Table 6.3 (Continued) Country
HIV prevalence
Turkey
0.005% (Afsar et al. 2008) 0.0% (Afsar et al. 2008) 0.0% (Afsar et al. 2008) 0.015% (Coskun et al. 2008) 0–0.66% (Arabaci et al. 2003)
West Bank and Gaza
0.006% (Maayan et al. 1994) 0.0% (Yassin et al. 2001)
Yemen, Republic of
0.1–0.3% (WHO/EMRO 2007a) 0.04% (Yemen National AIDS Control Programme 1998) 0.29% (Yemen National AIDS Control Programme 2001) 0.02% (WHO/EMRO Regional Database on HIV/AIDS)
of these countries, as defined technically by prevalence larger than 1% among pregnant women.1 Southern Sudan is of particular concern and could already be in a state of general population HIV epidemic, but conclusive evidence is still lacking. Technically speaking, the HIV epidemics in Djibouti and parts of Somalia are already generalized, but the context of HIV infection and risk groups in these countries suggest that HIV dynamics are mainly focused around concentrated epidemics in the commercial sex networks. The generalization of the epidemic, being larger than 1% among pregnant women, mainly reflects the large commercial sex networks in these countries in the context of major trade corridors, large foreign military installations, and political conflict. HIV prevalence in these countries is also much lower than HIV prevalence in countries in sub-Saharan Africa that truly have a general population HIV epidemic.2
GENERAL POPULATION AND RISK BEHAVIOR Data on sexual behavior among the general population continue to be rather limited. In particular, it does not appear that any nationwide sexual behavior survey has ever been conducted in MENA. Several studies, however, collected a reasonable amount of data in a few countries and these data provide a partial profile of sexual behavior in the general population. Below is a review of evidence on different aspects of risky 1 2
Pisani et al., “HIV Surveillance.” UNAIDS/WHO, AIDS Epidemic Update 2007.
behavior among the general population, including the nature of sexual behavior, nonconventional marriage forms and polygamy, and the overall nature and trends of risky behavior. Further data on sexual risk behavior among key vulnerable subgroups in the general population, such as prisoners, youth, and mobile populations, can be found in chapter 9. Further data on condom use and HIV knowledge and attitudes in the general population can be found in chapter 8. Levels of sexually transmitted infections (STIs) in the general population can be found in chapter 10.
Nature of sexual behavior Two case-control studies in Algeria and Morocco examining the epidemiology of human papillomavirus (HPV) infection, an STI that causes cervical cancer, provided valuable data on the sexual behavior of general population women who were in the control arm of this study. In the Algeria study, almost 30% of women reported more than one lifetime sexual partner, with 5% reporting three or more partners.3 Twenty-six percent of the women reported that their husbands had extramarital affairs with other women and 25% were unsure about their husbands’ extramarital affairs. Thirty-four percent reported that their husbands had sex with female sex workers (FSWs) and 10% were unsure about their husbands’ contacts with FSWs. Women in polygamous marriages (6% of women) were at higher risk of cervical cancer, suggesting that polygamy implies a higher level of sexual risk 3
Hammouda et al., “Cervical Carcinoma in Algiers.” General Population and HIV
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