Time for Strategic Action on HIV/AIDS in MENA Region

“We are no longer in the dark in terms of HIV spread
in MENA," says assistant professor of public health
Laith Abu-Raddad, PhD, who served as lead author
and principal investigator of the scientific study.

Laith Abu-Raddad, PhD, assistant professor of public health, played a leading role in development of a new regional report on HIV/AIDS in the Middle East and North Africa. The report, entitled “Time for Strategic Action,” was produced by the World Bank in collaboration with UNAIDS and WHO. It brings together, for the first time, a comprehensive collection of evidence on the spread of HIV in the MENA region.

The new report addresses what was a dearth of strategic information regarding the spread of HIV in MENA and summarizes the findings of the largest scientific study on HIV/AIDS in the history of the MENA region, providing the first comprehensive scientific assessment of the spread of HIV in MENA across different population groups and the various countries of the region.

Abu-Raddad, a World Bank Consultant, was the lead author and principal investigator of the scientific study. “We are no longer in the dark in terms of HIV spread in MENA. After nearly seven years of research, we have at last a comprehensive view of the status of the epidemic in this region and of the populations and countries most affected by this disease. The roadmap for what needs to be addressed in relation to HIV in MENA is now clear in front of us,” says Dr. Abu-Raddad.

The findings of the report advocate that policy efforts in MENA should focus HIV response among risk groups, rather than the general population where HIV transmission is very limited. Since the epidemic among these groups is still nascent, there is still a window of opportunity to address it before it grows steeply, an opportunity however that is narrowing and needs to be addressed.

The key findings of the report were disclosed during a briefing this morning in Dubai, UAE, attended by over 100 high-level participants, including Ministers of Health and Heads of the National AIDS Councils, and representatives of international agencies, the media, the civil society and the private sector /business leaders. The official launch of the report will be conducted at a special ceremony at the World Bank headquarters in Washington, DC.

Akiko Maeda, Manager for Health, Nutrition and Population Sector in the Human Development Department at the World Bank, said “Despite much progress in understanding HIV infectious spread globally, the Middle East and North Africa (MENA) region stands as the only region where knowledge of the epidemic continues to be very limited, inaccessible, and subject to much controversy. The MENA region is widely perceived as the anomaly in the HIV/AIDS world map and a real hole in terms of credible data.”

The involvement of Weill Cornell College in Qatar (WCMC-Q) in this study underlines the growing research capabilities of Qatar, particularly at WCMC-Q, which is a leading regional center of excellence in genomic biomedical research, according to Dr. Javaid Sheikh, dean.

“Dr. Abu-Raddad is a leading international researcher with vast experience in biostatistics and biomathematics. With its world-class research expertise and capabilities, WCMC-Q is well positioned to help Qatar reach its goals in research, science and the development of a knowledge economy,” says Dr. Sheikh.

Key scientific findings of the report:

• The evidence gathered indicates that, with the exception of Djibouti, Somalia and Southern Sudan, HIV transmission in the general population of MENA is limited and amongst the lowest worldwide. However, pockets of HIV transmission exist all over MENA in specific populations. HIV infections are found among networks and contacts of injecting drug users (IDUs), men who have sex with men (MSM), and female sex workers (FSWs) and their clients. In MENA, men practice most of the high-risk behaviors, and the majority of women acquire their infection from their infected spouses.

• While overall there is no considerable HIV transmission in the general population of MENA, substantial epidemics have emerged in the last decade among the three population groups of IDUs, MSM, and to a lesser extent FSWs and their clients; with variability between countries as to which of these population groups is experiencing the rising HIV epidemics.

• Overall, there was conclusive evidence for rising substantial epidemics among IDUs in a few countries and HIV prevalence, that is the fraction of individuals in a population group that are infected, ranged between 0 and 38%, reaching even higher rates among certain select injecting populations. (See table at right.) Levels of sharing of non-sterile injecting equipment were high among IDUs, which increases the risk of HIV transmission among members of this network.

• While HIV prevalence among MSM in MENA still remains lower than in other regions (range 0-28%), several countries are experiencing rising epidemics among this group and by 2008, this mode of transmission accounted for an increasing number of the total HIV infections in several countries. MSM in MENA appeared to engage in high levels of risk behavior such as multiple sexual partnerships, high levels of male sex work, and low rates of consistent condom use.

• Finally, the prevalence of female sex work in MENA is lower than global figures and generally, HIV prevalence among FSWs is still at low levels in most MENA countries, though at levels much higher than in the general population. Large epidemics among FSWs are found mainly in the regions bordering sub-Saharan Africa, namely Djibouti, Somalia, and Southern Sudan.

Press release by Kristina Goodnough