For years, the lack of reliable data on HIV/AIDS in the Middle East and North Africa led regional governments to believe they had somehow managed to escape the epidemic. But a new United Nations report shows that numbers are on the rise: more than 400,000 people are currently living with HIV across the Middle East and North Africa region, or MENA. Of those, 68,000 need anti-retroviral treatment, but only 14 percent are actually getting it. The rest may not even know they are infected.
Hind Khatib is a regional director of the U.N. Joint Programme on HIV/AIDS or UNAIDS. She has just returned from a two-day conference in Dubai, where regional leaders gathered to discuss the issue.
Khatib: It's still low prevalence, but you know we've just put out the synthesis report, which was an epidemiological study of HIV and its evolution in the region, and the report says that probably, at least for the near future, we'll never have an epidemic of HIV in the region. But still, there is evidence that HIV is growing among key populations. The key populations as defined by the study are the people who are mainly drug injectors, men who have sex with men, and sex workers.
So we thought that it's timely, especially that this year, there was a great effort by UNAIDS invested in the region to ensure that all the countries will actually report and live up to their commitments made to the 2001 Declaration in the U.N. General Assembly Special Session on HIV. The national reports clearly, from 20 countries out of the 21 countries in the region, Iraq was the only country that could not report, for understandable reasons - all 20 countries have shown that they have weak programs, weak surveillance, and that the coverage is very, very poor.
So yes, while we have national AIDS programs, while countries are attempting to draw up their national strategies, coverage, in terms of treatment, voluntary counseling and testing and even prevention, is very, very poor. So we thought this was the time to actually convene policy makers together with civil society with small communities of people living with HIV, to get together under one roof and start talking [about] what's next.
Hilleary: What's the biggest obstacle to people getting tested and treated for HIV/AIDS in the MENA region?
Khatib: It's stigma. Stigma and discrimination. People are afraid. I mean, I think that knowing how HIV basically gets transmitted is something that people are afraid, that people know that they have had extra-marital sex-the whole concept of men who have sex with other men--it's a big taboo, and the region does not want to admit that we have these groups. They don't want to admit to a lot of extra-marital activities.
So I think it's very much cultural and related also to religion and Islam, and people, you know, like to believe that we don't have such conducts here. But I think slowly, slowly, people here are that HIV is very much home-grown. Up until now, it has been the perception, 'Oh, we got it from outside.'
I think that with a lot of advocacy and, as you know now there is a good amount of popular faces, popular stars that also engage in HIV, whether it's through UNICEF, and recently UNAIDS has appointed its first regional Goodwill Ambassador [Egyptian actor Amr Waked was recently named the first UNAIDS Goodwill Ambassador for the Middle East and North Africa region by the Joint United Nations Program on HIV/AIDS], and we are very happy that he's coming out loud, speaking about stigma and discrimination, speaking about the rights of our key populations, speaking about the time to act, speaking about the right policies, targeted action. But I think there is a lot the region still needs to do to reduce fear.
Hilleary: What does the U.N. plan to do with the data it has gathered now?
Khatib: First, I think we are working with countries on improving the national strategies. So it's much more targeted and it doesn't address HIV as if it's a generalized epidemic. What's next is actually to have concerted efforts to bring up awareness, because if you don't bring awareness to all different targeted groups, including the health workers. Even if you do confidential testing, you will need the people who run those services to bring awareness and educate people. It's just educating.