The HIV prevalence among people who inject drugs in the Libyan capital Tripoli is at an alarming 87% according to the results from bio-behavioral surveys conducted by the Liverpool School of Tropical Medicine with the support of the European Union. Reaching out to 328 injecting drug users, 227 men who have sex with men (MSM) and 69 female sex workers, the study was designed to indicate the progression of HIV prevalence among key populations at higher risk.

The results of the study were presented during the first National HIV Symposium in post-conflict Libya that took place 26 June in the Libyan capital Tripoli under the auspices of the Libyan Minister of Health in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC).

In light of the new evidence, the Libyan Minister of Health, H.E. Dr Fatima Elhamrosh called for urgent action from all concerned sectors in Libya. “We will need to develop and implement comprehensive programs to respond to the growing AIDS epidemic among key populations in Libya,” said Minister Elhamrosh.

Before the revolution that took place in the spring of 2011, it was difficult for UNAIDS and international development partners to work systematically in Libya. AIDS was not openly discussed nor considered a priority. The new data confirms that the HIV situation in Libya is worse than what was officially reported in the past.

“We very much welcome the remarkable political commitment of the government of Libya towards responding to the AIDS epidemic,” said Hind Khatib, Director of UNAIDS Regional Support Team for Middle East and North Africa. “The commitment of Her Excellency, the Minister of Health to expand drug treatment services providing a range of evidence-based responses and the establishment of eight Voluntary Counselling and Testing centers focusing on key populations are clear examples of the growing governmental commitment,” added Ms Khatib.

UNAIDS recommendations in relation to HIV prevention responses among injecting drug users stress the need to develop a comprehensive set of measures consisting of the full range of treatment options—notably drug substitution treatment—and the implementation of harm reduction measures—through, among others, peer outreach to injecting drug users, and sterile needle and syringe programmes. Also, voluntary confidential HIV counseling and testing, prevention of sexual transmission of HIV among drug users (including condoms and prevention and treatment for sexually transmitted infections), access to primary healthcare and access to antiretroviral therapy. Such an approach must be based on promoting, protecting and respecting the human rights of drug users.

Following the change of government, UNAIDS has provided technical support to the Ministry of Health and UN Country Team in Libya to address the emerging HIV priorities. This has resulted in better identification of priorities, improved understanding of the HIV situation and response, the establishment of the Joint UN team on AIDS and improved commitment from the government, UN and civil society organizations.

At the end of the symposium, participants endorsed a statement of commitment to scale up the national AIDS response in Libya with focus on HIV prevention programs among key populations, rights of people living with HIV and expanded role of civil society in the national response.

UNODC also re-launched the second phase of their HIV project in Libya that focuses on HIV prevention among people who injecting drug and in prison settings. The project, funded by the Libyan government, was suspended in 2011 due to the security problems and is now being resumed.

"UNODC warmly welcomes the expressions of political will and commitment by the Libyan government to respond to the HIV and drug use crisis as a matter of national priority,” stated Masood Karimipour, Regional Representative of United Nations Office on Drugs and Crime. “UNODC is proud to be in partnership with Libya to help provide a comprehensive response to prevent drug use and the spread of HIV as well as to treat people in need in coordination with all national stakeholders, UNAIDS and the international community,” Added Mr Karimipour.

UNAIDS Executive Director Michel Sidibé (right) met with a group of young Moroccans on 4 April at the national headquarters of OPALS in Rabat.

Speaking with a group of young Moroccans on 4 April, UNAIDS Executive Director Michel Sidibé urged youth across the country—and region—to break the silence on AIDS and lead a revolution in HIV prevention.

“Young people were at the forefront of revolutions that brought political change to this region. I urge youth to launch a similar movement to stop new HIV infections,” said Mr Sidibé, addressing a group of young people at the national headquarters of OPALS (Organisation Pan Africaine de Lutte contre le sida), a non-profit organization based in Rabat.

Over the past decade, the number of new HIV infections among adults and children in the Middle East and North Africa increased from 43 000 to 59 000, according to UNAIDS estimates. In 2010, there were an estimated 470 000 people in the region living with HIV, up from 320 000 in 2001.

