Next month the Professional Centre for Diagnosing Infectious Diseases  in the Zablatani area of Damascus will begin offering tests for common sexually transmitted diseases (STDs) such as chlamydia alongside the current HIV screening. The Ministry of Health, which runs the country’s National AIDS Programme (NAP), hopes this will encourage more people to use the service centre and reduce the risk of STDs and HIV in particular.

Currently 200 people are tested for HIV each month at the Voluntary Counselling and Confidential Testing (VCCT) centre, part of the larger centre, but it has the capacity to provide the service to double that figure. “We want to see more people taking a voluntary HIV test,” says Dr Rana Ayazra, director of the centre. “The prevalence of HIV / AIDS in Syria is low but only regular tests and awareness can keep it like that.”

Syria’s prevalence rate of HIV / AIDS is one of the lowest in the Middle East. According to statistics released by the Syrian Government at the end of 2008, the total number of cases of HIV / AIDS in the country is 552 – an extremely low rate for a population of around 20 million people. Dr Ayazra admits that the number may be higher due to some infected  people remaining unaware of their condition but she is confident the real figure is of a similarly low magnitude.

Syria is predicting an increase in the prevalence of HIV / AIDS, however, since it is located in a high AIDS incidence zone. Studies have also found a high level of non-observance of prevention methods, especially by higher-risk groups such as sex workers or drug takers.

These concerns are backed up by evidence from the VCCT centre. The data show a low use of condoms – the only contraceptive which protects against STDs including HIV. According to figures from January 2009, only 14.8 percent of the visitors to the centre reported use of a condom.

This is especially worrying in cases – albeit a low number - of paid sex. The most recent report on HIV / AIDS in the Middle East by UNAIDS in 2008 states that: “Unprotected paid sex appears to be an important factor in the HIV epidemics throughout the Middle East.”

In addition, risky sexual behavior, finds the report, comes hand in hand with other risky behaviours, such as injected drug use - another method of transmission of HIV. A report by the Ministry of Health, UNODC and UNAIDS in 2007 found that 53 percent of injecting drug users also engaged in sex work – exposing them to the risk of infection with HIV through two different methods.

“Since the danger of infections is increasing among populations at higher risk and STI patients, we realised that there is a crucial need to upgrade the centre’s activities in Damascus,” says Dr Haytham Sweidan, NAP manager.

Only more tests will reveal the full and changing pattern of HIV/AIDS in Syria. But it is a subject that remains a social taboo. Syrian society is still predominantly conservative: sexual relations before marriage are uncommon and frowned upon, as is sexual contact between men. This poses a challenge for the NAP.

Those who do take an HIV test remain concerned not to be seen and often travel far to take the test. “People are scared to come to the centre in case someone sees them there,” says Dr Ayazra. “We have centres in every governorate in Syria but most people travel to a different centre – usually the one in Damascus – to be tested. I suspect many wealthy people go to Lebanon.”
Women in particular are reticent to be tested for HIV. Figures January 2009 reveal only 15 of the 203 visitors to the Damascus clinic were female. “I think this is partly owing to the fact that men are starting to have more relationships than women before marriage,” says Dr Ayazra “Or perhaps just that they are more open about it. There is still more stigma attached to women’s sexual behaviour.”

The advent of STD testing marks the final phase of a five year project to upgrade the centre carried out between the Ministry of Health and the UNFPA. Syria was early in establishing a national response to HIV / AIDS epidemic, by establishing the NAP and the NAC (National AIDS Committee) in 1986, before the first registered case of HIV in Syria in 1987. NAP cooperates with all governmental organisations and non-governmental organisations (NGOs) including the Revolutionary Youth Union, the Syrian Arab Red Crescent and the Syrian Family Planning Association.

Since 2004, the Professional Centre for Diagnosing Infectious Diseases has been cooperating with the UNFPA and Ministry of Health to raise awareness of HIV / AIDS and the availability of a free, voluntary and confidential test.

UNFPA supported the Ministry of Health to equip the centre and train its staff on the latest testing tecniques as well as on counselling skills. All those who visit the centre receive pre-counselling and post-counselling. In 2008 NAP developed the first national VCCT protocol.

Information and education is key to improving STD and HIV awareness in Syria. Information leaflets and lectures are two examples of ongoing initiatives, targeting young people and other specific groups. And word of mouth - peer recommendation is the most cited reason for visiting the VCCT centre.

STD tests including HIV, can be taken at the Professional Centre for Diagnosing Infectious Diseases in Zabalatani, Damascus.