Even when HIV education reaches Egypt, the stigma is so widespread that it somehow stifles knowledge from disseminating. At Nehad Helmy’s women’s clinic, the examination room looks out to her office, where the wall is adorned with certificates of her HIV training. She first became interested as a master’s student, when no one would treat a pregnant woman who appeared at an Egyptian hospital with HIV in 1997. A hospital cleaning woman helped the woman deliver her baby, Helmy recalled, prompting her to begin studying HIV and pregnancy.

She and her husband moved to Holland, where doctors often specialize in HIV treatment. She earned one certificate after another, and she admired how patients there were treated like anyone else. Determined to bring that care to Egypt, she came home in 2009 and sought to open an AIDS clinic, but she couldn’t win government approval.

Now she’s afraid to advertise her HIV specialty for fear that no one else will visit her clinic. Instead, she treats HIV patients on the sly and sends test results to her friends in Holland for advice.

“There is no hope and no progress,” Helmy said. “Doctors think I am crazy for working on this.”

Perhaps because of that, the nation is peppered with people such as Noor, Rose and their friend Manal, who’s 34. Manal was applying for a visa to Saudi Arabia when she learned through a blood test that she was HIV-positive. When she begged her family to get tested for no reason in particular, they figured out her secret. For a time, Manal’s relatives feared that they could contract the virus just by touching her, and because of that Manal wasn’t always allowed to pick up her baby niece.

When she finally was allowed to hold the child, she moved to kiss her niece and a couple of drops of blood from a loose tooth fell out of her mouth onto the baby’s hand. Manal panicked and repeatedly scrubbed the spot, fearing that she’d spread the virus. She’s since learned more about the risks and has become a silent advocate within her home; her neighbors don’t know that she’s HIV-positive.

“People with HIV have a right to live,” she said.