During the meeting, Mr Sidibé expressed concern over widespread stigma and discrimination in the region against people living with HIV and populations at high risk of infection, including sex workers, people who inject drugs and men who have sex with men. He noted that stigma drives vulnerable populations underground and away from HIV and health services.

Across the region, the special needs of youth—particularly sex workers, people who inject drugs, men who have sex with men and people living with HIV—remain inadequately addressed, noted the UNAIDS Executive Director.  He underscored the importance of empowering all young people with the knowledge and resources they need to lead a healthy sexual lifestyle.

Through 17 drop-in clinics, OPALS provides health services, access to condoms and HIV testing for young people, women, migrants, sex workers and other vulnerable populations in Morocco. Representatives from OPALS also travel in remote areas, providing door-to-door HIV testing and other prevention services.

In the meeting with Mr Sidibé, several young people highlighted the lack of sexual education in Morocco—both at school and within families. They expressed enthusiasm for UNAIDS’ youth-led policy project CrowdOutAIDS, which leverages new technologies to enable young people to fully participate in the development of the organization’s strategy on HIV and youth. Since the launch of the project in October 2011, some 5000 young people around the world have taken part.

Reaching most-at-risk populations

During his three-day mission to Morocco, Mr Sidibé paid a visit to the Association de Lutte contre le sida (ALCS) in Rabat, the first AIDS association established in the Maghreb region and the Middle East. Mr Sidibé praised Hakima Himmich, President of ALCS, and her staff for the organization’s excellent contribution to the HIV response—particularly its efforts to prevent HIV among populations at high risk of infection.

ALCS was established in 1998 when there were just 30 registered cases of AIDS in Morocco. In 1992, ALCS opened its first voluntary HIV testing and counselling centre, and since 1995, the organization has offered HIV prevention programmes for key populations at high risk of infection.

By 2011, more than 122 000 people at high risk of infection—including vulnerable and bridge populations (for example, clients of sex workers)—were benefiting from HIV prevention programmes in Morocco, largely through ALCS.  That same year, an estimated 58 000 people in Morocco were tested for HIV, many of them through ALCS.

According to studies conducted in 2011 by Morocco’s National AIDS Programme, ALCS and UNAIDS, 45% of sex workers and men who have sex with men in the country are currently reached through HIV prevention programmes and the rate of condom use among these key populations is about 50%.

During his visit to ALCS, Mr Sidibé sat in on a group discussion with women focused on HIV prevention. He also met a peer support group for people living with HIV and spoke with health personnel at an HIV testing centre.

UNAIDS Executive Director Michel Sidibé met with Princess Lalla Salma of Morocco on 4 April in Rabat.
Credit: Le Matin.ma

Morocco has a low national HIV prevalence, estimated at approximately 0.15% of the general population. However, recent data show a concentrated and growing HIV epidemic in the country among key populations.

According to government figures, an estimated 5.1% of men who have sex with men are living with HIV nation-wide. In the south-western city of Agadir, HIV prevalence among sex workers is about 5%. In Nador, a coastal city in the north-east, nearly one in five people who inject drugs is HIV-positive.

Focusing resources on populations at high risk of HIV infection is at the core of a new national AIDS strategy in Morocco. Launched in Rabat on 3 April by the Minister of Health, El Hossaine Louardi, Morocco’s five-year strategy is closely aligned with the targets of the 2011 Political Declaration on AIDS.

Addressing an audience of more than 300 national partners in the AIDS response—including government officials, civil society representatives and people living with HIV—Mr Louardi said that the national plan aims to halve new HIV infections and reduce AIDS-related deaths by 60% by the year 2016. He added the strategy is based on the principles of a right to health, accountability and inclusion of all partners in the HIV response.

Speaking at the launch ceremony, UNAIDS Executive Director Michel Sidibé called Morocco’s HIV response “exemplary,” with people placed squarely at the centre of national development efforts. He praised Morocco as a regional pioneer in protecting the health and human rights of vulnerable populations.

Morocco was the first Arab country to introduce harm reduction programmes for people who inject drugs, including methadone maintenance therapy and needle-syringe programmes. Evidence has shown that such programmes are essential to prevent the spread of HIV among key populations.

