More than 85 per cent of people who need life-saving HIV treatment in the Middle East do not receive it, as stigma and limited access to testing remain strong barriers to combating the virus.
As a result, the World Health Organisation (WHO), along with the Joint United Nations Programme on HIV/AIDS (UNAIDS), are campaigning to accelerate HIV testing and treatment coverage in the Middle East and North Africa (MENA) – a region that by far has the lowest access rates to treatment in the world.
In addition, UNAIDS estimates that about 80 per cent of people living with HIV in the region are not aware they are carrying the virus.
While the number of people becoming infected with HIV has slowed worldwide and AIDS-related deaths have slowed, this is not the case in MENA.
While there is limited reliable data, the WHO said in 2012, 347,000 people were living with HIV in MENA, a 127 per cent increase over the number living with HIV in 2001. In 2012, according to UNAIDS, there was up to 42,000 new infections and up to 26,000 AIDS-related deaths.
Ali Feizzadah, Regional Strategic Information Adviser at UNAIDS Middle East and North Africa, said there were several barriers preventing people in the region from accessing anti-retroviral therapy, including poor access to HIV testing and counselling and social stigma.
“Poor access to HIV testing and counselling is the result of several factors including low awareness and the fact that many people are not aware of the availability of testing and effective treatment options,” he said.
“Stigma and discrimination, and fear of being stigmatised or discriminated against by health care workers, friends and family add to the barriers against utilising available services. However, availability of services is also very low in the region; per capita, the region has the lowest number of HIV testing facilities of any region.”
As a result, the WHO is calling for urgent action to end the HIV treatment crisis, including that people living with HIV have easy access to testing and that those in need of life-saving anti-retroviral therapy, get it.
In Egypt, where HIV transmission is considered low (less than 1 per cent), stigma remains very high, largely because of government inaction, Egyptian sexual health activist, Ahmed Awadalla, said.
“The government doesn’t provide comprehensive sexual health education programs in schools, nor does it use nation-wide media campaigns to sensitise the public and create conversation,” he said.
“As a result, misconceptions, myths and negative attitudes are rife. Most people are afraid to come forward and get tested or access services … because stigma can lead people to lose their jobs and be shunned by loved ones. Mass education programs and anti-discrimination policies need to be promptly implemented to change this picture.”
Mr Awadalla, who is a sexual and gender-based violence officer at the African and Middle East Refugee Assistance, added that only 3 per cent of Egyptian youth have accurate knowledge of all HIV transmission routes.
Consequently, many of those living with HIV in the region are forced to keep their status a secret – shrouded behind a wall of public denial.
“Is there a ‘conspiracy of silence’ resulting in a failure to confront a public health scourge?” Dr Laith Abu-Raddad, from the Infectious Disease Epidemiology Group at Weill Cornell Medical College, along with colleagues, asked in an editorial in the medical journal BMJ recently.
While the authors noted that progress had been made in terms of HIV surveillance in the region, they emphasised that some areas of research were almost non-existent.
“Public health authorities in MENA have increasingly acknowledged that, in order to understand the dynamics of the HIV epidemic in their countries, it is important to know the trends in HIV and risk behaviour among the key populations at risk,” they wrote.
“The HIV epidemic is a growing reality that must be countered by an aggressive response.”
But as long as HIV remains a taboo topic, so too will peoples’ diagnoses and treatment in a region where same-sex relationships and premarital sex are often a crime.