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AIDS and the Middle East

23rd October 2006

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Estimates by the World Health Organization and the joint United Nations programme on HIV/AIDS show that HIV prevalence is low in the Middle East and North Africa region, at just 0.2%.

This is confirmed by studies of blood donors in Egypt, Jordan, Palestine, Iraq, and Syria, and by screening of patients admitted to hospital in Saudi Arabia.

Concentrated epidemics (prevalence of 5% or more in some subpopulations), are reported among intravenous drug users in Iran and Libya, whereas generalised epidemics (prevalence among pregnant women of over 1%) have been documented in Djibuti, Sudan, and some areas of Somalia.

The most recent estimate of the number of people living with HIV/AIDS in the Middle East and North Africa region is about half a million; the reliability of the estimate is low because of the paucity of accurate statistics, and depending on which countries are included in the definition of the region it may be higher or lower.

Overall, however, it suggests that the region comprises about 5% of the global population, but it accounts for a much lower percentage of people living with HIV/AIDS: about 1%.

A comparative analysis of data from African countries showed that the prevalence of HIV was negatively associated with the percentage of the population that is Muslim, but that the link between being Muslim and sexual risk factors is ambiguous and variable.

It is possible that some practices among Muslim populations contribute to decreasing the risk of HIV transmission. One is low alcohol use, which reduces disinhibition and hence risky behaviour. Another is male circumcision, which was shown to reduce infection in a recent trial, and whose protective effect may be shown if other ongoing trials find similar results.

However, traditional Muslim approaches have tended to be conservative, and it is difficult to break the silence around issues of sexual behaviour, especially those that deviate from religious norms.

An analysis of religious magazines and doctrinal pronouncements (fatwas) of the past decade found that strong moralising views prevailed; HIV was seen as divine punishment for deviance, whereas religion was a protection. Hence in many settings fears of stigma and discrimination are great against people living with HIV/AIDS. But more flexible approaches can also be found. A theology of compassion and approaches advocating harm reduction seem to be emerging in several Muslim countries, and greater acceptance of HIV positive people is justified with reference to religion.

The Middle East and North Africa region is generally thought to be characterised by gender inequality, and indeed many indicators of women's position are unfavourable.

Statistical evidence indicates that the percentage of women among people living with HIV/AIDS is lower in the Middle East and North Africa (most under 25%) than in other regions (for example, 57% in sub-Saharan Africa).

Several practices increase women's vulnerability: marriage patterns and age differences between spouses; cultural expectations of women's innocence, making it difficult for them to access information on risks; and the resurgence of early forms of temporary marriages, which may be religously sanctioned in circumstances such as poverty, travel, or tourism.

Medicines for HIV are now provided in several countries, with some governments providing antiretrovirals free of charge or at subsidised prices. But global statistics show that the availability of antiretrovirals in the Middle East and North Africa is largely insufficient (about 5% of those needing treatment), underscoring the need for greater mobilisation to scale up access to treatment.

Although knowledge is still inadequate and stigma and discrimination prevail in many settings, there is greater visibility and more public discussion of HIV/AIDS in the region.


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