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Communities at the Centre COMMUNITIES AT THE CENTRE THE RESPONSE TO HIV IN MIDDLE EAST AND NORTH AFRICA GLOBAL AIDS UPDATE 2019 Cover photo credit: UNAIDS/P. Virot. CONTENTS MIDDLE EAST AND NORTH AFRICA 3 Algeria 14 Djibouti 16 Egypt 18 Iran (Islamic Republic of) 20 Jordan 22 Kuwait 24 Lebanon 26 Libya 28 Morocco 30 Oman 32 Qatar 34 Saudi Arabia 36 Somalia 38 Sudan 40 Syrian Arab Republic 42 Tunisia 44 Turkey 46 United Arab Emirates 48 Yemen 50 ANNEX ON METHODS 53 FIGURE 15.1 Number of people living with HIV who are not on antiretroviral therapy (aged 15 years and over), by sex, high-burden countries in Middle East and North Africa, 2018 Iran (Islamic Republic of) MIDDLE EAST AND NORTH AFRICA MIDDLE EAST AND NORTH Sudan Egypt Morocco Algeria 0 10 000 20 000 30 000 40 000 50 000 60 000 Number of people living with HIV who are not on antiretroviral therapy Řada1 Řada2 Males Females Source: UNAIDS 2019 estimates. 2 REGIONS IN FOCUS MIDDLE EAST AND NORTH AFRICA AT A GLANCE The epidemic in the Access to HIV testing, The increase in annual While some countries Middle East and North treatment and care in new infections is a have made progress Africa continues to grow, the region is well below sign that prevention in generating and with a 10% increase in the global average. Less programmes in many using timely strategic new infections and a 9% than half of people living countries are not information, increased increase in the annual with HIV are aware of reaching sufficient investment is needed number of AIDS-related their serostatus, and numbers of people at to fill large gaps in the deaths between 2010 treatment gaps among high risk of HIV infection. generation and use of and 2018. men are larger than they Almost all new HIV data to guide policies are among women in infections are among key and programmes. many countries. populations and their sexual partners. HIV prevention and treatment programmes in the Humanitarian emergencies pose an additional Middle East and North Africa are not keeping pace with challenge. The Middle East and North Africa hosts the the region’s growing epidemic. The annual number of largest number of refugees and displaced people in people acquiring HIV continued to rise in 2018, although the world due to the protracted emergencies in Libya, some countries with relatively higher burdens—including the Syrian Arab Republic, Yemen and elsewhere. the Islamic Republic of Iran, Morocco and Somalia—are Efforts to provide integrated HIV and other health notable exceptions. Most HIV infections occurred among services for refugees and other displaced persons marginalized and vulnerable populations who are poorly are being boosted by approval from the Global Fund served by HIV and other vital services. to Fight AIDS, Tuberculosis and Malaria (the Global Fund) of a US$ 36.4 million Middle East Response Strengthened political commitment is evident in a few Grant in December 2018. This grant is focused on countries, such as Algeria and Morocco, but the region’s addressing HIV, tuberculosis and malaria services overall HIV response is well off-track and far from in five countries (Iraq, Jordan, Lebanon, the Syrian reaching the 90–90–90 targets. In the five countries with Arab Republic and Yemen) that are affected by the highest HIV burden in the region, 80 000 men and humanitarian crises (1). 40 000 women (approximately 70% of adults living with HIV in these countries) were not accessing life-saving antiretroviral therapy in 2018 (Figure 15.1). 3 MIDDLE EAST AND NORTH AFRICA STATE OF THE EPIDEMIC PART 1 | PART TITLE FIGURE 15.2 Number of new HIV infections, An estimated 20 000 [8 000–40 000] people acquired Middle East and North Africa, 2000–2018 HIV in the Middle East and North Africa in 2018, a 10% increase compared with 2010 (Figure 15.2). This s Percentage n regional increase hides several successes in the region. o change in new i ct Three countries with higher HIV burdens—the Islamic HIV infections e f in Republic of Iran, Morocco and Somalia—are among since 2010 V the five countries in the region where annual new HIV w HI infections have declined by more than 10% since 2010 +10% ne f (Figure 15.5). In other countries, increases in incidence o r of more than 20% have occurred, including in Algeria e b (29%), Yemen (35%), Jordan (53%) and Egypt (196%). m u N More than