General Characteristics of Child Sexual Offenders in Hatay, Turkey

Objective:

Child sexual offenders are a poorly studied and relatively neglected population in our country. This study aims to evaluate the relationship between criminal behavior and socio-demographic characteristics of a series of child sexual offenders.

Materials and Methods:

The records of social worker interviews with 48 child sexual offenders between 2009 and 2013 were used. The reports issued by social workers regarding child sexual offenders were retrospectively examined, since these reports were relatively the most thorough documents including offenders’ personal and familial characteristics, and criminal event information. Cases were investigated in terms of socio-demographic and psychosocial characteristics.

Results:

There were 48 children interviewed based on an alleged sexual crime, during four-year of study period. All of the cases were male and their ages ranged between 12 and 17 years. Of these, 50% were students at any grade of school. Five cases were living in social service facilities. Only two cases involved incest. Of all, three offenders were accused of repeated sexual crimes. Type of sexual assault was anal penetration in 20 (41.7%) cases. Of all cases, 19 were cigarette smoker, while 4 were drug abusers. The families of 12 (25%) cases suffered from low socio-economic status, while 23 (47.9%) offenders were members of broken families. According to social worker reports, 47 cases had criminal responsibility based on their psychosocial development. Out of all cases, 7 children were suspected of suffering from impulse control disorder and one was suspected to be mentally retarded. Twelve cases were reported to need consulting and social protective services.

Conclusion:

The rate of offenders with interrupted education was considerably high. Interestingly the number of male victims and the frequency of cases involving anal penetration were high. Obtained results suggest that male children of broken and scattered families, and particularly those lacking father’s supervision were more likely to commit a sexual crime.

Types of sexual acts committed by child sexual offenders

Crime types	n	%
Rape
➢ Anal penetration to a boy (Sodomy)	19	39.6
➢ Rape to a girl	20	41.7
➢ Anal penetration to a girl (Sodomy)	1	2.1
Touching a girl	7	14.6
Touching a boy	1	2.1
Total	48	100

Full article at:   http://goo.gl/hc9Gmw

By:  M. Mustafa Arslan,1 D. Sumeyra Demirkiran,1 Ramazan Akcan,2 Cem Zeren,1 and M. Hanifi Kokacya3

¹Department of Forensic Medicine, Mustafa Kemal University School of Medicine, Antakya, Hatay, Turkey

²Department of Forensic Medicine, Hacettepe University School of Medicine, Ankara, Turkey

³Department of Psychiatry, Mustafa Kemal University School of Medicine, Antakya, Hatay, Turkey

This article was presented as a poster in World Forensic Festival, South Korea, 2014.

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Sexual Dysfunction in Men Diagnosed as Substance Use Disorder

Illicit drugs are often used as aphrodisiacs to enhance sexual performance and/or pleasure; however, the available data suggest that most illicit drugs have adverse effects on erection, sexual desire and ejaculation latency in males and that these effects are not fully understood. 

This study aimed to determine the effect of illicit drug abuse on male sexual function, based on the International Index of Erectile Function (IIEF) score. This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center, Ankara, Turkey. Males diagnosed as substance use disorder according to DSM-IV (n = 101) were included as the patient group, and age-matched healthy male volunteers (n = 43) were included as the control group. A 30-item sociodemographic interview form developed by researchers and the 15-item IIEF were administered to all the participants. Data were compared between the patient and control groups. 

Mean IIEF score was 46.7 ± 3.3 in the patients that used alcohol, 23.7 ± 3.3 in the opioid users, 34.1 ± 5.3 in the ecstasy users, 43.5 ± 4.2 in the cannabis users and 55.3 ± 1.6 in the control group. There was not a significant difference between the alcohol and cannabis users' mean IIEF scores and that in the control group, whereas there was a significant difference between the opioid and ecstasy users' mean IIEF scores and that in the control group. All IIEF subscale scores in the opioid users were significantly lower than in the control group. IIEF erectile function, sexual desire and general satisfaction subscale scores were significantly lower in the ecstasy users than in the control group. In the alcohol users only, the IIEF general satisfaction subscale score was lower than in the control group (P < 0.005).

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By:  Kumsar NA1, Kumsar Ş2, Dilbaz N3.

