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HIV/AIDS cases rising in Mideast, North Africa

by Cesar Chelala

The number of cases of HIV/AIDS in the Middle East and North Africa (MENA) region, although small compared to other regions in the world, is significant and is a cause for concern.

Although the MENA region has just 2 percent of the world’s HIV caseload, it is one of two regions in the world with the fastest growing HIV/AIDS infection rate.

According to U.N. statistics, 500,000 adults and children in the region live with the virus. AIDS-related mortality has almost doubled in the past decade among adults and children while diminishing or remaining the same in the rest of the world.

The predominance of the infection among some groups of people in the MENA region reflects the diversity of the countries’ population as well as the differing attitudes, culture, political commitment and the availability and access to HIV services.

While in some countries it affects mainly people who inject drugs, in other countries it tends to afflict men who have sex with men or with sex workers.

The existence of a large population of male migrant workers in the region explains the spread of the infection upon their return to their home countries. The assumption is that a large proportion of women living with HIV in the region acquired the infection from spouses who practiced high-risk sexual behavior while away from them.

Several factors explain the sharp increase in the number of HIV-infected people in the Middle East and North Africa. Among those factors are a lack of awareness, denial of reality and misinterpretation of facts.

Other important issues are income inequalities, labor migration, unemployment — particularly among the young — gender inequality and a number of social and cultural values and prejudices in the sundry societies.

The economic costs of a large HIV/AIDS epidemic can be substantial. A World Bank study estimates that a full-blown HIV/AIDS epidemic could reduce the average growth rate in the MENA region by 1.5 percent per year for the period 2000-2025.

Cumulatively this would represent a potential loss in production of about 35 percent of the current gross domestic product value by 2025.

Several studies show that poverty and income and gender inequality facilitate the spread of HIV epidemics. While the incidence of abject poverty in the MENA region is relatively low, a significant proportion of the population lives on less than $2 per day, which makes it extremely vulnerable to the effects of the epidemic should anybody in the household be affected by the infection.

The overall response to the infection is still inadequate despite innovative interventions by some nongovernment organizations. Stigma against the infection is remains widespread, hindering the implementation of effective policies.

Stigmatized HIV-infected people suffer from low self-esteem and are more likely to engage in high-risk behavior. Others go underground, making it harder to conduct epidemiological surveillance to keep track of the infection.

Because a significant proportion of the population is under 24 years of age, special programs and messages should be targeted at this age group.

It is estimated that, by 2035, the MENA region will have 100 million youths whose needs and aspirations will have to be addressed properly. Street children should be included in education and prevention efforts. A World Bank report estimates that more than 70 percent of male street children in Egypt are engaged in commercial sex.

To keep HIV/AIDS prevalence rates low, there are four levels of intervention: advocacy, information/education, prevention and timely treatment.

It is widely known that HIV/AIDS is a developmental issue that demands the collaboration of different sectors and actors to implement adequate policies.

The relatively low rates of infection have made governments in the region complacent in their approach to HIV/AIDS infection, which is precisely the wrong way to deal with this situation.

There is now a window of opportunity to control its spread and avoid a catastrophic epidemic in the future.

Cesar Chelala, M.D. and Ph.D., is an international public health consultant and the author of “AIDS: A Modern Epidemic,” a publication of the Pan American Health Organization.