Two women walk along a cornice in Alexandria, Egypt, September 2017.
Editor's note:A version of the story appears in CNN's Meanwhile in the Middle East, a three-week overview of the region's top stories.Sign here.
"I didn't even know what it was," said a 50-year-old Egyptian mother of a cluster of skin-like growths around her external genitalia that resulted fromvirusIt is often sexually transmitted.
She was surprised when her gynecologist informed her that the growths were caused byThe human papilloma virus, known as HPV.She was then referred for a test that could detect any abnormalities in the cells of the cervix. Fortunately, no changes were found in these cells.
The woman spoke to CNN on the condition of anonymity for fear of being ostracized from a community where sexually transmitted infections remain taboo. She said she had never heard of the virus before, but regardless of how she contracted it, she believes awareness and vaccinations are essential for girls, including her own daughter. She said the vaccine could have helped her avoid the current plight.
His case is one of manyEgyptand it comes as activists and medical professionals sound the alarm about an issue they believe is being overlooked in the country, namely the reluctance of many conservative doctors and parents to give girls the HPV vaccine.
According to experts, the problem stems from a lack of awareness and understanding of the virus, as well as the lingering social stigma that the disease is a sign of promiscuity among women.
This has led countless women down the painful path of HPV infection, experts say, which causes more than 95% of women's cervical cancers, according to the World Health Organization (WHO).
According to WHO, cervical cancer is the fourth most common type of cancer among women worldwide. In 2020, around 342,000 women died worldwide. About 90% of new cases and deaths this year have been 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 common vaccine in the Global South," said Lobna Darwish, a gender and human rights specialist at the Egyptian Initiative for Personal Rights (EIPR), wholaunched its own awareness campaign in March 2022.
"Very few countries in the Global South actually do this (routine HPV vaccination), and Egypt has a chance to be one of the leaders (in this programme)," he said.
Egypt's health ministry posted short information leaflets about the virus on its social media platforms, highlighting some of its key symptoms and asking women to schedule routine checkups. The ministry also recommended that women be vaccinated against HPV.
In 2020, WHO launchedA global strategy to accelerate the eradication of cervical cancer, the first global commitment to eradicate cancer, setting the goal of fully vaccinating 90% of girls against HPV by the age of 15.
However, progress in Egypt has been slow. Activists and medical professionals say that in addition to the lack of awareness about the virus and the social stigma around sex and STDs, poor advice from some doctors and even the price of the vaccine may also be contributing to the crisis.
In Egypt, the vaccine is not subsidized, 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. According to official figures, the average household income in Egypt is EGP 69,000 per year, which is just over $2,200.
The number of doses and the schedule of their administration depend on the age of the recipient, in accordance with the WHO recommendation of December 2022, however, in some cases, up to three doses may be required. However, last year, the WHO decided that based on the latest developments in scienceone shot would provide enough protectionfor girls and women up to 20 years of age.
The vaccine reached Egypt in 2009. And although the official Egyptian vaccination center in some places offers two brands of vaccines, experts say few people were willing to use them.
"Such things don't happen in our community"
Cervical cancer can be completely cured if detected at an early stage.
However, doctors and ordinary people in Egypt often stigmatize those infected with HPV and other sexually transmitted diseases, believing that they have deviated from religious and cultural norms.
Others have long viewed the vaccine with suspicion due to misinformation.
"People would say: it's a foreign vaccine to make girls infertile," said the 50-year-old mother. "And others would say: it only spreads obscenity and vice, and it will make women feel (sexually) comfortable."
In Egypt, extramarital sex remains a major social taboo, and screening for STDs and infections in public clinics is not easy, especially if the patients are not married.
Patients often have to seek examination and treatment at expensive private clinics, which are mainly concentrated in the capital, Cairo.
But activists are determined to change that. Ola Arafa, 26, a medical graduate at Mansoura University in Mansoura, Manchester, is working with her supervisor, Professor of Gynecology, Dr Rafik Barakat, to investigate HPV prevalence and spread in the north-eastern city of Mansoura. Sensitization between patients and doctors.
Arafa surveyed 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 or how to prevent it.
Their findings only made the goal of raising awareness among "different age groups and socio-economic groups" all the more urgent.
People often say, "Things like this don't happen in our community, so we don't need a vaccine," Arafa told CNN.
Barakat said some doctors are reluctant to explain the nature of HPV for fear of severe reactions.
"But gradually these (traditions) are naturally changing," he said, adding that as more patients with genital warts come to clinics, the HPV debate inevitably opens up.
"Because of his work ethic, a doctor has a duty to provide all information to patients," human rights activist Darwish told CNN, adding that it is also important that when giving all information to their patient's patients, doctors do so. It is obvious that there is no moral or ethical judgment.
Barakat said Egypt has no national HPV testing programs but "in some places they do exist" in some cities and provinces.
Other Middle Eastern countries, including Saudi Arabia, the United Arab Emirates and Libya, have added the HPV vaccine to their national immunization programs.
Although Egypt's progress on this issue has been slow, changes are already taking place.
Nisreen Salah Omar, Member of the Egyptian House of Representatives and Professor of Microbiology and Immunology at Mansoura University, has been campaigning since December 2022 for the HPV vaccine to be routinely given to all children in Egypt as part of the state health system.
These efforts gained momentum in January, when the House acceded to his request and sent an official recommendation to the health minister.
Many people are waiting for the fruits of years of pro-vaccine campaign, hoping to finally put an end to a preventable virus that could be a silent killer.
"It's a disease that can be controlled," said the 50-year-old. "No matter how dangerous it is, it can be controlled."