• 1Sakarya University Training and Research Hospital Psychiatry Clinic, Sakarya, Turkey.
• 2Sakarya University Training and Research Hospital Urology Clinic, Sakarya, Turkey.
• 3Üsküdar University NP Hospital, Istanbul, Turkey. 
• Andrologia. 2016 Mar 4. doi: 10.1111/and.12566. 

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Custody and Prison Deaths Autopsied in Istanbul between 2010 and 2012

The occurred death of a convict in prison, police custody cell or in a hospital always attracts public attention and can be considered as a complex phenomenon. 

The aim of this study is to evaluate the data obtained from autopsies performed to the custody and prison deaths in Istanbul and to discuss the possible solutions by comparing with the literature. It is also aimed to discuss the postponement of the sentence and presidential amnesty facts in Turkey. 

Deaths of inmates, which occurred in hospitals, prisons, prison medical rooms, police vans and police custody cells between 2010 and 2012 in Istanbul, Turkey were included in the study. Totally 125 cases were found and 98.4% of them were male. Natural deaths accounted for a great majority of deaths (83.2%). The most common natural cause was cardiovascular diseases. Unnatural deaths accounted for 15.2% of the deaths. Death reason cannot be determined for 1.6% of the cases. More than half of the cases (56%) were died at the hospital, 34.4% were died at the prison, 4% of them at the police van, 3.2% were died under police custody and 2.4% were died at the prison medical room. Moreover, twelve of these cases had applied to Third Specialization Board previously for postponement of the sentence or Presidential amnesty. Totally five of these cases found suitable for postponement of the sentence. 

Prison conditions should be improved, prisoners with chronic diseases should be examined periodically and if appropriate their sentences should be postponed until they heal.

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By:  Ünal V1, Özgün Ünal E2, Çetinkaya Z3, İmalı M4, Gürler S5, Koç S6.

• 1The Council of Forensic Medicine, Bahcelievler, Istanbul 34196, Turkey. Electronic address: volkanunal75@yahoo.com.
• 2The Council of Forensic Medicine, Bahcelievler, Istanbul 34196, Turkey. Electronic address: unalesra@yahoo.com.
• 3The Council of Forensic Medicine, Bahcelievler, Istanbul 34196, Turkey. Electronic address: drzafer03@hotmail.com.
• 4The Council of Forensic Medicine, Bahcelievler, Istanbul 34196, Turkey. Electronic address: muratimali@msn.com.
• 5The Council of Forensic Medicine, Bahcelievler, Istanbul 34196, Turkey. Electronic address: selcukgurler@gmail.com.
• 6Department of Forensic Medicine, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey. Electronic address: sermetkoc@istanbul.edu.tr.
• J Forensic Leg Med. 2016 Jan 12;39:16-21. doi: 10.1016/j.jflm.2016.01.009. 

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HIV-1 Transmitted Drug Resistance Mutations in Newly Diagnosed Antiretroviral-Naive Patients in Turkey

HIV-1 replication is rapid and highly error-prone. Transmission of a drug-resistant HIV-1 strain is possible and occurs within the HIV-1-infected population. In this study, we aimed to determine the prevalence of transmitted drug resistance mutations (TDRMs) in 1,306 newly diagnosed untreated HIV-1-infected patients from 21 cities across six regions of Turkey between 2010 and 2015. TDRMs were identified according to the criteria provided by the World Health Organization's 2009 list of surveillance drug resistance mutations. 

The HIV-1 TDRM prevalence was 10.1% (133/1,306) in Turkey. Primary drug resistance mutations (K65R, M184V) and thymidine analogue-associated mutations (TAMs) were evaluated together as nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. NRTI TDRMs were found in 8.1% (107/1,306) of patients. 

However, TAMs were divided into three categories and M41L, L210W, and T215Y mutations were found for TAM1 in 97 (7.4%) patients, D67N, K70R, K219E/Q/N/R, T215F, and T215C/D/S mutations were detected for TAM2 in 52 (3.9%) patients, and M41L + K219N and M41L + T215C/D/S mutations were detected for the TAM1 + TAM2 profile in 22 (1.7%) patients, respectively. 

