Cairo’s medieval core—with its narrow streets and winding alleys—has remained nearly unchanged since the 10th century. Still, it is young by Egyptian standards.

Since the middle of the 20th century, Cairo has seen an increased volume of human movement, but whatever changes have resulted, public discussion of sexuality has remained fundamentally the same.

Egypt, like most Arab countries, has surprisingly low official HIV rates. The World Health Organization (WHO) estimate for Egypt this year: Approximately 20,500 people have HIV, and some 8,100 adults are living with AIDS. However, we very well may have a caseload as much as 10 times higher than WHO’s estimate. But that’s still only 80,000 cases—tiny in the context of Egypt’s 60 million-plus citizens. We have a chance to stop the epidemic before it starts.

The process required for an HIV test is no help. Egypt has no anonymous testing, and those who use the government’s testing services must submit a picture ID. Even private labs are required by law to report positive test results to the Ministry of Health. And a test at the ministry or labs are at prices out of reach of ordinary citizens.

In addition, the nation’s 17 “fever hospitals,” which specialize in infectious diseases, don’t provide any antiretroviral treatment, opting instead to treat only specific opportunistic infections.

An integral element of raising awareness has been the Ministry of Health’s hotline, started in September ’96, the first in the Middle East. The number is on billboards that read, “Ask about AIDS.” Still, people are scared to call. They do not trust strangers. Especially when the stranger is a government worker.

What’s worse, the gaping holes in the blood-screening system alone show the country is ill-prepared to defuse an AIDS explosion. When Egypt is ready to confront this threat seriously—with anonymous testing and accessible treatment options—the window of opportunity may be shut. This golden chance will have come and gone.