BEIRUT — At a time when HIV rates have stabilised or declined elsewhere, the epidemic is still advancing in the Arab world, exacerbated by factors such as political unrest, conflict, poverty and lack of awareness due to social taboos.
According to UNAids (the Joint United Nations Programme on HIV and Aids), an estimated 270 000 people were living with human immunodeficiency virus (HIV) in the countries of the Middle East and North Africa (MENA) region in 2012.
“It is true that the Arab region has a low prevalence of infection, however it has the fastest growing epidemic in the world,” warns Dr Khadija Moalla, an independent consultant on human rights/gender/civil society/HIV and Aids.
With the exception of Somalia and Djibouti, the HIV epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users.
The United Nations estimates that there were 31 000 new cases and 16 500 new deaths in 2012 alone. “Infections grew by 74% between 2001 and 2012 while Aids-related deaths almost tripled,” Dr Matta Matta, an infection specialist based at the Bellevue Hospital in Lebanon, says.
However, both Moalla and Matta explain that figures can be often misleading in the region, due to under-reporting and the absence of consistent and accurate surveys.
With the exception of Somalia and Djibouti, the epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users.
In Libya, for example, 90% of those in the latter category also live with HIV, notes Matta. Furthermore, adds Moalla, most Arab countries do not have programmes allowing for exchange of syringes.
The legal framework criminalising such activities in most Arab countries means that it is difficult to reach out to specific groups.
With the exception of Tunisia, which recognises legalised sex work, female sex workers who work clandestinely in other countries are not safeguarded by law and thus cannot force their clients to use protection, which allows for the spread of disease.
Lack of awareness, the absence of voluntary testing and of sexual education, social taboos, as well as poverty, are among the factors driving HIV in the region.
“Arab governments and societies deny the epidemic and the absence of voluntary testing means that for every infected person we have ten others that we do not know about,” stresses Moalla.
People living with HIV or those at risk face discrimination and stigma. “More than half of the people living with HIV in Egypt have been denied treatment in healthcare facilities,” Matta explains.
This bleak scenario is compounded by the security challenges prevailing in the region which not only make it difficult to deliver prevention and other programmes, but also restrict access to services by those on treatment and cause displacement and loss of follow-up according to the UNAids report.
The war in Iraq that began in 2003, for example, led to the destruction of most of the country’s programmes and facilities under the National Aids Programme and, according to Moalla, the national aids centre in Libya was recently burnt down.
In addition, in some countries, conflict has significantly increased the vulnerability of women. By 2012, for example, only 8% of the estimated number of pregnant women living with HIV in the MENA region received appropriate treatment to prevent mother-to-child transmission according to the UNAids report.
Meanwhile, only a few governments have worked on effective programmes to fight the epidemic, although there are signs of the emergence of non-governmental organisations tackling the problem with people living with HIV and providing them with support.
“North African countries and Lebanon have generally done better than others, while Gulf countries are doing the least,” Moalla, adding that less than one in five people living with HIV are receiving the medicines they need in the Arab region, said.
While some efforts have been made with the UNDP HIV Regional Programme pioneering legal reform in several countries, as well as drafting an Arab convention on protection of the rights of people living with HIV in partnership with the League of Arab States, these are not enough.
“The Arab world attitude taking the high moral ground on the issue of HIV is no barrier for the epidemic,” Matta says. “The region’s governments need to address a growing problem that is only worsened by the general upheaval.”