Nonnucleoside reverse transcriptase inhibitor-associated TDRMs were detected in 3.3% (44/1,306) of patients (L100I, K101E/P, K103N/S, V179F, Y188H/L/M, Y181I/C, and G190A/E/S) and TDRMs to protease inhibitors were detected in 2.3% (30/1,306) of patients (M46L, I50V, I54V, Q58E, L76V, V82A/C/L/T, N83D, I84V, and L90M). In conclusion, long-term and large-scale monitoring of regional levels of HIV-1 TDRMs informs treatment guidelines and provides feedback on the success of HIV-1 prevention and treatment efforts.

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By:   Sayan M^1,2, Sargin F³, Inan D⁴, Sevgi DY⁵, Celikbas AK⁶, Yasar K⁷, Kaptan F⁸, Kutlu S⁹, Fisgin NT¹⁰, Inci A¹¹, Ceran N¹², Karaoglan I¹³, Cagatay A¹⁴, Celen MK¹⁵, Koruk ST¹⁶, Ceylan B¹⁷, Yildirmak T¹⁸, Akalın H¹⁹, Korten V²⁰, Willke A²¹.

¹ Faculty of Medicine, Clinical Laboratory, PCR Unit, University of Kocaeli , Kocaeli, Turkey .

² Research Center of Experimental Health Sciences, University of Near East , Nicosia, Northern Cyprus .

³ Goztepe Educational and Research Hospital, Clinic of Infectious Diseases, Medeniyet University , Istanbul, Turkey .

⁴ Faculty of Medicine, Department of Infectious Diseases, University of Akdeniz , Antalya, Turkey .

⁵ Educational and Research Hospital, Clinic of Infectious Diseases , Sisli Etfal, Istanbul, Turkey .

⁶ Educational and Research Hospital , Clinic of Infectious Diseases, Ankara Numune, Ankara, Turkey .

⁷ Educational and Research Hospital, Clinic of Infectious Diseases , Bakırkoy Dr. Sadi Konuk, Istanbul, Turkey .

⁸ Educational and Research Hospital, Department of Infectious Diseases, University of Katip Celebi , İzmir, Turkey .

⁹ Faculty of Medicine, Department of Infectious Diseases, University of Pamukkale , Denizli, Turkey .

¹⁰ Faculty of Medicine, Department of Infectious Diseases, University of 19 Mayıs , Samsun, Turkey .

¹¹ Educational and Research Hospital, Clinic of Infectious Diseases , Istanbul Kanuni Sultan Süleyman, Istanbul, Turkey .

¹² Educational and Research Hospital, Clinic of Infectious Diseases , Haydarpasa Numune, Istanbul, Turkey .

¹³ Faculty of Medicine, Department of Infectious Diseases, University of Gaziantep , Gaziantep, Turkey .

¹⁴ Faculty of Medicine, Department of Infectious Diseases, University of Istanbul , Istanbul, Turkey .

¹⁵ Faculty of Medicine, Department of Infectious Diseases, University of Dicle , Diyarbakır, Turkey .

¹⁶ Faculty of Medicine, Department of Infectious Diseases, University of Harran , Urfa, Turkey .

¹⁷ Faculty of Medicine, Department of Infectious Diseases, University of Bezm-i Alem , Istanbul, Turkey .

¹⁸ Educational and Research Hospital, Clinic of Infectious Diseases , Istanbul Okmeydani, Istanbul, Turkey .

¹⁹ Faculty of Medicine, Department of Infectious Diseases, University of Uludag , Bursa, Turkey .

²⁰ Faculty of Medicine, Department of Infectious Diseases, University of Marmara , Istanbul, Turkey .

²¹ Faculty of Medicine, Department of Infectious Diseases, University of Kocaeli , Kocaeli, Turkey .

AIDS Res Hum Retroviruses. 2016 Jan;32(1):26-31. doi: 10.1089/AID.2015.0110. Epub 2015 Oct 21.

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Opinions and Attitudes About Vasectomy of Married Couples Living in Turkey

This study was conducted as a descriptive study, designed to determine the opinions and attitudes of married couples living in Turkey about vasectomy. 