Mr Sidibé recognized in his remarks a new medical assistance scheme for the country’s low-income population called RAMED (Régime d’Assistance MÉdicale des Economiquement Démuni). Under RAMED, 8.5 million Moroccans living below the poverty line, or just under 30% of the population, will benefit from partial or total exemption from treatment costs at public hospitals.

“RAMED is an important reform for social justice and the redistribution of opportunity,” said Mr Sidibé. “Providing vulnerable populations with social protection is a key strategy in the HIV response,” he added.

Recognizing Princess Lalla Salma’s contribution

Earlier in the day, Mr Sidibé met with Princess Lalla Salma of Morocco, wife of King Mohammed VI and President of the Association Lalla Salma de Lutte contre le Cancer, a national non-profit organization. He thanked the Princess for her participation in last year’s UN General Assembly High Level Meeting on AIDS and for her on-going advocacy and support for programmes aimed at improving the health of women and children. In recent years, the Princess has been a leading voice in promoting the importance of integrated services for reproductive health and cervical cancer.

A call for reduced dependency on external HIV aid

In a separate meeting with Morocco’s Minister of Health, Mr Sidibé thanked the Minister for his efforts to push forward the Arab AIDS Initiative at a recent conference in Jordan. The new initiative is expected to accelerate national and regional efforts to achieve the targets of the 2011 Political Declaration on AIDS.

Noting that Morocco relies on external aid to fund 50% of its national AIDS response, Mr Sidibé urged the country’s leadership to assume a greater share of HIV investments. “A new funding paradigm is needed in Morocco and across the African continent—one that is written and owned by African countries,” he said.

Underscoring that a vast majority of HIV drugs prescribed in Africa are imported, Mr Sidibé called for the local production of antiretroviral medicines. He spoke of the need for a single African drug regulatory agency to ensure the faster roll-out of quality-assured medications across continent.

UNAIDS Executive Director Michel Sidibé (left) met with the President of the Algerian Senate, Abdelkader Bensalah, at the Council of the Nation headquarters in Algiers on 2 April.

Algeria’s early and swift response to the HIV epidemic has kept national HIV prevalence low, at approximately 0.1% of the population. Since 1998, the government has offered free antiretroviral treatment to all people who are eligible. New HIV infections among children in Algeria have been virtually eliminated.

In a meeting on 2 April with the President of the Algerian Senate, Abdelkader Bensalah, UNAIDS Executive Director Michel Sidibé commended Algeria as a champion in the AIDS response—both at home and across the region.

During his meeting with Mr Bensalah at the Conseil de la Nation headquarters in Algiers, Mr Sidibé acknowledged the critical role that Algeria has played in mobilizing high-level commitment for the AIDS response within the African Union and in the League of Arab States. He noted that Algeria’s Chairmanship of the Group of 77 (G-77) provides an important platform for galvanizing further support for the regional response to HIV.

Touching on a theme from his recent missions in Africa, Mr Sidibé praised Algerian leaders for funding more than 93% of national HIV programmes through domestic sources. “Across Africa, too many countries remain too dependent on external HIV aid. Algeria’s country-owned HIV response is an example for others to follow,” he said.

Speaking on behalf of President Abdelaziz Bouteflika, Mr Bensalah underscored that the Algerian government hopes to finance 100% of its AIDS response in the coming years. He said that Algeria is committed to the targets of the 2011 Political Declaration on AIDS and to the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

A call for a more inclusive society

Meeting later in the day with Algeria’s Minister of Religious Affairs, Mr Bouabdellah Ghlamallah, Mr Sidibé requested the Minister’s support in ensuring a more inclusive society based on tolerance, compassion and respect for all human beings. He said that people of Islamic faith could promote HIV prevention by serving as a bridge between scientific evidence and social change.

Mr Ghlamallah reaffirmed the Ministry’s support for people living with HIV and populations at high risk of HIV infection. He said that the Ministry would continue to support El Hayet—a non-governmental organization of people living with HIV—in its efforts to reach the goal of zero discrimination.

“Religion must play an important role in preventing HIV and addressing questions around drug use and sexuality,” said the Minister.

Partnership to promote AIDS research

UNAIDS Executive Director Michel Sidibé (left) and the Algerian Minister of Health, Dr Djamel Ould Abbès, signed an agreement on 2 April to create an African AIDS Research Centre in Tamanrasset, Algeria.

