The regional HIV epidemic

The HIV epidemic in the WHO Eastern Mediterranean Region has been expanding for the past decade. The estimated number of people living with HIV in the Region was 560 000 in 2010.

Although overall HIV prevalence in the Region is still low at 0.2%, new infections reached 82 000, including 7400 children, in 2010. The rising number of new infections puts the Region among the top two regions in the world with the fastest growing HIV epidemics. At the same time, AIDS-related deaths have been increasing, reaching an estimated 38 000 in 2010.

The regional HIV epidemic reflects the diversity of the Region with different populations being most affected in different places. Countries in the Region are increasingly recognizing the importance of having better data on these varied epidemics.

While only a few years ago there was very little reliable information, today most countries have evidence confirming concentrated epidemics in one or more most-at-risk populations. This includes:

concentrated HIV epidemics among injecting drug users in Pakistan (21%), Islamic Republic of Iran (13%), Libya (22%), Afghanistan (7%) and Egypt (6.7%)

HIV epidemics increasingly noted among men who have sex with men, including in Egypt (6%) and Tunisia (5%)

elevated HIV prevalence among in female sex workers Djibouti, Morocco and Somalia

evidence of onwards transmission of HIV from male migrant workers to their spouses upon return to their home countries.

The response to HIV in the Region: achievements and gaps

Treatment

The availability, access and quality of health-sector interventions for HIV/AIDS varies greatly between countries of the Region.

Access to treatment has improved steadily, with a nearly 25% increase in people on antiretroviral therapy (ART) between 2009 and 2010, from 15 473 to 19 050.

Nonetheless, the Region continues to demonstrate the lowest coverage of all regions in key HIV health sector interventions. This includes:

10% coverage for ART

5% coverage for paediatric HIV treatment

4% coverage for effective antiretroviral regimens to prevent mother-to-child transmission.

Five countries in the Region contribute over 80% of the estimated 190 900 people living with HIV regionally in need of ART: Sudan and South Sudan (together 93 000), Islamic Republic of Iran (26 000), Somalia (25 000) and Pakistan (22 000).

Voluntary HIV counselling and testing

Although knowing ones HIV status is a pre-condition for accessing treatment, increasing access to HIV testing remains a challenge. Most HIV testing in the Region is mandatory, and even where quality voluntary HIV counselling and testing is available, it is not always readily accessible to those at highest risk. Nearly 60% of HIV tests carried out between 1995 and 2008 were for migrant workers, while only 4% of tests were for key populations at higher risk.

Reaching most-at-risk populations

Sexual transmission is a major driver of the HIV epidemic in the Region and reducing it requires reaching the populations at greatest risk of HIV exposure, including men who have sex with men and sex workers. There is still very limited experience and capacity in developing the most efficient and appropriate strategies and service-delivery models for these population groups in most countries. The same situation prevails regarding the prevention of HIV infection among people who use drugs.

Main challenges

The major challenges for an effective response to the HIV epidemic in the Region are:

insufficient or unreliable information on the extent and local trends of the HIV epidemic

low national commitment and domestic investment in HIV programmes with a growing dependence on Global Fund to Fight AIDS, Tuberculosis and Malaria grants in low and low-middle income countries, although fewer countries will qualify for support according to new eligibility criteria (2012)

the stigma attached to HIV and to risk behaviours associated with HIV transmission, and the discrimination towards people living with HIV and people engaging in risk behaviours

inadequate approaches in the delivery of prevention services for people at risk of HIV and in the delivery of treatment and care services for people living with HIV (e.g. lack of integration where possible and lack of targeted approaches where needed)

limited engagement and capacities of civil society organizations, who are often better suited to reach stigmatized populations

the need to intensify strategically-useful partnerships within the Region and with other organizations globally.