HIV/AIDS: Trends in the Middle East and North Africa Region

HIGHLIGHTS

• New HIV infections have been on the rise in the Middle East and North Africa (MENA) region in recent years.
• There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region.
• Overall, the major route of infection in the MENA region seems to be sexual transmission, but a range of challenges limit interventions to determine the actual sexual trends.
• Despite unfavorable conditions, many countries in the region have put significant efforts into scaling up their response to this growing epidemic.

OBJECTIVES:

To give an overview of the HIV epidemic in the Middle East and North Africa (MENA) region.

METHODS:

Articles on the MENA region were reviewed.

RESULTS:

The MENA region comprises a geographically defined group of countries including both high-income, well-developed nations and low- and middle-income countries. While the annual number of new HIV infections in Sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, which is the highest increase among all regions in the world. Moreover, the number of AIDS-related deaths in 2013 was estimated to be 15000, representing a 66% increase since 2005. However, the current prevalence of 0.1% is still among the lowest rates globally. There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region. Despite unfavorable conditions, many countries in the region have put significant effort into scaling up their response to this growing epidemic, while in others the response to HIV is proving slower due to denial, stigma, and reluctance to address sensitive issues.

CONCLUSIONS:

The HIV epidemic in the MENA region is still at a controllable level, and this opportunity should not be missed...

Overall, the major route of infection in the MENA region seems to be sexual transmission. In 2011, heterosexual sex was the most common reported mode of HIV transmission among men in Tunisia (44.4%), UAE (50.0%), Syria (54.5%), Jordan (66.7%), Morocco (81.9%), Kuwait (100%), and Palestine (100%).⁸However, a range of challenges including (but not limited to) those listed below, limit interventions to determine the actual sexual trends, making the current data unreliable.

• The prevalence data available for KPs are principally derived from passive surveillance data, which tend to underestimate the role of high-risk behaviors because of individuals’ fear of disclosure.⁹
• There is intense HIV-related stigma and discrimination in the region, which is likely a major challenge for behavioral research.¹⁰
• Same-sex conduct is illegal in 76 countries, 19 of which are in MENA. In seven countries, including Iran, Saudi Arabia, Somalia, Sudan, and Yemen, homosexual acts are subject to the death penalty in some cases.⁶ Other countries, including Algeria, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, the Syrian Arab Republic, Tunisia, and the UAE, either criminalize adult consensual same-sex sexual conduct or have criminally prosecuted lesbian, gay, bisexual, and transgender people under other laws on the basis of their sexual orientation and gender identity.⁶
• Cultural and religious norms disapproving and penalizing sex between men may contribute to the nondisclosure of homosexual orientation and/or sexual conduct.¹¹

Other challenges that may be related to HIV surveillance in the MENA countries include infrequent surveillance of populations most at risk of HIV infection, lack of behavioral data, over-reliance on HIV case reporting and facility-based surveillance, and limited quality of HIV surveillance in general.¹²

  

Full article at:   http://goo.gl/e48IMn

By:  Gökengin D1, Doroudi F2, Tohme J3, Collins B4, Madani N5.

¹Department of Clinical Microbiology and Infectious Diseases, Medical Faculty, Ege University, Bornova, Izmir, Turkey. Electronic address: deniz.gokengin@ege.edu.tr.

²UNAIDS - The Joint United Nations Programme on HIV/AIDS (UNAIDS), Islamic Republic of Iran. Electronic address: DoroudiF@unaids.org.

³M-Coalition, Yazbeck Center, Achrafieh, Beirut, Lebanon. Electronic address: jtohme@afemena.org.

⁴International HIV Partnerships, London, UK. Electronic address: bc@ihp.hiv.

⁵Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: navid_madani@dfci.harvard.edu.

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