During his mission, the UNAIDS Executive Director signed an agreement with the Minister of Health, Dr Djamel Ould Abbès, to establish an African AIDS Research Centre in Tamanrasset, a city in southern Algeria. Scheduled to open in 2013, the Centre will facilitate the regional exchange of scientific knowledge and expertise in the domain of HIV and public health.

“This is a ‘win-win’ partnership between UNAIDS and the Government of Algeria,” said Dr Ould Abbès, noting that the collaboration would marry the technical expertise of UNAIDS with Algeria’s national resources and regional contacts.

Addressing stigma and discrimination

Speaking with key partners in the HIV response on 1 April—including health professionals, government officials, AIDS activists, people living with HIV and representatives of the United Nations—Mr Sidibé underscored the need to intensify national and regional efforts to eliminate stigma and discrimination.

“Stigma drives people living with HIV and populations at high risk of HIV infection underground,” said Mr Sidibé. “It prevents vulnerable populations from accessing the HIV and health services they need.”

The HIV epidemic in the Middle East and North Africa (MENA) region has been on the rise since 2001.
Credit: UNAIDS/P.Virot

“We will save no effort to prevent new HIV infections and new AIDS related deaths in our region,” said H.E. Dr Abdel Latif Wreikat, Minister of Health of Jordan and the Chair of the 37^th Session of the Council of Arab Ministers of Health held on 14-15 March 2012 in Amman, Jordan.

At the session, the Council of the Arab Ministers of Health, representing the member countries of the League of Arab States, officially launched the Arab AIDS Initiative. This initiative aims at accelerating national and regional AIDS responses to achieve the targets set in the 2011 Political Declaration on AIDS. “We are committed to maintain HIV prevalence low in the Arab countries” stressed Dr Wreikat.

At the heart of the new initiative are the development of a “Unified Arab AIDS Strategy on HIV and AIDS” and the constitution of a technical committee to follow up the development and implementation of the new strategy. Overall, the strategy will help countries in the region to better understand their epidemics; create stronger political commitment and higher investment on AIDS; and will contribute to streamline AIDS within the wider development agenda. The technical committee will review the global targets of the Political Deceleration and develop a regional roadmap to reach them by 2015.

Sima Bahous, Assistant Secretary General of the League of Arab States expressed their determination to “work with our Member States to meet the commitments they made in signing the Political Deceleration on AIDS.”

This unprecedented initiative culminates a growing partnership between UNAIDS and the League of Arab States. A series of regional and sub-regional consultations and workshops took place during 2011 to unite Arab countries in their responses to AIDS. These trainings, which took place under the umbrella of the League of Arab States, were facilitated by UNAIDS who helped develop the agenda as well as the recommendations. UNAIDS has also assisted countries throughout the year in reviewing their National Strategic Plans to ensure that human rights were included in their national AIDS responses.

“We are pleased to see AIDS at the top of the priorities of the Arab League at a time of competing political priorities in the rapidly changing Arab World,” said Hind Khatib, Director of UNAIDS Regional Support Team for Middle East and North Africa. 

The HIV epidemic in the Middle East and North Africa (MENA) region has been on the rise since 2001. Although the overall HIV prevalence in the region is still low, the rise in new infections has put MENA among the top two regions in the world with the fastest growing HIV epidemic. Approximately 500 000 people are living with HIV in the region and AIDS-related mortality has almost doubled in the past decade among both adults and children.

The HIV epidemic is primarily concentrated among people who inject drugs, men who have sex with men and sex workers. However, the epidemic reflects the diversity of the region with different populations more heavily affected in different places. Such diversity is further amplified by differing attitudes, policies, political commitments and the availability of and access to HIV prevention and treatment services in the different countries.

As Libya celebrates the first anniversary of the 17 February revolution, UNAIDS together with the governing National Transitional Council are putting the building blocks in place to rejuvenate the country’s AIDS response.  

Following UNAIDS Executive Director meeting with the Libyan Deputy Minister of Health Dr. Adel M. Abushoffa, a short term plan has been set up for the country’s AIDS response. The foundation has also been laid to the development of a comprehensive national strategic plan on AIDS.

In collaboration with the World Health Organization (WHO), UNAIDS is providing technical guidance to the government through a resident UNAIDS Senior Advisor to monitor the HIV epidemic, identify priorities and together with the government identify the main gaps in the response.

