This interview with Sayed El Zemari, an International Health Expert and former practising Medical Doctor from Egypt, is part of the Behind Bars series by Kevin Osborne and the International Planned Parenthood Federation.

“In the West it may work to change the law and then expect change on the ground. But this experience does not translate to my culture.

I am not saying stop working with the law, but first work within the custom, religion, and the culture of the people. Don’t just target the person to change his behaviour—you also need to work with his community.”

“In Egypt the law does not have the same position as it does for people in the West. The law on the ground in the Middle East and Africa is not respected as it should be. Many times you change the law, but nothing changes on the ground. 

So you say: ‘don’t smoke in enclosed places’ – yes it’s a very good law! But no one respects it, no one enforces it and people don’t believe they should.

Female circumcision, for example, is an age-old tradition in Egypt, Sudan, and Somalia. Due to exposure to other cultures and the results of evidence-based research we now realize its negative consequences. It is not unusual to find a Minister of Justice after giving an official presentation about such law, then go home to celebrate the circumcision of his daughter.
 
“It is not criminalization (in the law) but the way people approach it that has a meaning in their lives.

It is the culture, the religion, the community that refuses to accept, say, public homosexuality. You can find articles addressing homosexuality in  Arabic literature going back hundreds of years.

During my childhood I knew some peopIe who were known to be gay; whether practicing or not, and they had some sort of acceptance within their communities and were enjoying their standard basic rights, for instance: to live, to be educated, to work and to marry (the opposite sex). But when it comes to being out on the street and saying ‘Hey, I am gay and I have these rights  …’ – it’s not on.

“There is law, and there is law in the traditional or customary sense. Let me give one example: I work with men who have sex with men (MSM) as part of HIV key populations, and one of them needed to have an operation on his bowel. He came to me for help to find a surgeon so I went to some colleagues and said ‘Do you know how HIV is transmitted?” He said: ‘Yes, I know’. I said ‘Do you think is it transmitted by coughing or sneezing?” He said:‘No’. 

“What if a surgeon operates on someone who is living with HIV, is he in danger of HIV transmission if he uses normal precautionary measures for infection control?’ He replied: ‘No’. 

Fine. So I told him that I have a person who is living with HIV and in need of an operation. Was he willing to do it? He told me No, no, no.

I asked him “Why?” He said No, just no.

I moved from one to another until I increased the money to double the original cost for the operation and the fourth one agreed to do the surgery.

But I cannot describe for you how this patient was humiliated on the operating table. The way the surgeon was gossiping and talking—I mean maybe because of the change in anatomy he realized that he was an MSM? I don’t know, but the harm that the surgeon and nurses did to this patient in terms of what they said was much greater than the pain of the operation itself.

“The question whether HIV transmission should be a criminal offence is a good one. If transmission is intentional, then yes, I think there is a need for some action to be taken. However there are many degrees of punishment. When it is careless or negligent, I would also say yes. As a medical doctor, I know that many people die because of malpractice, and I cannot forgive someone for that.

It is the same for the traffic accidents — if someone kills my son because he is reckless, I cannot forgive him. In the same way, if someone who knows that he is HIV positive is careless and just allows my son or my daughter to become HIV infected I would feel the same.

I am not saying he should get the highest degree of punishment but, for sure, something should be done. In terms of disclosure, I think if someone is not going to use a condom then they should disclose if they are HIV positive. Either use a condom or disclose, so that the other person can decide.

“I am not a legal person and I am not sure what an appropriate punishment should be, but, for example, in the case of medical doctors and malpractice, they can be stopped from practicing for a month or two, or fined. I consider it to be a minor incident, not a major one, there are worse things that could happen, but there should be some penalty in place.

“There have been a lot of efforts in using the law to change risky social behaviours — like female genital mutilation (FGM) or MSM. In the West it may work to change the law and then expect change on the ground. 

But this experience does not translate to many other cultures. I am not saying stop working with the law, but first work within the custom, religion, and the culture of the people. Don’t target the person to change his behaviour—you need to work with the community.

“No one can deny that the law is important, but in many countries new laws means new opportunities for corruption. So it is better to work with communities and with their leaders rather than devoting too much attention to the law.”