Middle East and North Africa Report on AIDS | 2011
Lebanon (37%) and Morocco (30%). Most countries are falling short of the goal of universal access to treatment. Also, the number of people needing treatment has increased from 57 000 in 2001 to 210 000 in 2010, both due to a higher HIV prevalence in the region and a change in the World Health Organization (WHO) guidelines for treatment eligibility. It is worth noting that four countries in the region contribute 85% of the estimated ART eligibility: Iran (26 000), Pakistan (22 000), Somalia (25 000) and Sudan (93 000). Achieving regional targets for ART access mainly relies on these four countries scaling up their national treatment strategy, together with serious commitment to expand HIV testing and counselling, which is the most critical step to accessing treatment.
Major challenges to reach universal access The common threads that link all countries in the MENA region are the insufficient political leadership and stigma and discrimination. Stigma and discrimination is one of the primary reasons that people living with HIV or key populations at higher risk do not have access to essential HIV services, as they constrain the effectiveness of the region’s response to HIV. For example, stigma and discrimination limits: • the ability of governments and civil society to provide services • the ability of key populations to access services that are available • the amount of data available for evidence-informed decision-making. The civil society is playing a significantly larger role in the HIV response than it was only a few years ago. However, one of the key challenges facing CSOs that want to scale-up programmes is the need for the tools and training required to work effectively with key populations at higher risk. Work with key populations can be demanding in any setting; yet, it is significantly more difficult in settings where the levels of stigma and discrimination are high and overall support from government does not exist. Associations for people living with HIV are typically at the frontline of care and prevention for populations affected by HIV. In the MENA region, these associations do not have the staff and financial means to sustain their work. They often face significant and persistent stigma and discrimination within their local communities, which means their outreach work can come with considerable personal risk and makes the path towards realization of positive health, dignity and prevention for all people living with HIV in the region even longer. Finally, funding for HIV prevention is an issue across the region, regardless of a country’s economic status. Based on data supplied by the countries as part of their global reporting, it is clear that the amount of funding allocated for prevention is not sufficient, particularly among countries that can afford to increase their domestic spending on HIV prevention.
Many countries have discriminatory laws and policies, hindering an effective HIV response.
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