The sample consisted of 350 women. Researchers used a questionnaire to collect data. Descriptive statistics and chi-square analysis were used. The results showed that 14% of women and 43.0% of men were of the opinion that undergoing a vasectomy procedure was a sin. Chi-square analysis determined statistically significant differences between the male and female groups (p < .05). 

More than 88.0% of the men were not willing to have vasectomy and 35.4% thought that vasectomy had a negative effect on marriage and sexual health. In addition, 58.9% thought that vasectomy had a negative effect on men's health. Women were more likely than men to see vasectomy as merely a cultural taboo instead of a sin. 

Sociocultural factors, such as ideas that contraception is the woman's responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, as well as misconceptions about vasectomy such as concerns about sexual functioning, psychological effects, and effects on physical strength, were determined to be the main barriers for vasectomy use in Turkish culture. 

The study recommends determining strategies for overcoming sociocultural barriers by raising awareness and increasing the utilization of vasectomy. Couple-specific family planning programs can make an important contribution toward improving awareness of the benefits of vasectomy.

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By:  Kısa S1, Savaş E2, Zeyneloğlu S3, Dönmez S2.

• 1Gazi University, Ankara, Turkey.
• 2Gaziantep University, Gaziantep, Turkey.
• 3Gaziantep University, Gaziantep, Turkey simge@gantep.edu.tr. 

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Religiosity & Youth Substance Use in a Muslim Context

The literature shows that young people are more vulnerable than adults to substance use. Religiosity is one of the factors that has been considered to protect youth from substance use and has also been interpreted as contributing to the substance abuse recovery process. 

Conceptualizing religiosity as a multidimensional construct, this study aimed to investigate the influence of religiosity on substance use among youth. Three dimensions of religiosity—belief about religion, religious self-practice, and religious social environment—were examined as predictors of substance use. 

The survey data collected in 2010 by the Governance of Istanbul, Istanbul Department of Education, and Istanbul Police Department were used. Participants were high school students (n = 31,272) between 14 and 18 years old. Structural equation modeling was used for statistical analysis and hypothesis testing. 

The study found a negative relationship between the three dimensions of religiosity and substance use. Religious social environment was found to be the strongest of the three dimensions. 

The findings suggest that religion has the potential to reduce the risk of substance use among youth. Implications for future research and policymakers were also discussed.

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By:  Ali Unlu^a* & Ismail Sahin^b

• ^a Sanliurfa Police Department, Turkish National Police, Sanliurfa City, Turkey
• ^b Ankara Police Department, Turkish National Police, Ankara, Turkey

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The Effect of Counselling on Nausea & Vomiting in Pregnancy in Turkey

Highlights

• Counselling reduces the severity of nausea and vomiting in pregnancy.
• Counselling is effective for the duration of mild and moderate nausea and vomiting.
• The number of weekly telephone follow-ups of women who have counselling was significantly less.

Abstract

Objectives

The aim of this study was to assess the effects of follow-up counselling on the duration and severity of nausea and vomiting in pregnant women.

Study design

This study is quasi-experimental and included 62 pregnant women with nausea and vomiting. The group that received counselling was considered to be the experimental group, and the group that received a standard outpatient clinic service was the control group. Data were collected with a demographic data form, that is, the Nausea and Vomiting in Pregnancy Instrument and Pregnancy Unique Quantification of Emesis and Nausea. Significance tests of the differences between two mean values, the Mann–Whitney U test and survival analyses were used to test the hypotheses.

Results

In pregnant women with mild or moderate nausea and vomiting, nausea and vomiting terminated in a significantly shorter time in the experimental group than in the control group (p < 0.001), but this difference was not significant for pregnant women with severe nausea and vomiting (p > 0.05). In addition, the number of weekly telephone follow-ups in the experimental group was significantly smaller (p < 0.001).

Conclusion

Counselling effectively reduced the duration and severity of mild or moderate nausea and vomiting during pregnancy. However, it did not affect the duration of severe nausea and vomiting during pregnancy.

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By:  Gözde Gökçe Isbir, Samiye Mete

Affiliations

• School of Health, University of Nigde, Nigde, Turkey

Correspondence

• Corresponding author. School of Health, Nigde University, Niğde Zübeyde Hanım, Sağlık Yüksekokulu Derbent Yerleşkesi, 51100 Merkez, Nigde, Turkey. Tel.: +90 388 211 28 33
• 
  

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Evaluation of Social & Demographic Characteristics of Incest Cases in a University Hospital in Turkey

BACKGROUND:

Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest.

