after some 400
years
Moses departed to the mountain and
stayed there for 40 days in order to
receive the 10 Commandments
Moses broke the first set of the
tablets of stone after returning from
the mountain
Apis sacred bull
During their 40 years in Sinai
“wilderness” they did battle with the
Midianites
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Israelites Campus
 After returning from the battle
with 24.000 Midianites women,
Moses’ troops in Sinaï suffered
from the “issue”
 Moses recognised that the
“issue” was associated with
sexual intercourse
 Moses ordered a quarantine for
one week away from the camp
( Numbers 31)
Prostitution in Egypt
19th & mid 20th century
 Prostitute was considerably stratified
in terms of social class “al-jawari”, a
term that originally designated slave
girls and ethnic origin “al-ghawazi”
mainly from gypsy tribes
 Prostitution in Egypt evolved yet
another stratum , with the influx of
European immigrants after the
British occupation 1882 -- women of
primarily Italian, Greek and French
origin
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Transmission Dynamics
A. Core group: high-risk persons:


High rate of infection
Frequent changes of sexual
partner
B. Bridging population:
 Social condition e.g., single,
teenager
 Economic condition e.g.,
poverty
York et al., Dynamics & control of the
transmission of gonorrhea. Sex
Transm Dis 1978 ; i74( suppl 2):
(S 134- S 143)
History of legal prostitution in Egypt
 In 1882 the ministry of interior
issued a nine-article edict
regulating the relationship between
prostitutes and the authorities.
 In 1896 an ordinance on brothels
was issued.
 In 1905 a law regulating the issue
was passed.
 In 1922 prostitution was codified
and legalised.
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Lock hospital
Al Haud Al Marsoud Hospital
(1902)
 Lock hospitals were used to confine
and treat prostitutes
 Some medical and disciplinary
exercise to control STIs and
prostitute
 No other adequate mean of
medical policing could be found
 The incidence of STIs continued to
rise despite the regular inspection
and confinement of infected
prostitutes
STI hospital, prostitution zone,
Brothel house
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Tertiary Syphilis
Syphilis treatment and
fate
 Late in the 19th century and
early in the 20th century
mercury and its compounds
were widely used to treat STI’s
 By the 1920s Salvarsan and neosalvarsan were used, but some
doubts were expressed about
their safety and efficacy in
syphilis
 1930s full-body fever machine
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Rules to be followed
by the examining venereologist
1. All parts of the body must
be examined
2. Newest tools of medical
science must be used.
3. Examination must be
combined with councelling
Prostitution, and VD a political
hornets’ nest (1922-1949)
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" Slaughterhouses of Virtue" & "Official prostitution
in Egypt." by Sheikh Mahmoud Abul-Uyun
Two articles put the authorities under considerable
pressure, to the extent that the public prosecutor
announced he would issue a detailed report on the
case
The existence of prostitution in a country where the
constitution stipulates that Islam is the state religion
"was an unsatisfactory situation that can please no
one.“
The public prosecutor defence , referred to the tragic
results of the closure of the prostitution quarters
Rise in the rate of VD following this action that the
citizens , pressed for the renewal of the permit to
reopen the prostitution quarters
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Negligence of STI in Egypt
 Official preoccupation with “major” epidemic diseases
with high morbidity and mortality levels
 Powerful cultural, social and economic forces which
have facilitated the spread of STIs, while inhibiting
their effective observation and control
 Dermatologist which are supposed to be venereologist
are not interested in the whole issue
 Patients are reluctant to be examined
Treatable but Incurable
Sexually Transmitted Infections
 A shift from curable infections
towards treatable but incurable
viral diseases , such as HPV,
HSV and HIV has changed the
SCENE substantially
 In disciplines treating STIs ,the
last decades has been a
challenge
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The role of health services in
STI prevention and care
Total population
asymptomatic
Infected with STI
Partner notification, case finding, screening
Seeking care
Correct diagnosis
Correct treatment
Treatment completed
Cure
Promotion of health care
seeking behaviour
Improve quality of care
Attitudes of personnel
Syphilitic Chancre + Molluscum
Contagiosum + Venereal Wart
Venereal warts
Chancre
Molluscum contagiosum
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Old Fears come back
HIV/AIDS 1980’s
 Old fears in the early 1980’s combined with popular and
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media homophobia were transferred to this new menace
Terror of innocent infection through lavatory seats, or
shared utensils
Revulsion from doing anything for sufrrers being
transmitted through sexual relations
Demands that “ something to be done”
Prostitutes should be licensed again and regularly
inspected
Tensions between government and voluntary organizations
Conflicts between the interventionist school and the
religio- moral lobby
Current MOHP Efforts to Standardize Quality
RTI/STIs Activities
 Collaboration between Curative and Preventive
Care
 National HIV/STIs Surveillance plan
 National Guidelines for the management of
STIs
 STIs training curriculum
 Establishment of Pilot STI clinics:
 Cairo Skin and STI Hosp. (El Haud El Marsoud)
 STI clinic in Alexandria (Karmooz)
 Sharm El Sheikh
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STI Program in Egypt
Training
Manual
Poster
National
Guidelines
STI Clinic Inauguration
Cairo-Alexandria-Sharm
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The First Step Toward Eradication
of STI
“As a disease control
program
approaches the end-point of
eradication, it is the program not
the disease ,which is more likely to
be eradicated”
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Thank
you
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