one third of HIV infections in 2018 were 0 among people who inject drugs, and key populations 0 8 0 0 1 1 0 0 0 and their sexual partners accounted for approximately 2 2 2 TITLE OF THE ARTICLE 95% of all new infections in the region (Figure 15.7). New HIV infections Source: UNAIDS 2019 estimates. HIV services focused on these key populations are New HIV infections scarce, and they often operate in contexts marked FIGURE 15.3 Number of AIDS-related deaths, by punitive laws and harsh social reproach. HIV Middle East and North Africa, 2000–2018 prevalence is highest among gay men and other men who have sex with men, among whom it exceeded 5% Percentage s in half the countries reporting data (Figure 15.6). h t change in AIDS- a e d related deaths d Poor access to HIV services for key populations is also since 2010 e t a reflected in the 9% increase in the annual number el r - of AIDS-related deaths since 2010, which reached S +9% ID an estimated 8000 [5000–14 000] deaths in 2018. A f The region’s incidence-prevalence ratio was 8.0% o r e [3.5–16.3%] in 2018––less than the 10.1% [4.4–20.6%] b m estimated for 2010, but far from the 3.0% epidemic u N 0 transition benchmark. 0 8 0 0 1 1 0 0 0 2 2 2 The scant data available on thePART sizes of1 key| PART populations TITLE AIDS-related deaths Source: UNAIDS 2019 estimates. reflects the incompleteness of HIV strategic information systems in the Middle East and North Africa. Given AIDS-related deaths that almost all new HIV infections in the region are FIGURE 15.4 Incidence-prevalence ratio, associated with key populations, this deficiency must Middle East and North Africa, 2000–2018 be addressed so that more effective and focused HIV programmes can be put into action. 2018 35 Incidence-prevalence o i ratio t 30 a r e c 25 n le 8.0% a 20 v e r [3.5–16.3%] p - 15 e c n e 10 d i c n I 5 3 0 0 2 4 6 8 0 2 4 6 8 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 Incidence-prevalence Target value Source: UNAIDS 2019 estimates. Incidence: prevalence ratio Target 4 1 2 3 TITLE OF THE ARTICLE REGIONS IN FOCUS FIGURE 15.5 Percentage change in new HIV infections, by country, Middle East and North Africa, 2010–2018 250 196 200 150 100 53 Per cent 50 29 29 35 18 21 22 24 0 -2 -12 -11 -50 -25 -43 -40 -100 Source: UNAIDS 2019 estimates. TITLE OF THE ARTICLE PART 1 | PART TITLE FIGURE 15.6 HIV prevalence among key populations, FIGURE 15.7 Distribution of new HIV infections Middle East and North Africa, 2014–2018 (aged 15–49 years), by population group, Middle East and North Africa, 2018 14 12 Remaining FIGURE 15.XG Percentage change in new HIV infections, by country, Middlepopulation East and NorthSex workers Africa, 2010–2018 10 5% 12% 8 Clients of sex 6 workers and sex Per cent partners of other 4 key populations 4.2 1.9 28% 2 2.1 1.7 0.2 0 Sex workers (n = 9) People who Gay men and other men who inject drugs Gay men and other men who have sex with men (n = 6) have sex with men 37% People who inject drugs (n = 8) 18% Transgender people (n = 1) Prisoners (n = 9) Source: UNAIDS special analysis, 2019. Source: UNAIDS Global AIDS Monitoring, 2014–2018. 10 5 Figure resource availability, by source,......, 2010–2018, and projected resource needs by 2020 is designed separately as a part of Figures 10xx-16xx 4 11 MIDDLE EAST AND NORTH AFRICA PART 1 | PART TITLE TABLE 15.1 Estimated size of key populations, Middle East and North Africa, 2018 Country National adult population (15+) Sex workers Sex workers as per cent of adult population (15+) Gay men and other men who have sex with men Gay men and other men who have sex with men as per cent of adult population (15+) People who inject drugs People who inject drugs as per cent of adult population (15+) people Transgender people as per Transgender cent of adult population (15+) Prisoners Prisoners as per cent of adult population (15+) Iran (Islamic 62 613 000 210 000 0.34 Republic of) Kuwait 3 307 000 5200 0.16 Lebanon 4 718 000 17 000 0.35 Morocco 26 362 000 84 000 0.32 Oman 3 785 000 Tunisia 8 856 000 22 000 0.25 National population size estimate Local population size estimate Insuffi cient data No data The regions for which the local population size estimate refers are as follows: Oman: Samail Sources: Global AIDS Monitoring, 2018; United Nations, Department of Economic and Social Affairs, Population Division.
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