Middle East and North Africa

The advance of AIDS in the Middle East and North Africa has continued with latest estimates showing that 35,000 [16,000-65,000] people became infected with HIV in 2007. Approximately  380,000 [270,000-500,000] people are living with HIV in this region.

Although HIV surveillance remains weak in this region, more comprehensive information is available in some countries (including Algeria, Libya, Morocco, Somalia, and Sudan). Available evidence reveals trends of increasing HIV infections (especially in younger age groups) in such countries as Algeria, Libya, Morocco and Somalia.

The main mode of HIV transmission in this region is unprotected sexual contact, although injecting drug use is becoming an increasingly important factor (and is the predominant mode of infection in at least two countries, Iran and Libya).

Infections as a result of contaminated blood products, blood transfusions or a lack of infection control measures in health care settings are generally on the decline, but remain problems in some countries. The percentage of total reported AIDS cases attributed to contaminated blood decreased from 12% in 1993 to 0.4% in 2003.

Except for Sudan, national HIV prevalence levels are low in all countries of this region. However, most of the epidemics are concentrated geographically and among particular at-risk populations, including sex workers and their clients, drug injectors, and men who have sex with men.

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.

On both fronts, scant information has been gathered; this suggests that there is a likelihood that HIV is transmitted through other risky behaviours or in other contexts.

For example, in several countries of this region, a combination of inadequate surveillance data and strong sociocultural taboos against sex between men could be hiding sex between men as a factor in HIV transmission.

Little is known about HIV transmission in prisons, although available data point to elevated risk in those settings. HIV prevalence of 18% has been reported in prisons in Tripoli, Libya, 2% in Sudan in 2002 and almost 1% in Morocco in 2003.

HIV prevention programmes and services remain sporadic in this region. Knowledge of AIDS is generally poor, and preventive practices are rare, even among populations most at high risk of becoming infected. Substantive efforts are clearly needed to introduce more effective HIV prevention strategies in the Middle East and North Africa.