With annual World AIDS Day taking place 1 December, this new Egyptian film, which was shown at the recent London Film Festival, is very topical.

The subject of HIV in European and American cinema has of course been explored in many films (such as “Savage nights” (1992), “Philadelphia” (1993), “The Hours” (2002), and “Angels in America” (2003)). However depictions of HIV positive characters in Arab cinema have been scarce, characteristically portraying HIV patients as promiscuous sinners who deserve to be ill, or else as victims of an American conspiracy to spread HIV infection amongst young people in the Arab world.

Based on a real life story, the new film “Asmaa” by Egyptian director Amr Salama and starring actress Hind Sabry is therefore a welcome advance in the handling of such a taboo subject in Arab cinema. The main protagonist, Asmaa, is a middle-aged widow who works as a cleaner in Cairo International Airport, and cares for her elderly father and her rebellious daughter. In a shocking opening scene, Asmaa is thrown out of an operating theatre where she was about to have surgery, after informing her surgeon that she is HIV positive.

Through cleverly structured flashbacks, we see Asmaa as a strong young woman defying cultural conventions, and standing up against a male-dominated workplace. Contracting the HIV virus becomes her “death sentence” – she is forced to hide her ailment in an environment where stigma and discrimination are rife. Public ignorance of the mode of virus transmission makes her ostracised in her workplace. Bouts of gall bladder colic compel her to seek surgery, but the medical body proves as ignorant as the lay public, with no doctor or hospital willing to perform her surgery.

In desperation, Asmaa turns to an arrogant TV talk-show host for help, but he is only interested in exploiting her for higher viewing rates. Asmaa discloses her HIV status on live national TV, and demands that the medical profession fulfil their duties towards her by providing her with gall bladder surgery.  The response from viewers is highly unsympathetic, with comments like “It is a disease of others”, “Patients with HIV deserve what they get as they brought it upon themselves” being typical.

Fortunately, Asmaa is able to attend a weekly support group for HIV patients, run by a sympathetic doctor.  Although she attends in secret, the experience is transformative. Her journey from a scared, introverted woman to an empowered individual aware of her human and constitutional rights is handled by the director with warmth and compassion.

The variety of themes examined in this film, including confidentiality, HIV patients’ right to treatment, counselling and support, in addition to the excellent narrative style and the heartfelt emotional portrayal of its heroine, make it essential viewing for doctors, medical ethicists and human rights organisations, as well as the public.

The making of this film was concluded before the revolution in Egypt began, and the director has no notion how it will be received by the public, medical organisations, the government or the religious sector. He has however stated that “After the Egyptian revolution everything has a political touch to it. The possibility of censorship by Egyptian people is now more of issue than government censorship. There are some current trends of moving towards a more conservative atmosphere in the country. Some groups have already started talking about “a black list” and boycotting some movies. I am worried about the future. My film is about fighting fear and silence, and I will fight for the rights of film-makers to express their opinions freely”.

Studies in Egypt have shown that HIV positive women are especially vulnerable to discrimination in the workplace, and lack of understanding from their families. Lack of educational resources, and abandonment by families and friends are confounded by neglect from the medical establishment, ultimately leading to a cycle of self-loathing, self-blame, and social isolation (Khattab et al 2007). The most relevant message of this film is that HIV should not be a taboo anymore. Egypt needs to move from a state of perpetuated myths borne out of ignorance to open minded informed debate and discussion. This is as true of  the HIV debate as it is of the broader social and political debate.

“Asmaa” is due for general release in Egypt towards the end of November.

References

Khattab et al 2007. All alone, the stories of Egyptian women living with HIV, stigma, and isolation. Egyptian Society for Population studies and Reproductive Health (ESPSRH). United Nations Development Fund for Women- UNIFEM publication.

Address for correspondence

Khalid Ali, senior lecturer in Geriatrics, Brighton and Sussex Medical School, khalid.ali@bsuh.nhs.uk