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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Epidemiology of Hepatitis C Virus in the Arabian Gulf Countries: Systematic Review & Meta-Analysis of Prevalence

HIGHLIGHTS

• HCV prevalence is at around 1% in the Arabian Gulf region.
• Higher prevalence in expatriate populations reflects prevalence in origin countries.
• Evidence of ongoing HCV transmission through exposures linked to medical settings.
• Injecting drug use does not appear to be the dominant contributor to HCV incidence.

OBJECTIVE:

To systematically review and synthesize epidemiological data on hepatitis C virus (HCV) in the Arabian Gulf countries, and assess the country-specific prevalence among nationals and expatriate populations.

METHODS:

We conducted a systematic review of HCV antibody prevalence and incidence in the Arabian Gulf countries based on the items outlined in the PRISMA statement. Meta-analyses were conducted incorporating inverse variance weighting and using a random-effects model to pool summary estimates of HCV prevalence among general population groups, for nationals and the entire resident population.

RESULTS:

We identified 557 prevalence measures and one incidence measure in the Arabian Gulf countries. 

HCV prevalence among nationals was 0.24% in the United Arab Emirates (UAE), 0.44% in Kuwait, 0.51% in Qatar, and 1.65% in Saudi Arabia. No data was available for Bahrain and Oman. Among the entire resident populations, HCV prevalence was 0.30% in Bahrain, 0.41% in Oman, 1.06% in Qatar, 1.45% in Kuwait, 1.63% in Saudi Arabia, and 1.64% in UAE. Higher prevalence was observed among expatriate populations such as Egyptians. Among high risk populations, HCV prevalence was as high as 78.6% in the multi-transfused and 74.6% in people who inject drugs.

CONCLUSIONS:

National-level HCV prevalence in the Arabian Gulf region is comparable to global levels. Higher prevalence is found in specific expatriate populations reflecting the prevalence in their countries of origin. Most exposures appear to occur in high risk groups and are often linked to medical care.

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

By:  Mohamoud YA1, Riome S1, Abu-Raddad LJ2.

• 1Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
• 2Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, USA; College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar. Electronic address: lja2002@qatar-med.cornell.edu.
• Int J Infect Dis. 2016 Mar 17. pii: S1201-9712(16)30999-7. doi: 10.1016/j.ijid.2016.03.012.

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