women in the general population.386 In Southern Sudan, HIV prevalence was 4.4% in Yei town, where half of the respondents were internally displaced, but only 0.4% in Rumbek town, where the level of displacement is considerably lower.387 In North Sudan, the prevalence among ANC women who were internally displaced (1.6%) was much higher than that of other pregnant women (0.3%).388 No evidence has been found in MENA to support the claim that refugees spread HIV infection in host communities.389
HIV spread among refugees and internally displaced persons Several other point-prevalence surveys documented the level of HIV spread among displaced populations in MENA. Among Afghani refugees in the Islamic Republic of Iran, HIV prevalence was 0.2%.390 Among Sudanese refugees, separate studies reported that HIV prevalence was 5.0% and 1.2% for ANC attendees and 0.8% for prevention of mother-to-child transmission (PMTCT) attendees in Kenya391; 5% for men and 2% for women in Ethiopia392; and 1% and 2.7% in Uganda.393 In several studies in Sudan, HIV prevalence among IDPs or refugees was 1.57%,394 1%,395 4%,396 1%,397 0.26%,398 and 0.27%.399 Among Somali refugees attending ANCs in Kenya, HIV prevalence was 0.7% in 2003,400 1.4% in 2005,401 and 1% in 2006.402 Also at this 386
Somaliland Ministry of Health and Labour, Somaliland 2007 HIV/ Syphilis Seroprevalence Survey. 387 Kaiser et al., “HIV, Syphilis, Herpes Simplex Virus 2, and Behavioral Surveillance.” 388 Sudan Ministry of Health, Sudan National HIV/AIDS Surveillance Unit. 389 UNHCR, “HIV Behavioural Surveillance Survey”; Spiegel et al., “Prevalence of HIV.” 390 SeyedAlinaghi, “Assessing the Prevalence of HIV.” 391 UNHCR, HIV Sentinel Surveillance among Conflict Affected Populations. 392 Holt et al., “Planning STI/HIV Prevention.” 393 UNHCR, HIV Sentinel Surveillance Report; Uganda MOH, STD/HIV/ AIDS Surveillance Report. 394 SNAP and UNAIDS, “HIV/AIDS Integrated Report North Sudan, 2004–5.” 395 Ahmed, Internally Displaced People. 396 SNAP, “HIV Sentinel Surveillance.” 397 Ahmed, Internally Displaced People. 398 Sudan National AIDS/STIs Program, 2007 ANC HIV Sentinel Sero-Survey. 399 Ibid. 400 UNHCR, “HIV Sentinel Surveillance in Dadaab Refugee Camps” (2003). 401 UNHCR, “Sentinel Surveillance Report Dadaab Refugee Camps” (2005). 402 UNHCR, HIV Sentinel Surveillance among Antenatal Clients and STI Patients. 138
Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa
location, studies found that HIV prevalence was 0.1% among Somali refugees attending ANCs who were offered PMTCT services, and 2.0% (2003), 1.7% (2005), and 0.9% (2006) among Somali refugees attending STI clinics.403
Analytical summary Population mobility is a key HIV risk factor in MENA due to the sheer size of the mobile populations and the extensive presence of this vulnerability across MENA countries. The complex emergencies that continue to be present in the region lead to increased vulnerability to HIV. It is therefore important that forcibly displaced populations are included in national HIV programs and have universal access to prevention, treatment, and care programs.
STREET CHILDREN Though prisoners, youth, and mobile populations are the key vulnerable populations in MENA, another important vulnerable population is that of “street children.” The presence of street children is an increasingly emerging phenomenon in several MENA countries, as well as globally.404 Causes of this phenomenon in MENA include poverty, family disruption, natural and manmade disasters, following friends, and desiring drugs.405 There are two types of street children: “home-based,” where children spend most of the day on the street but still return home at night and may have some family support; and “street-based,” where children spend most of day and night on the street and are functionally without family.406 Boys often engage in odd jobs, begging, theft, and sex work.407 Girls, who have fewer work opportunities, obtain money primarily through begging and sex work.408 Street girls in Sudan reported being frequently raped by street boys,
403
Ibid. Dallape, “Urban Children”; UNICEF, The State of the World’s Children 2006. 405 Khalil, Street Children and HIV/AIDS; Kudrati et al., “Sexual Health and Risk Behaviour.” 406 Khalil, Street Children and HIV/AIDS. 407 Kudrati, Plummer, and Yousif, “Children of the Sug.” 408 Ibid. 404