MSM HIV EPIDEMIC IN MIDDLE EAST AND NORTH AFRICA

Researchers have warned that HIV epidemics are emerging in several countries in the Middle East and North Africa among men who have sex with men (MSM).

They say that though HIV infection levels were historically very low in the Middle East and North Africa, substantial levels of HIV transmission have been found, beginning in 2003, among MSM.

To complicate matters MSM are a largely hidden and stigmatised population in this part of the world, where homosexuality is criminalised and even incurs the death penalty in some regions.

“The Middle East and North Africa can no longer be seen as a region immune to the HIV epidemic,” said Ghina Mumtaz, a senior epidemiologist at Weill Cornell Medical College-Qatar and the main author of the study.

“Based on multiyear analysis of thousands of data sources, we documented a pattern of new HIV epidemics that have just emerged among men who have sex with men in the last few years in several countries of the region.”

The study reports that rates of HIV infection among MSM vary across the region but have already exceeded 5 percent, the threshold defining concentrated epidemics, in several countries such as Egypt, Sudan and Tunisia.

In one area of Pakistan, the infection rate among men who have sex with men has already reached 28 percent. Moreover, by 2008, transmission of HIV via anal sex among men represented more than a quarter of reported cases of HIV in several countries in the region.

“The level of HIV infection among men who have sex with men tells only half of the story. We also documented high levels of risky practices that will likely expose this population to further HIV transmission in the coming years,” said Dr. Laith Abu-Raddad, principal investigator of the study.

Roughly 2–3 percent of males were found to engage in anal sex with other males, a rate that is comparable to that in other regions. These males were typically involved in several types of HIV-related, high-risk behaviour. For example, they had between 4 and 14 sexual partners in the past six months and their rates of consistent condom use were generally below 25 percent.

In addition, between 20 and 75.5 percent of men who have sex with men exchanged sex for money, and these men commonly had several female sexual partners. The researchers also found a considerable level of intravenous drug use among men who have sex with men.

“There is a narrowing window of opportunity to prevent further epidemics. Policy-makers in the Middle East and North Africa should address this growing health challenge from a public health perspective. This will also limit the potential for HIV transmission to spread to other population groups,” said Mumtaz.

A few countries in the region have started to develop creative means of dealing with this public health issue through the establishment of surveillance systems and support for non-governmental organisations that deliver HIV services. However, the authors emphasised that these programs need to be expanded in scale and initiated in all countries to achieve a substantial impact.

The findings were published this week in PLoS Medicine and represent the first study of its kind.