Chapter 13
Summary of Recommendations
This chapter focuses on key strategic recommendations related to the human immunodeficiency virus (HIV) epidemiology in the Middle East and North Africa (MENA) presented in this report. The following recommendations are based on the identification of the HIV epidemic status in MENA, through this synthesis, as a low HIV prevalence setting, but with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also briefly discussed, but detailed recommendations are beyond the realm of this report. It is not part of the scope of this report to provide intervention recommendations for each MENA country.
RECOMMENDATION 1: INCREASE AND EXPAND BASELINE AND CONTINUED SURVEILLANCE The data synthesis and HIV transmission concentration in priority populations, as described in this report, highlight the need for HIV surveillance of these at-risk groups. However, resistance to acknowledging the existence of priority populations including injecting drug users (IDUs), men who have sex with men (MSM), and female sex workers (FSWs) can still be found among stakeholders in MENA. The low HIV prevalence found in sporadic and
nonrepresentative populations at low risk of infection, such as blood donors, is feeding a culture of complacency toward the epidemic that is blind to the reality of nascent HIV epidemics in hard-to-reach and stigmatized populations. The low HIV prevalence in the general population may mask a much higher prevalence in priority populations. HIV is not spreading evenly among the different subpopulations within each MENA country. Finding the subpopulations where HIV is currently spreading is a key challenge.1 Inadequate surveillance continues to be one of the most pervasive problems in the region.2 Despite recent progress in several countries such as Morocco and Sudan, epidemiological and methodological surveillance remains limited.3 Although surveillance has been expanded to include sentinel surveillance of pregnant women in a few countries, efforts need to be expanded and focused on surveillance of priority and vulnerable populations, including the mapping of risk and vulnerability factors, risk behavior measures, population size estimations, and, importantly, measurements of HIV prevalence and biomarkers of risk such as sexually transmitted infections (STIs) and hepatitis C virus (HCV) prevalence levels. Mapping of priority populations is a necessary prerequisite to prevention efforts among these groups. The 1
El Feki, “Middle-Eastern AIDS Efforts.” UNAIDS and WHO, AIDS Epidemic Update 2006. 3 Obermeyer, “HIV in the Middle East.” 2
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