MATERIAL AND METHODS:

Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study.

RESULTS:

The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims.

CONCLUSIONS:

Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Full article at:  http://goo.gl/lY7qLa

By:  Ali Yildirim,1,A,C,E,F Erdal Ozer,1,A,B,E Hasan Bozkurt,2,E Sait Ozsoy,3,F Ozgur Enginyurt,4,D,F Durmus Evcuman,5,FRiza Yilmaz,6,D and Yunus Emre Kuyucu7,C

¹Department of Forensic Medicine, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey

²Department of Child Pyschiatry, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey

³Department of Forensic Medicine, Gulhane Military Medical Academy, Ankara, Turkey

⁴Department of Family Medicine, Ordu University Faculty of Medicine, Ordu, Turkey

⁵Department of Forensic Medicine, Council of Forensic Medicine, Istanbul, Turkey

⁶Department of Forensic Medicine, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey

⁷Department of Biostatistics, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey

Corresponding Author: Ali Yildirim, e-mail: moc.oohay@46miridliyila

 

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Human Immunodeficiency Virus & Viral Hepatitis among High-Risk Groups: Understanding the Knowledge Gap in the Middle East & North Africa Region

To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners.

We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors’ replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies.

HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis among male sex workers selling or exchanging sex for money.

The MENA countries are in urgent need of advanced research and strengthening of the data collection systems and reporting practices of these infections among key populations.

Table 1

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among prisoners from Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
Egypt	500	41.0	0.0	9.8	15.8	0.0	0.0	0.0	[14]
Iran	160	16.6	0.6	0.6	NS	0.0	NS	NS	[15]
	392a	35.9	17.0	4.5	80.5	0.8	14.5	0.8	[16]
	358b	34.7	0.0	6.1	8.1	0.0	0.0	0.0	[17]
	163	34.5	0.0	7.4	7.4	0.0	0.0	0.0	[18]
	249a	35.4	15.1	4.7	64.8	1.1	14.3	1.1	[19]
	150a	31.4	42.5	18.9	75.9	NR	NR	NR	[20]
Lebanon	580	31.7	0.2	2.4	3.4	0.0	0.0	0.0	[21]
Libya	6371	> 16	18.2	6.9	23.7	NR	NR	1.5	[22]

aAmong prisoners who inject drugs;

bDrug-related convictions; n: Sample size; NR: Not reported; NS: Not studied. All numbers were rounded to the nearest 1. HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among female sex workers and men who have sex with men in Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
FSWs
Lebanon	103a	≥ 18	0.0	0.0	0.0	0.0	0.0	0.0	[23]
Libya	69a	≥ 15	10.1	2.9	7.2	0.0	4.3	0.0	[24]
Turkey	130	38.9	0.0	3.1	0.8	0.0	0.0	0.0	[25]
MSM
Lebanon	101a	≥ 18	1.0	1.0	0.0	0.0	0.0	0.0	[23]
Libya	227a	≥ 15	5.3	3.1	8.4	0.0	4.4	0.0	[24]

aNon-adjusted prevalence using respondent-driven sampling method. All numbers were rounded to the nearest 1. HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 3

