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Assessment of Situation and Response of Drug Use and Its Harms in The ASSESSMENT OF SITUATION AND RESPONSE OF DRUG USE AND ITS HARMS IN THE MIDDLE2021 EAST AND NORTH AFRICA ASSESSMENT OF SITUATION AND RESPONSE OF DRUG USE AND ITS HARMS IN THE MIDDLE2021 EAST AND NORTH AFRICA DISCLAIMER This document is provided by the Middle East and North Africa Harm Reduction Association (“MENAHRA”) for informational purposes only. MENAHRA assumes no responsibility for any errors or omissions in these materials. MENAHRA makes no, and expressly disclaims, any warranties, expressed or implied, regarding the correct- ness, accuracy, completeness, timeliness, and reliability of the current document. Under no circumstances shall MENAHRA, their affiliates, or any of their respective partners, officers, directors, employees, agents or representatives be liable for any damages, whether direct, indirect, special or consequential damages for lost revenues, lost profits, or otherwise, arising from or in connection with this document and the materials con- tained herein. All materials contained in this document are protected by copyright laws, and may not be reproduced, re- published, distributed, transmitted, displayed, broadcast or otherwise exploited in any manner without the express prior written permission of MENAHRA. MENAHRA’s names and logos and all related trademarks and other intellectual property are the property of MENAHRA and cannot be used without its written permission. © All rights reserved - MENAHRA 2021 First Edition 2021 ISBN 978-9953-0-5409-4 MENAHRA MIDDLE EAST AND NORTH AFRICA HARM REDUCTION ASSOCIATION Hayek Roundabout, BBAC Building Sin El Fil, Lebanon Telephone: +961 1 493211 Email: [email protected] Website: www.menahra.org 7. TABLE OF CONTENTS Foreword .................................................................................................................................................................9 About MENAHRA ..............................................................................................................................................9 Acknowledgments ...........................................................................................................................................10 Note on country coverage and reported figures ..............................................................................................10 Acronyms and Abbreviations ..............................................................................................................................11 List of Tables and Figures........................................................................................................................................12 Executive Summary ..............................................................................................................................................13 Background ...........................................................................................................................................................20 Situation Assessment Method ............................................................................................................................23 Regional Overview ...............................................................................................................................................26 Drug Use: Extent and Patterns .........................................................................................................................26 Injecting Drug Use ............................................................................................................................................28 HIV and Viral Hepatitis epidemics in the region ............................................................................................32 HIV and Viral Hepatitis among PWID and other converging key populations ............................................34 PWID ..............................................................................................................................................................34 Other Key Populations with overlapping risk behaviour ............................................................................36 HIV testing and treatment cascade .................................................................................................................38 Harm Reduction Response ..............................................................................................................................40 Laws and Policies ..............................................................................................................................................44 NGO involvement .............................................................................................................................................46 Country Profiles* ..................................................................................................................................................48 Afghanistan .......................................................................................................................................................49 Algeria ...............................................................................................................................................................51 Bahrain ...............................................................................................................................................................53 Egypt ..................................................................................................................................................................54 Iran .....................................................................................................................................................................57 Iraq .....................................................................................................................................................................60 Jordan.................................................................................................................................................................62 Kuwait ................................................................................................................................................................64 Lebanon .............................................................................................................................................................66 Libya ...................................................................................................................................................................70 Morocco ............................................................................................................................................................73 Oman .................................................................................................................................................................77 Pakistan ..............................................................................................................................................................79 Palestine ............................................................................................................................................................83 Qatar ..................................................................................................................................................................86 Saudi Arabia ......................................................................................................................................................87 Syria....................................................................................................................................................................89 Tunisia ................................................................................................................................................................91 United Arab Emirates .......................................................................................................................................93 Yemen ................................................................................................................................................................95 Concluding Remarks and Strategic and Operational Areas for Prioritisation ................................................98 References ...........................................................................................................................................................103 8 FOREWORD Dear readers, with great pleasure I represent to you, once again, the MENAHRA Regional Situation Assess- ment to the public health sector in general, and the harm reduction community in specific. This is the forth assessment of the situation of HIV and response of drug use and its harms in twenty countries in the Middle East and North Africa (MENA) for the past ten years as it is a contribution to regional literature, and has been conducted as part of the information and knowledge building services that MENAHRA aspires to offer to civil society and the scientific community in the region. I invite you all to read and use the information of this report that proves new dimensions in a wide view of drug use related harms. The report of this year was a challenge for us that we managed to overcome despite all the obstacles espe- cially the ones linked to COVID19 pandemic and too many other difficulties that we are suffering from
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