In the short term, the Libya has requested UNAIDS to support the procurement of antiretroviral (ARV) treatment drugs for around 3000 people living with HIV while working in parallel to reestablish the ARV supply and procurement system that has been interrupted for more than six months. The ARVs are now being shipped to the country.

UNAIDS is taking the lead in coordinating the UN system’s response to AIDS in Libya and new partnerships have been established with key donors such as the European Commission.

Some of the critical long term issues that need attention include strengthening the human resource base of the health system and ensuring that healthcare workers have the skills to provide HIV prevention and treatment services.

The AIDS response also has to focus on reducing stigma and discrimination, especially by health workers, decentralization of HIV-related services, reaching people at increased risk of HIV such as sex workers, men who have sex with men, people who inject drugs as well as migrants and displaced people. The long term national strategic plan will focus on building the capacity of civil society organizations to implement HIV prevention outreach programmes.

As a first step to developing evidence informed AIDS response, Libya, in collaboration with WHO and UNAIDS, is strengthening its HIV surveillance system. Information about the epidemiological situation in Libya is sparse, yet preliminary assessments indicate a severe epidemic among people who inject drugs as well as anecdotal information about HIV infection among sex workers and sex trade on migration routes in the south of the country.  

First Deputy Minister of Health of Libya, Dr. Adel M. Abushoffa (Left) and UNAIDS Executive Director Michel Sidibé

A Libyan delegation headed by the Deputy Minister of Health Dr. Adel M. Abushoffa met with UNAIDS Executive Director Michel Sidibé on 24 January at UNAIDS headquarters in Geneva, Switzerland. The aim of the meeting was to set up the short-term priorities for the country’s response to AIDS as well as to establish the basis for the development of a strong national AIDS plan.

Libya is gradually recovering from civil war. As a result the country is spearheaded by a transitional government that has the rebuilding of social and health services among its priorities, including HIV. 

“We have important and urgent issues to tackle regarding the provision of health services to the people of Libya, including the need to deal with refugees coming from all parts of the country,” said Mr Abushoffa. “We count on UNAIDS to help us re-establish a functioning health system through an integrated approach to resolve the post crisis health situation in the country.”

During the meeting, UNAIDS offered its support and expertise to the government in defining an inclusive strategy that will bring all sectors together to effectively respond to AIDS in the country. In collaboration with the World Health Organization (WHO), UNAIDS will also provide technical guidance to the government in terms of monitoring the epidemic, identifying priorities and building the government’s capacity to take ownership of the response. 

“We are encouraged by Libya’s pursuit of democracy,” said Mr Sidibé. “UNAIDS will do its part in providing solutions for the reconstruction and sustainability of the health system, helping the country provide universal access to HIV services to all it citizens.”

HIV surveillance needed

Peripheral health services in the country are hardly functioning due to shortage of liquidity, supplies and staff. The remaining functioning hospitals carry the burden of primary care and additional caseload of war wounded due to the occasional fighting still taking place. The transitional government is also faced with other immediate health challenges such as securing drug supply; disease control; information and surveillance.

The HIV prevalence prior to the war was estimated at 0.13% based on a 2006 survey with the main mode of transmission being the sharing of contaminated injecting equipment among drug users. Mr Sidibé pointed out the importance of accurate and up-to-date HIV information in order to develop evidence-based programmes that efficiently respond to specific contexts. 

Between 2000 to 3000 people living with HIV were accessing antiretroviral (ARV) treatment before the war. Now the ARV supply has been interrupted for more than six months. Despite efforts from the Ministry of Health to procure the HIV drugs, challenges remain. The ministry of Health together with WHO has discussed the possibility to launch an appeal to get immediate supply of ARVs on loan from other countries or from drug companies. UNAIDS will coordinate the work of the UN in collaboration with the transitional government in order to re-construct the procurement and supply system of ARVs to restore the continuity of services and support to people living with HIV.

The Middle East and North Africa regional Report on AIDS 2011 is launched in Cairo on the 4th of December 2011.
Credit: UNAIDS.