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among injecting drug users in Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
Cyprus	40	25-31	0.0	0.0	50.0	0.0	0.0	0.0	[27]
Iran	202	-	NR	NS	52.0	NS	9.4	NS	[28]
	417	≥ 17	24.4	NS	80.0	NS	24.0	NS	[29]
	258	28.8	18.8	NS	65.9	NS	NR	NS	[30]
	233	32.3	7.7	22.7	40.3	4.7	6.4	4.7	[31]
	117a	< 30	0.7	0.7	59.0	0.0	0.0	0.0	[32]
	899	33.9	10.7	50.7	34.5	7.8	8.7	6.5	[33]
	100	17-58	19.0	6.0	56.0	NR	15.0	5.0	[34]
	268	37.0	10.8	6.0	39.2	NR	NR	NR	[35]
	153	30.7	5.9	22.9	59.5	2.0	5.2	1.3	[36]
	539	35.3	NR	NR	NR	0.0	1.1	NR	[37]
	200	36.5	1.5	4.5	12.0	0.0	0.0	0.0	[38]
	1327	26.5	20.2	NS	13.5	NS	NR	NS	[39]
	518	35.2	15.5	3.7	69.5	0.6	11.2	0.6	[16]
Israel	743	33.8	1.9	8.6	69.3	NR	NR	NR	[40]
Lebanon	106a	≥ 18	0.9	2.8	52.8	0.0	0.0	0.0	[44]
Libya	328a	≥ 15	87.1	4.5	94.2	4.2	83.2	NR	[41]
Palestine	192	41.3	0.0	2.6	43.8	0.0	0.0	0.0	[42]
Saudi Arabia	297	31.0	0.7	6.1	37.7	NR	NR	NR	[43]

aEstimated prevalence using respondent-driven sampling method. All numbers were rounded to the nearest 1. n: Sample size; NR: Not reported; NS: Not studied; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 4

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among different populations from Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
HIV infected individuals
Iran	64	-	-	-	-	18.8	NS	NS	[49]
	168	38.7	-	-	-	NS	87.5	NS	[50]
	1338	32-42	-	-	-	NS	78.0	NS	[51]
	106	36.6	-	-	-	20.8	67.0	NR	[52]
	80	37.0	-	-	-	11.3	33.8	25.0	[53]
	130	50.2	-	-	-	11.5	77.0	9.2	[54]
	391	-	-	-	-	14.5	72.0	7.9	[55]
	201	36.0	-	-	-	44.3	67.2	36.3	[56]
	1444	38.4	-	-	-	NS	78.4	NS	[57]
Morocco	503	39.0	-	-	-	29.4	5.4	NR	[58]
Sudan	358	35.0	-	-	-	26.8	NS	NS	[59]
Turkey	949	37.9	-	-	-	0.0	0.9	0.0	[60]
Blood donors
Cyprus	5057	34.5	0.0	3.0	0.5	0.0	0.0	0.0	[61]
Iran	6499851	-	< 0.1	0.6	0.1	NR	NR	NR	[62]
	2026628	38.0	< 0.1	0.4	0.1	NR	NR	NR	[63]
UAE	592	-	1.2	67.2	31.6	NR	NR	NR	[64]
Others
Cyprus
Soldiers	12488	34.5	0.0	2.2	0.5	0.0	0.0	0.0	[61]
Iran
HBV patients	264	41.6	0.4	-	4.5	0.4	NR	NR	[65]
HIV infected patients’ partners	168	33.2	NR	NS	NR	NS	9.5	NS	[50]
Non-injecting drug users	336	28.5	1.5	5.6	4.5	1.2	0.9	0.9	[31]
Referral from behavioral counseling center	379	29.7	4.0	2.9	35.6	0.8	3.4	0.3	[66]
Libya
General Population	9170	34.0	0.2	3.7	0.9	< 0.1	0.1	< 0.1	[67]
Medical waste handlers	300	-	0.0	2.3	2.7	0.0	0.0	0.0	[68]
Non-Medical waste handlers	300	-	0.0	0.3	0.0	0.0	0.0	0.0	[68]
Turkey
ER patients	1000	51.7	0.0	5.0	1.8	0.0	0.0	0.0	[69]
In and out-patients	97000-225000	-	0.3	33.9	1.2	NR	NR	NR	[70]

All number were rounded to the nearest 1. n: Sample size; NR: Not reported; NS: Not studied; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Full article at:  http://goo.gl/FW5TbL

  

By:  Nada M Melhem, Nour Rahhal, Rana Charide, Khalil Kreidieh, and Rolla El-Khatib

Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Nour Rahhal, Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Rana Charide, Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Author contributions: Melhem NM designed and wrote the paper; Rahhal N, Charide R and Kreidieh K reviewed the literature, prepared the tables and contributed to the write-up; El-Khatib R critically read the manuscript.

Correspondence to: Nada M Melhem, PhD, Assistant Professor of Infectious Diseases, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, 325 Van Dyck Hall, 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon. bl.ude.bua@nmehlem

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