Feature story

Breaking the silence: Fact and priorities for the AIDS response in the Middle East and North Africa

21 February 2011

Credit: The World Bank

Information about the spread of HIV in the Middle East and North Africa region has been extremely limited, with no real picture of the epidemic emerging. As a major contribution to increasing knowledge of AIDS in the region, the World Bank recently convened a discussion to highlight the first ever comprehensive scientific analysis of the epidemic.

A groundbreaking report, a joint effort involving the World Bank, UNAIDS and the World Health Organization, was the focus of the event at the Bank’s Washington Headquarters. The event on 15 February brought together policy makers from the region, politicians, researchers, civil society actors, and partners. They discussed the findings and implications for prioritizing resources amid the fundamental social and political changes currently affecting the region.

HIV in North Africa and the Middle East

HIV infection has already reached all corners of North Africa and the Middle East. There are substantial differences in the way the virus is spread across the region and various risk contexts are present. The epidemic has become generalized in Djibouti and Sudan, though prevalence in the general population in most other countries is low. The nearly one million people  who inject drugs (0.2% of the population), men who have sex with men and their sexual partners, and commercial sex networks are the most impacted by HIV. A significant number of individuals have also contracted the virus while living and working abroad.

Levels of risk behaviour, such as using non-sterile injecting equipment, are high in a number of countries in the region. This confirms the potential for further HIV spread among the key populations.

A number of social challenges, including pervasive stigma, are also facilitating the spread of the virus.

The way forward

The priorities are clear to address the problem of the rising epidemics in the region and it is time for policy makers and partners to take action

Laith J. Abu-Raddad, Assistant Professor of Public Health and Director of the Biostatistics and Biomathematics Research Core at Weill Cornell Medical College in Qatar

Laith J. Abu-Raddad, the report’s main author, who participated in the World Bank discussion, believes that with today’s greater understanding of the epidemic, time is of the essence in building a more meaningful response. “We are no longer groping in the dark on HIV in the region. The data are now available and we have a good understanding of what’s happening with regard to HIV transmission and the populations affected.” He added, “The priorities are clear to address the problem of the rising epidemics in the region and it is time for policy makers and partners to take action.”

Participants at meeting agreed that the current political climate presents a window of opportunity for sustained change. They called on policy makers to focus investment on evidence-informed prevention efforts for key populations to yield long term health and social benefits.

Stigma and discrimination must also be challenged and access to testing, care, and treatment services expanded substantially.

A partnership with civil society, concerned populations and people living with HIV will be the cornerstone of effective implementation. Strengthening grassroots organizations is considered essential for cementing progress made and reaching the most stigmatized and vulnerable.

The report includes data on Afghanistan, Algeria, Bahrain, Djibouti, the Arab Republic of Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic, Tunisia, the United Arab Emirates, West Bank and Gaza (Occupied Palestinian Territories), and the Republic of Yemen.