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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Sexual Offenses among Children in the North of Jordan: An Exploratory Study

Sexual offenses are an important global health problem threatening people of all age groups. There are no reported studies regarding sexual violence among children in Jordan. Therefore, this study aimed to examine the problem of sexual violence among children in the Northern region of Jordan. 

A retrospective design was adopted to review all reports from the Forensic Medicine Teaching Center of North of Jordan clinic on cases of sexual-related assaults that occurred between 2003 and 2007. Reports were reviewed for age, gender, toxicological analysis, and relevant information provided by victims and their relatives. 

Results indicated that 53% of the cases were male victims, with a male to female ratio of 1:1. Ages ranged from 3 to 18 years with a mean age of 12.5 years. Most cases were considered indecent assaults, while 37.1% were cases of rape. In most cases, offenders were strangers. It could be concluded that Jordanian children are as susceptible to sexual assaults as their counterparts worldwide. 

This study is the first to report sexual offenses among children in Jordan. As such, it provides baseline data that can be used to inform policy and prevention strategies focused on reducing sexual violence among this vulnerable segment of the Jordanian population.

Purchase full article at:   http://goo.gl/EvXVas

By:  Shotar AM1, Alzyoud S, Oweis A, Alhawamdeh KA, Khoshnood K.

• 1 Department of Legal Medicine, Toxicology and Forensic Science, School of Medicine , Jordan University of Science and Technology , Irbid , Jordan.
• J Child Sex Abus. 2015;24(5):538-54. doi: 10.1080/10538712.2015.1042181. 

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Current Knowledge, Attitude & Patterns of Oral Contraceptives Utilization among Women in Jordan

Background

Studies exploring the knowledge, attitude and patterns of OCs use among women in Jordan are lacking. The aim of this study was to assess knowledge, attitude, and patterns of oral contraceptives (OCs) utilization among women in Jordan.

Methods

A face-to-face questionnaire inquiring demographic information and issues related to knowledge and use of OCs was completed by women (n = 1571), who have had used OCs at least once in their lifetime. A model was created to assess the effects of knowledge, attitude and previous experience on the patterns of OCs utilization.

Results

Jordanian women exhibited positive attitudes towards OCs efficacy and safety. This positive attitude was approvingly associated with the patterns of use. However, only half of participating women reported that they knew how to use OCs. About 60 % of women received recommendations for OCs use from a physician. Moreover, women’s knowledge about OCs mechanism of action was obtained namely from physician (29.9 %). Side effects were reported in 75.1 % of participating women. Reported side effects were headache (41.2 %), mood swings (35.5 %), irritability (33.5 %) and weight gain (28.7 %). Interestingly, the occurrence of side effects was the main reason for OCs discontinuation.

Conclusion

The study showed that women who have positive attitude toward OCs tend to utilize them more appropriately. However, there is still need for educational programs to enhance knowledge about OCs utilization in Jordan.

Below:  Side effects encountered by women using oral contraceptives

Below:  Reasons for oral contraceptives cessation for women in Jordan

Full article at:   http://goo.gl/x21NcO

By:   Sanaa K. Bardaweel^1*, Amal A. Akour² and Maria-Vanessa Z. Kilani¹

¹Department of Pharmaceutical Sciences, Faculty of Pharmacy, The University of Jordan, Queen Rania Street, Amman 11942, Jordan

²Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942, Jordan

 

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Effects of Intimate Partner Physical Violence on Newborns’ Birth Outcomes among Jordanian Birthing Women

Intimate partner physical violence against women (VAW) during pregnancy is a common experience all over the world. In Jordan, the number is double the reported international average. Data on effect of violence on birth outcomes are important for planning, implementing, and evaluating maternal health programs. 

The research question was, “Does intimate partner physical VAW during pregnancy increase the risk of negative birth outcomes for newborns among birthing women in Jordan?” Natural experiment design was used for this study. A consecutive sampling technique was used for selecting the victims of physical violence (n = 79) and a simple random sampling for selecting non-victims (n = 79). Intimate partner physical violence was measured by using the Arabic version of World Health Organization’s (WHO) domestic violence questionnaire, which has an accepted interrater validity. Analysis of covariance (ANCOVA) and chi-square were used to detect the differences in birth outcomes between the victims and non-victims of physical violence. 

The results showed that there is a significant difference in newborn’s birth weight between the victims of violence and non-victims with a small effect size. However, there were no significant differences between the two groups in preterm birth and assisted newborn ventilation. The non-significant effect of violence on the incidence of preterm birth contradicts the published literature. Intimate partner violence (IPV) is rooted in Jordanian culture and widely accepted among married Jordanian women. 

Midwives, doctors, educators, and policy makers should work together to eradicate violence and detect victims of it, to improve birth outcomes and decrease newborn morbidity and mortality rates.

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By:   Sanaa Abujilban, PhD1, Lina Mrayan, PhD1, Hanan Al-Modallal, PhD1, Esra’a Isaa, BSc1

1. ¹Hashemite University College of Nursing, Zarqa, Jordan

1. Sanaa Abujilban, Faculty of Nursing, Department of Maternal, Child, and Family Health Nursing, Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan. Email:abujelban@yahoo.co.uk

 

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