From: Berhane Habtemariam (Berhane.Habtemariam@gmx.de)
Date: Wed Jun 30 2010 - 08:32:29 EDT
MIDDLE EAST: New HIV report turns up some surprises
DUBAI, 30 June 2010 (IRIN) - Statistics on the prevalence of HIV/AIDS in the
Middle East are hard to come by but a new study launched on 28 June in the
United Arab Emirates has attempted to gather all existing data into one
place and add some analysis and action points for policymakers.
"In all previous reports we thought there was no HIV data from this region.
But there turned out to be lots of data here," said Laith Abu Raddad,
director of the Biostatistics and Biomathematic Research Core at Weill
Cornell Medical College in Qatar and the principal author of the study (not
yet available online).
"This report is basically more like a scientific epidemiological study:
Getting pieces of data, thousands of data that we managed to collect from
every country in the region, putting them together and analysing them to see
what they tell us in terms of HIV epidemiology," he said.
The report, characterizing the HIV/AIDS epidemic in the Middle East and
North Africa, is a joint effort of the World Bank, the UN Joint Programme on
HIV/AIDS (UNAIDS) and the World Health Organization (WHO). It covers 23
countries that the three organizations include in their MENA (Middle East
and North Africa) region.
According to UNAIDS, about 412,000 people were living with HIV in MENA by
the end of 2008, up from 270,000 in 2001. The report said most new
infections were from within commercial sex and drug-taking populations.
The report divides the MENA region into two categories according to HIV
prevalence: the "subregion with considerable prevalence" (Djibouti, Somalia,
Southern Sudan); and the Core MENA region, where HIV prevalence is described
as "very limited" (the rest of MENA countries).
Sudan, Somalia and Djibouti
"In north Sudan, we used to think in the past that we have a much more
serious problem of HIV but now the data set is more complete, it's clear
that north Sudan really is quite similar to the rest of the MENA countries.
But in south Sudan we may have a generalized epidemic," Abu Raddad said. A
generalized epidemic is one that has spread beyond high-risk minority
populations to the general population.
A 2003 UNAIDS and WHO report referred to in the study said Sudan had a 2.6
percent HIV prevalence rate.
Abu Raddad said Djibouti "was the Disneyland of risk behaviour" and had a
large number of Ethiopian sex workers serving truck drivers and foreign army
bases. "We have this corridor which is certainly full of HIV, but the rest
of the country is fine," he noted.
A 2008 UNAIDS report said Djibouti had a 3.4 percent HIV prevalence rate in
its capital and a 1.1 percent rate outside it.
"Technically speaking, the HIV epidemics in Djibouti and Somalia are already
generalized, but the context of HIV infection and risk groups in these
countries suggests that HIV dynamics are mainly focused around concentrated
epidemics in the commercial sex networks," said the new report.
Pakistan, Afghanistan and Iran
The report said Pakistan and Iran, where HIV prevalence is low among the
general population, faced concentrated HIV epidemics among injecting drug
users (IDUs), while this was also a significant mode of transmission for HIV
in Afghanistan.
"We know we have a concentrated epidemic among IDUs in Pakistan, and the
increase was very rapid over the past few years. In Karachi, for example, we
had near zero percent among this group in 2003 or 2004 and then within six
months it jumped to 24 percent."
He said this increase could be attributed to needle sharing, poverty and a
lack of awareness.
Egypt and Tunisia
Egypt has a different pattern in terms of the spread of HIV. Surveys of risk
groups showed that HIV prevalence was very low among IDUs and female sex
workers (FSWs). "This is not a surprise for FSWs. In those kind of
conservative countries in the region - and Egypt is one them - we see very
little prevalence of HIV among FSWs. But having very low prevalence among
IDUs is quite a surprise," Abu Raddad said.
He said that Egypt appeared to be having an HIV epidemic among men having
sex with men (MSM), at a prevalence rate of 6 percent.
"The country also has an interesting pattern. Usually HIV epidemics start
with IDUs and then move to MSM, which we see in Iran and Pakistan. But this
is not the case in some countries, like Egypt and Tunisia, where the
epidemic is starting with MSM," Abu Raddad said.
Dearth of data
Experts said that despite all the information from different sources that
the new report brings together, the region still does not have enough data
to form a coherent strategy to tackle HIV/AIDS. The report conceded that the
MENA region "continues to be viewed as the anomaly in the HIV/AIDS world
map".
"This is because we have not invested enough in building the right
surveillance systems, so we don't have systems that actually detect and
follow up on this issue," Hind Khatib, regional director of UNAIDS, told
IRIN.
"Political commitment should be matched with domestic resources and
investment in human resources, which is limited in the region. You have to
spend on your programmes and systems and you have to have strategic
directions that are focused on the drivers of the epidemic," Khatib said.
She said she hoped to see the governments of the many low-income countries
in the region allocate more funds to HIV programmes, particularly in light
of the fact that the financial crisis had made it harder for countries to be
eligible for assistance from the Global Fund to Fight AIDS, Tuberculosis and
Malaria.
Experts agreed that the main challenge for the region was the stigma of
HIV/AIDS and discrimination against people living with it.
"We have to bring in the people living with HIV and the civil society. We
have to open up in our thinking and policies," Khatib said.
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