Two women walk along the Corniche in Alexandria, Egypt, in September 2017.
Editor's note:A version of this story appears in CNN's Now in the Middle East newsletter, which offers a quarterly look at the region's biggest stories.Enter here.
"I didn't even know what it was," the 50-year-old Egyptian mother said of the buildup of spot-like growths on her skin around her external genitalia caused by aVirusIt is often sexually transmitted.
She was shocked when her gynecologist told her that the growths were caused by that.Human papillomavirus, known as HPV.She was then referred for a test to check for cervical cell irregularities. Fortunately, no changes were detected in these cells.
The woman spoke to CNN on condition of anonymity for fear of being ostracized from her community, where the topic of sexually transmitted infections remains taboo. She said she had never heard of the virus before, but she believes education and vaccination are vital for girls, including her own daughter, regardless of how she contracted it. The vaccine could have helped her avoid her current plight, she claimed.
His case is one of many inEgypt, and it comes at a time when activists and medical workers are sounding the alarm about an issue they say is being overlooked in the country: the reluctance of many conservative doctors and parents to give girls the flu vaccine. HPV.
Experts say the problem stems from a lack of awareness and understanding of the virus, as well as the persistent social stigma that the disease is a sign of promiscuity among women.
According to experts, this has caused countless women to become infected with HPV, the virus that causes more than 95% of all cervical cancers in women, according to the World Health Organization (WHO).
According to the WHO, cervical cancer is the fourth most common cancer among women worldwide, killing some 342,000 women worldwide in 2020. About 90% of new cases and deaths this year occurred in low- and middle-income countries.
According to the World Bank, Egypt is a lower-middle-income country.
"The main problem is that it's not really a widespread vaccine in the Global South," said Lobna Darwish, head of gender and human rights at the Egyptian Initiative for Personal Rights (EIPR).launched its own awareness campaign in March 2022.
"Very few countries in the Global South are routinely vaccinating against HPV, and Egypt has an opportunity to be one of the pioneers (in this program)," he said.
The Egyptian Health Ministry has posted short educational brochures about the virus on its social media platforms, pointing out some of its main symptoms and urging women to arrange routine checkups. The ministry also recommended women get vaccinated against HPV.
In 2020, the WHO launched theGlobal strategy to accelerate cervical cancer elimination, the first global commitment to eliminate cancer, with the goal of fully vaccinating 90% of girls against HPV before the age of 15.
However, progress in Egypt has been slow. Activists and medical workers say that, along with a lack of awareness about the virus and social stigma around sex and STIs, poor advice from some doctors and even the price of the vaccine could be contributing to the crisis.
The vaccine is not subsidized in Egypt, making it a luxury only the rich can afford.
The HPV vaccine costs between EGP 800 ($25.9) and EGP 1,000 ($32) per dose. The average household income in Egypt is 69,000 Egyptian pounds a year, or just over US$2,200, according to official figures.
The number of doses and their timing depend on the age of the recipient, according to the WHO recommendation of December 2022, but some may require up to three doses. However, the WHO decided last year that, based on the latest scientific evidenceA shot would provide adequate protection.for girls and women under 20 years of age.
The vaccine arrived in Egypt in 2009. And while Egypt's official vaccination center offers two brands in some places, experts say not many people have been interested in using them.
"Things like this don't happen in our community"
Cervical cancer can be fully treatable if caught early.
However, it is common in Egypt for health professionals and ordinary people to stigmatize people with HPV and other sexually transmitted infections, believing that they have deviated from religious and cultural norms.
Others have long viewed the vaccine with suspicion due to misinformation.
"People would say: This is a foreign vaccine that tries to make girls infertile," said the 50-year-old mother. "And others would say: This will only spread obscenity and vice and make women feel (sexually) comfortable."
In Egypt, extramarital sex remains a major social taboo, and screening for sexually transmitted diseases and infections is not easy to perform in public clinics, especially when patients are not married.
Patients often have to undergo check-ups and treatment at expensive private clinics, most of which are located near the capital, Cairo.
But activists are determined to change that. Ola Arafa, a 26-year-old medical graduate of Mansoura University's Mansoura Manchester Medical Program, with her supervisor Professor of Gynecology Dr Rafik Barakat, collaborated to study the prevalence and spread of HPV in the north-eastern city of Mansoura to raise awareness among patients and physicians.
Arafa conducted a survey at several Mansoura University outpatient clinics and found that while more than half of the participants had heard of cervical cancer, they did not know how it was related to HPV.
Sus hallazgos hicieron aún más convincente su objetivo de crear conciencia sobre el tema entre “diferentes grupos de edad y grupos socioeconómicos”.
People tend to say, "These things don't happen in our community, that's why we don't need the vaccine," Arafa told CNN.
Barakat said some doctors are reluctant to explain the nature of HPV for fear of backlash.
"But little by little, naturally, these (traditions) are starting to fail," he said, adding that the HPV debate will inevitably open up as more genital wart patients come to clinics.
"Due to professional ethics, it is the responsibility of the doctor to provide all the information to his patients," Darwish, the human rights activist, told CNN, adding that it is also important for doctors to keep their patients fully informed, it is clear that they do not there is moral or ethical judgment.
There are no national HPV screening programs in Egypt, Barakat said, but in some cities and provinces "they exist on a case-by-case basis."
Other Middle Eastern countries have included the HPV vaccine in their national immunization programs, including Saudi Arabia, Libya, and the United Arab Emirates.
Although Egypt is making slow progress on this issue, change is underway.
Nisreen Salah Omar, a member of the Egyptian House of Representatives and Professor of Microbiology and Immunology at Mansoura University, has been campaigning since December 2022 to ensure that the HPV vaccine is routinely given to all children in Egypt as part of the state health plan. system.
Those efforts received a boost in January when the House of Representatives complied with his request and sent an official recommendation to the Secretary of Health.
Many are waiting to see the fruits of years of pro-vaccine campaigning, hoping to finally end a preventable virus that may be a silent killer.
"It's a disease and it can be controlled," says the 50-year-old. "Although it is dangerous, it can be controlled."