Available data illustrate that the passive facility-based surveillance at STD clinics and VCT centers is to a large extent not capturing the dynamics of HIV transmission in MENA. An active surveillance among priority populations incorporating an integrated biobehavioral surveillance methodology would be a much more effective approach in generating interpretable data on HIV epidemiology in MENA.
HIV/AIDS AMONG TUBERCULOSIS PATIENTS HIV/AIDS among tuberculosis (TB) patients is a useful indicator of the maturity of the HIV epidemic in a given setting because it reflects the presence of advanced HIV or AIDS cases in the population. Table D.2 (appendix D) summarizes the results of available point-prevalence surveys among TB patients.
Analytical summary Available prevalence surveys among TB patients suggest that apart from Djibouti, Somalia, and Sudan, HIV prevalence among TB patients is generally low. HIV has clearly been making inroads into a subset of the populations in Djibouti, Somalia, and Sudan for at least a decade. The limited prevalence among TB patients in the rest of MENA countries is probably a consequence of either the recent introduction of HIV into highrisk networks or the very low levels of HIV prevalence in the whole population, except possibly for small pockets of high-risk priority groups.
FURTHER POINT-PREVALENCE SURVEYS Table D.3 (appendix D) lists a summary of point-prevalence surveys extracted from the United Nations Joint Programme on HIV/AIDS (UNAIDS) epidemiological facts sheets on each MENA country over the years. Some of the data reported here are gleaned from country-based case notification surveillance reports9 or are provided through national-level agencies. These surveys may not be conducted using sound methodology or internationally accepted guide9
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WHO/EMRO Regional Database on HIV/AIDS.
Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa
lines for HIV surveillance. There is also very limited information on the populations on which these measurements were made. Given theses limitations, the prevalence levels may not be representative of the populations that they are supposed to represent. However, despite these limitations, these measures are useful to corroborate the rest of the pointprevalence surveys discussed in the previous chapters and, indeed, convey the same picture of HIV epidemiology in MENA.
Analytical summary The further point-prevalence surveys in table D.3 are generally consistent with those reported in the previous chapters and follow similar patterns. Injecting drug users (IDUs) and men who have sex with men (MSM) are the key priority groups for HIV infectious spread in MENA, followed by FSWs, but mainly in Djibouti, Somalia, and Sudan. There is very limited HIV prevalence in the general population. The fluctuations among some of these data may suggest a lack of representation. To maximize the explanatory power of point-prevalence data, MENA countries need to conduct pointprevalence measurements using consistent and standard methodology and internationally accepted guidelines for HIV surveillance.
HIV-POSITIVE RESULTS EXTRACTED FROM HIV/AIDS CASE NOTIFICATION SURVEILLANCE REPORTS Many countries in MENA routinely test different population groups for HIV. These groups include blood tissue and organ donors, blood recipients, pregnant women, marriage applicants, university students, public sector employees, out-migrants (for visa to work abroad), in-migrants (for residency or visa renewal), prisoners, TB patients, suspected AIDS cases, VCT attendees, STD clinic attendees, sexual contacts of people living with HIV (PLHIV), “bar girls,� FSWs, MSM, drug users, and IDUs. The results of 53 million HIV tests reported to the World Health Organization (WHO), as part of the HIV/AIDS case notification surveillance reports, show an overall prevalence of