UNAIDS Update
UN report criticises AIDS surveillance in MENA region

UNAIDS recently released the AIDS epidemic update 2005 report. Callan
Emery takes a look at what the report has to say about the Middle East
North Africa region.

The AIDS epidemic update 2005, a joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation (WHO) report, released in December has some alarming information.

Worldwide there are now more than 40 million people living with HIV/AIDS. In 2005 nearly five million people became infected with HIV.

This is more than in any other single year since the first case was diagnosed in 1981, despite increasing worldwide efforts to fight the spread of the disease. HIV/AIDS has now touched virtually every country in the world, and continues to destroy health, lives, families and societies. In 2005 alone, AIDS caused the deaths of approximately 3.1 million people worldwide, 570,000 of these were children under 15 years of age.

MENA region

The Middle East North Africa (MENA) region has not escaped the voracious spread of HIV/AIDS. According to the AIDS epidemic update 2005 67,000 (35,000-200,000) people became infected with HIV last year in the MENA region and an estimated 58,000 (25,000-145,000) adults and children died of AIDSrelated conditions.

It is estimated that there are 510,000 (230,000-1.4 million) people living with HIV in this region. However, a large proportion of these figures can be attributed to Sudan which, according to the report, is by far the worst-affected country in the region. The hard-hitting report criticises the lack of effective HIV surveillance in the Middle East and North Africa and says data remains insufficient for many countries in the region.

The report goes on to say that “substantive efforts are clearly needed to introduce more effective HIV prevention strategies in the Middle East and North Africa. HIV prevention programmes and services remain sporadic in the region. Knowledge of AIDS is generally poor and preventive practices are rare.” The main mode of HIV transmission is unprotected sex “although injecting drug use is becoming an increasingly important factor”.

Here it points to Iran: “HIV is circulating widely among drug injectors, of whom there were an estimated 200,000 in 2003, and looks set to spread further. “Most of the users were young (median age was 25 years) and three quarters of them were injecting heroin. About 40% of those who had used non-sterile injecting equipment had done so in prison. Indeed, incarceration appeared to be associated with risk behaviours for HIV infection – a troubling finding, given that, by some estimates, almost half Iran’s total prison population comprises people detained or convicted on drug-related charges.”

According to a recent report by BBC reporter Andrew North, “Afghanistan does not have a major AIDS problem – on paper”. He says there are only 35 confirmed cases at Kabul's blood bank – but the reality in the war-shattered country is much harder to gauge. Like Iran, Afghanistan has an estimated one million injecting drug users and the UN fears AIDS could spread rapidly among them. The UN report also notes that in some countries in the region strong sociocultural taboos about sex between men could be hiding this behaviour as a factor in HIV transmission. “Across the region, there is a clear need for more, better and in-depth information about the patterns of HIV transmission, especially the roles of sex work and of sex between men.”

In Yemen, HIV transmission is believed to be related to commercial sex, while injecting drug use appears to be a more prominent mode of transmission in Bahrain, Kuwait and Oman. About 600-1,000 people are believed to be living with HIV in Jordan, where adult HIV prevalence appears to be very low (about 0.02%). About half the infections are attributed to unprotected sex; yet, an extensive survey among young people has found casual sex was relatively rare and condom use moderately high (40%) among those who did have non-marital sex. In Saudi Arabia “research conducted in the capital Riyadh indicates that about half of HIV infections have been occurring during heterosexual intercourse.

Most women infected with HIV were married and had acquired the virus from their husbands, while most men had been infected during paid sex. Sex between men and injecting drug use accounted for a small minority of infections, but a large proportion (26%) of infections found in this study were attributed to the transfusion of contaminated blood or blood products early in the epidemic. The overall scale remains unknown, however, with estimates of the number of people living with HIV ranging from just over 1,000 to more than 8,000,” according to the UNAIDS report.

Official data from Egypt indicate an epidemic that is driven mainly by unprotected sex – with heterosexual intercourse accounting for about one half of HIV cases where the mode of transmission was noted, and sex between men for a further one fifth. Injecting drug use was the mode of transmission in just 2% of HIV cases. The report fails to mention any facts and figures for the UAE, Syria, Palestine and Lebanon, suggesting that there is scant information provided by these countries.

World AIDS Day

Dr Peter Piot, the executive director of UNAIDS, said on 1 December – the 18th World Aids Day: “The world faces a choice in the global response to AIDS. We can either continue to accept that global efforts will fail to keep pace with ever increasing numbers of HIV infections and AIDS related deaths or we can recognise the exceptional global threat posed by AIDS and embrace an equally exceptional response.

“The lessons of nearly 25 years into the AIDS epidemic are clear. Investments made in HIV prevention break the cycle of new infections. Investments made in HIV treatment and care give people longer, better and more productive lives. By making these investments, each and every country can reverse the spread of AIDS.

“At the World Summit in New York last September, all UN Member States pledged to developing and implementing a package for HIV prevention, treatment and care with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it. Effective comprehensive prevention treatment and care programmes need to be scaled up on a massive scale so that everyone who needs them can benefit from them,” Piot said.