A report on the HIV epidemic in the Middle East and North Africa (MENA) shows that while the overall HIV prevalence in the region is still low, the rise in new infections since 2001 has put the MENA region among the top two regions in the world with the fastest growing HIV epidemic.

The report was released on the 4 December under the auspices of the League of Arab States (LAS) in Cairo, Egypt. The event brought together the Arab States delegates and Ambassadors accredited to the Arab Republic of Egypt, civil society organizations including associations of people living with HIV, donors, religious leaders, community groups and media, private sector, Goodwill Ambassadors and UN agencies.

The report shows that there has been significant policy development and scale up of programmes indicating an increased political will in the region to address the AIDS epidemic. The majority of countries in the region have put in place national strategies to address AIDS and some have initiated programmes for key populations at higher risk, including sex workers, people who inject drugs and men who have sex with men.

UNAIDS Deputy Executive Director Programmes, Dr Paul De Lay, applauded the progress made. “Ten years ago, HIV was not on the political agenda in the Middle East and North Africa. Today, all countries in the region have become more engaged in the HIV response,” said Dr De Lay.

According to the report, the estimated number of adults and children living with HIV in the region increased from 330,000 [200,000-480,000] in 2001 to 580,000 [430,000- 810,000] in 2010. The report attributes this rise to increased number of new HIV infections among key populations at higher risk and transmission of the virus to their sexual partners.

In 2010, there were 84,000 [57,000-130,000] new HIV infections and 39,000 [28,000-53,000] AIDS-related deaths in the Middle East and North Africa region. The annual estimated new HIV infections and AIDS-related mortality has almost doubled in the past decade. While countries have increased provision of antiretroviral therapy (ART) by 25% in the last year, the total regional coverage remains low, with only 8% of eligible people living with HIV accessing treatment in 2010.

Civil society organizations are now playing a more prominent role in the HIV response compared to just a few years ago. However, key challenges to scale up AIDS programmes among key populations at higher risk of HIV still remain. “Work with key populations is difficult in settings where the levels of stigma and discrimination are high and the overall support from governments is limited,” said Mrs Hind Khatib-Othman, UNAIDS Director of the Regional Support team for MENA region.

Key political declarations adopted in the region include the 2010 Dubai Consensus Statement and the 2011 Riyadh Charter. Professor Ziad A. Memish, Assistant Deputy Minister of Health for Preventive Medicine of the Kingdom of Saudi Arabia, representing the Minister of Health who is also Chair of the Ministerial Steering Committee of the LAS, spoke about the Arab Initiative—a follow up mechanism to the Riyadh Charter—as an important step for the region to ensure it lives up to international commitments.

Dr Sima Bahous, Assistant Secretary General and Head of the Social Development Sector at the League of Arab States welcomed the report and pointed to the existing relations of cooperation between the Arab League and UNAIDS. Dr Bahous also stressed the Arab League’s keenness to work with all the relevant stakeholders to achieve the targets of the Millennium Developmental Goals and the 2011 Political Declaration on HIV/AIDS adopted by the UN General Assembly. “It is time to act on the commitments and take necessary measures to keep HIV prevalence low,” said Dr Bahous.

The report outlines many recommendations on how to strengthen the AIDS response in the MENA region. These include review of laws and policies that hinder access to HIV prevention and treatments services, to invest smartly using an evidence-informed and human rights based approach, and the importance of strong political leadership.

“Decision-makers need to demonstrate the political courage to focus the response on the populations most affected by HIV. The 2011 Political Declaration should be the foundation for such leadership,” concluded Dr De Lay.

Participants at the Qatar Symposium. Doha, Qatar. 02 November 2011

Families need to be empowered to provide the first line of protection against stigma, raise HIV awareness and decrease new HIV infections in the Middle East and North Africa (MENA) countries according to the participants of the recently concluded Qatar Symposium.

The event, which took place 1 – 2 November 2011 in Doha, was organized by the Doha International Institute for Family Studies and development (DIIFSD), UNAIDS and UNICEF to examine the linkages between family, Millennium Development Goals and AIDS in the Middle East.

“We need to address the AIDS epidemic with responsibility and courage,” said Dr Sima Bahous, Assisstant Secretary General of the League of Arab States. “HIV hinders the social, economical and developmental progress of the region and has a negative impact on the health of the family.” 

