There is no single epidemic in the Middle East and North Africa – learning from facts to shape the AIDS response

UNAIDS Secretariat, the World Bank and WHO

7th August 2008

Socio – Political Context in MENA

HIV epidemic – trends, patterns

Snapshot of the response to AIDS in the region - socio-cultural and political context related to HIV

Main challenges, opportunities

Outline

Socio – Political and Economic Context in MENA 431 million people in 22 countries: One third of the population in the

region is below 15 years old

Gender differences are still considerable: education, work opportunities, public life

Diverse development indicators Life expectancy – 43 to 79 years old age range

Contrasting economic situation: low income to high level income

Pervasive conflict, political instability and insecurity – threatening the developmental gains made

Summary of Situation, December 2007

There is no single epidemic in MENA: HIV prevalence estimated 0.3% with notable variations Low prevalence

Concentrated among IDUs

Generalized

Estimated 40 000 new infections Diverse epidemic situations

Sexual transmission is the main mode of infection

Drug injecting-related transmission in Afghanistan, Iran, Libya with

variations and diversity within the country

Increasing MTCT data in a few countries

Diversity and Patterns of Epidemic Increased evidence of diverse epidemics across geographical areas

within the country

Higher level of infection and risk behaviors among most at risk of populations

Low level of condom utilization among sex workers and limited availability

and access to adapted HIV prevention services

Increased concern with HIV prevalence rates among men who have sex

with men [6.2% in Egypt, 9.3% in Sudan, etc]

Evidence of overlapping risks between different patterns of sexual transmission as well as with drug injection

Evidence of emergence of concentrated epidemics among populations and specific settings in MENA

Other Aspects of Vulnerability

Changing norms of behavior of young people

Prison setting – high risk behaviors and document elevated HIV prevalence in a few countries

Mobility and migration Economic within the region and across the region

Conflict and instability

E.g. North Africa, Red Sea and Gulf of Aden, Gulf countries

Socio-economic and gender disparities

Example of risks and vulnerability -Needle Sharing

Emergence of drug injecting as a potential important driving factor of the epidemic

41%47%

59.00%64.70%

44%

0%

10%

20%

30%

40%

50%

60%

70%

Algeria Morocco Egypt Lebanon Libya

Elevated levels of needle sharing

Risk of overlapping risks and bridging populations

Sex work

IDU

MSMe.g. 20 – 87% have female partners

Partners

MENA an Opportunity to avert the epidemic and reach Universal Access

Snapshot of the Response‘Comprehensive’ response – recognize HIV within national priorities and have embraced Universal Access

Algeria, Djibouti, Morocco, Somalia, Sudan, Iran Relative visibility of epidemic, link between HIV and politically important

concerns (IDU in Iran)

Adapted and potentially effective responses – frame AIDS as a programmatic priority and have adopted Universal Access

Jordan, Lebanon, Oman, Tunisia, Yemen Efforts to adapt and focus the response to the prevalence settings (MARPs,

people living with HIV, scaling up)

Overcoming key political obstacles – stage of the responsecoupled with political constraints on how AIDS is positioned

Egypt, Gulf Countries, Libya Limited profile of the AIDS response due to related concern of political

considerations

Snapshot of the Response

Security and post-conflict context –facing devastating impact of conflicts, humanitarian crisis and security challenges

- Afghanistan, Iraq, and Occupied Palestinian Territories, Somalia

Yemen, UNHCR

Snapshot on HIV response in MENA

Prevention: Increased focus on those most in need, establishment of programmes for key populations in several countries

(sex work, IDUs, MSM, migrants and specific groups)

Treatment, care and support: Increased access to treatment but far from sufficient – 7% of those in need receive treatment

Resources: Approx. US$ 431 million from GFATM for HIV in MENA over the last four years

Services: Increased coverage in terms of availability of services –

establishment of VCT sites at decentralized level, treatment sites

Civil Society and Associations of people living with HIV: Regional network revitalized, increased involvement of NGOs in theresponse

Invigorated associations and support groups of people living

Morocco

Algeria

Tunisia

Libya

Sudan

Somalia

Djibouti

Egypt

Iran

Afghanistan

Yemen

Saudi Arabia

Iraq

Oman

UAE

Bahrain

Qatar

SyriaLebanon

Jordan

OPT

Emergence of actions and programmes for Sex work and HIV

’90s

’99 -2000

2005 Regional Training on Sex Work

Multi sector response, reaching most at risk and vulnerable groups, involvement of civil society and PLHIV

Scaling up Towards Universal Access to HIV Prevention,

Treatment, Care and Support

Political

Commitment

-NACs

-Public resources to AIDS

Social

Stigma

Discrimination

-MARPs

-People living with HIV

-Travel restrictions & other policies

Know your Epidemic

Scale up the response

-Effectiveness, coverage, sustainability, resources

Challenges

Scaling up towards Universal Access for all in the Middle East and North Africa