The Qatar Symposium focused on how investments in children, young people and women can have a real impact in reducing the HIV prevalence in the region. MENA is one of the few regions in the world where the AIDS epidemic is still on the rise with an HIV prevalence that has doubled in the last 10 years and where AIDS related deaths have tripled.

Topics discussed at the conference included the goal to eliminate new HIV infections among children, the need for HIV prevention programs that focus on children and young people most at risk of infection as well as how family affects their involvement in potentially risky behaviour.

According to Shahida Azfar, UNICEF Regional Director in MENA, a significant number of women, young people and children are affected by HIV in the region despite the gains made during the past decade. In 2009, more than 6 400 children aged 0-14 years old in MENA countries became infected with HIV. The number of children living with HIV (aged 0-14 years old) rose to 21 000 and in the same year, young people (aged 15-24) living with HIV were around 94 000.

UNAIDS Regional Director for MENA Hind Khatib accepting an award from Lt. General Dahi Khalfan Tamim, Commander in Chief, Dubai Police on behalf of UNAIDS Executive Director Michel Sidibé.

Participants agreed that families can be highly protective as they offer a dependable means of HIV prevention education and the clout to keep children in school, on track and out of risk. Family support can improve adherence to HIV treatment, provide sustaining care and offer the first line of protection against stigma and isolation.

“Countries in MENA need to help families mobilize against AIDS through education, outreach and helping to rise up against the stigma associated with AIDS,” said Dr Faleh Mohammed Hussain Ali, Assistant Secretary General for Policy Affairs at the Supreme Council of Health in Qatar.

In addition to placing the family at the heart of the AIDS response, participants also called for enhanced political commitment and better engagement of civil society including the media.

UNAIDS Regional Director for MENA Hind Khatib stressed that achieving UNAIDS vision of zero discrimination, zero new HIV infections, and zero AIDS related deaths will require more than simply accepting the validity of current political, social and scientific approaches. “It will require a deliberate creative act of promoting family ties and cultural values, confronting social norms and re-examining laws that detract people of their dignity and respect.”

Credit: UNAIDS/P.Virot

Men who have sex with men (MSM) and transgendered people are amongst the most stigmatized populations in the Middle East and North Africa (MENA). In spite of social tension and sensitivities, most countries in the region have recognized the importance of programming for, and working with, MSM to strengthen effective national AIDS responses. Nevertheless, existing prevention programmes have remained limited in scope and scale, highlighting limitations in coverage and quality.

In this context, UNAIDS brought together representatives from civil society, governments, national AIDS programmes and regional and international partners to a workshop in Lebanon to discuss ways to scale up interventions that focus on the needs of MSM in the region.

The workshop was organized in collaboration with Helem-Lebanese Protection for LGBT association, the International AIDS Alliance (AA) and the Regional Arab Network Against AIDS (RANAA). It focused on the outcomes of a policy research project entitled “Enabling Access to HIV Services for Men Who Have Sex with Men - Situational analysis and Partnership Development”. The main purpose of the research, conducted in Algeria, Lebanon, Morocco and Tunisia, was to identify ways to enable and facilitate this access to HIV services.

Existing repressive laws and policies deter MSM from seeking HIV prevention, treatment, care and support services.  Currently 18 of the 21 countries that form the MENA region criminalize male to male sex behaviour—and 4 enforce capital punishment.

Participants at the meeting highlighted the importance of creating enabling environments that allow unrestricted dissemination of prevention messages and services, appropriate provision of HIV treatment, care and support services, and the empowerment of MSM and transgender population in planning, implementing and evaluating programme strategies.

Participants also reviewed a handbook developed by UNAIDS, based on field experiences and lessons learnt, to inform effective, expanded and culturally sensitive programmatic interventions among MSM and transgender people.

“Most programmes in MENA are still at a pilot stage. We need to scale up current programs using the extensive experience over the last years. This handbook, adapted to the region’s context, will hopefully inform interventions among MSM and transgender people,” said Ms Nicole Massoud, Regional Monitoring and Evaluation Advisor for the UNAIDS regional support team.

There are no reliable estimates of the number of men who have sex with men in the region. However, there is documented evidence of increased HIV spread and risk among MSM and transgender people, which may result in concentrated HIV epidemics over the next decade.