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Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa Public Disclosure Authorized Characterizing the Public Disclosure Authorized HIV/AIDS Epidemic in the Middle East Public Disclosure Authorized and North Africa TIME FOR STRATEGIC ACTION Public Disclosure Authorized Laith J. Abu-Raddad, Francisca Ayodeji Akala, Iris Semini, Gabriele Riedner, David Wilson, and Ousama Tawil Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa TIME FOR STRATEGIC ACTION Laith J. Abu-Raddad, Francisca Ayodeji Akala, Iris Semini, Gabriele Riedner, David Wilson, and Ousama Tawil Washington, D.C. © 2010 The International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org E-mail: [email protected] All rights reserved 1 2 3 4 13 12 11 10 This volume is a product of the staff of the International Bank for Reconstruction and Development / The World Bank. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development / The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; telephone: 978-750-8400; fax: 978-750-4470; Internet: www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: [email protected]. ISBN: 978-0-8213-8137-3 eISBN: 978-0-8213-8138-0 DOI: 10.1596/978-0-8213-8137-3 Cover design by Naylor Design. Library of Congress Cataloging-in-Publication Data Characterizing the HIV/AIDS epidemic in the Middle East and North Africa : time for strategic action / Laith Abu-Raddad . [et al.]. p. ; cm. Includes bibliographical references. ISBN 978-0-8213-8137-3 1. AIDS (Disease)—Middle East. 2. AIDS (Disease)—Africa, North. I. Abu-Raddad, Laith. II. World Bank. [DNLM: 1. Acquired Immunodeficiency Syndrome—epidemiology—Africa, Northern. 2. Acquired Immunodeficiency Syndrome—epidemiology—Middle East. 3. HIV Infections— epidemiology—Africa, Northern. 4. HIV Infections—epidemiology—Middle East. 5. HIV Infections—transmission—Africa, Northern. 6. HIV Infections—transmission—Middle East. 7. Health Planning—Africa, Northern. 8. Health Planning—Middle East. 9. Health Policy— Africa, Northern. 10. Health Policy—Middle East. 11. Risk Factors—Africa, Northern. 12. Risk Factors—Middle East. WC 503.4 JA2 C469 2009] RA643.86.M628C53 2009 614.5'9939200956—dc22 2009041797 Contents Acknowledgments .............................................................................................................................. xi Executive Summary ........................................................................................................................ xiii Key Definitions and Abbreviations ........................................................................................xxi Chapter 1 Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa: Why and How?.................................1 Background and Rationale for This Report ...............................................................................................1 Conceptual Framework and Research Methodology ................................................................................3 Bibliography ...............................................................................................................................................8 Chapter 2 Injecting Drug Users and HIV ..............................................................11 HIV Prevalence among IDUs .................................................................................................................... 11 Hepatitis C Prevalence as a Proxy Marker of Risky Behavior among IDUs ........................................... 13 Prevalence of Drug Injection ................................................................................................................... 13 Female Injecting Drug Users ................................................................................................................... 16 Injecting Drug Users and Risky Behavior ................................................................................................ 16 Knowledge of HIV/AIDS ......................................................................................................................... 21 Bibliography ............................................................................................................................................. 25 Chapter 3 Men Who Have Sex with Men and HIV ........................................31 HIV Prevalence among MSM .................................................................................................................. 31 Prevalence of Homosexuality .................................................................................................................. 31 Men Who Have Sex with Men and Risk Behavior ................................................................................. 33 Knowledge of HIV/AIDS .......................................................................................................................... 38 Analytical Summary ................................................................................................................................. 39 Bibliography ............................................................................................................................................. 39 Chapter 4 Commercial Sex and HIV .......................................................................43 HIV Prevalence among FSWs .................................................................................................................. 43 Context of Commercial Sex in MENA ..................................................................................................... 43 Forms of Commercial Sex ........................................................................................................................ 46 Prevalence of Commercial Sex ................................................................................................................ 47 Commercial Sex and Risk Behavior ......................................................................................................... 48 Knowledge of HIV/AIDS .......................................................................................................................... 53 Analytical Summary ................................................................................................................................. 53 Bibliography ............................................................................................................................................. 54 v Chapter 5 Potential Bridging Populations and HIV .................................59 Context of Bridging Populations in MENA ........................................................................................59 HIV Prevalence in Potential Bridging Populations ...........................................................................59 Potential Bridging Populations and Risk Behavior ............................................................................60 Vulnerability of Sexual Partners of Priority Populations ..................................................................61 Analytical Summary ...........................................................................................................................62 Bibliography .......................................................................................................................................62 Chapter 6 General Population and HIV ...........................................................65 HIV Prevalence in the General Population ........................................................................................65 General Population and Risk Behavior ..............................................................................................69 Male Circumcision .............................................................................................................................73 Analytical Summary ...........................................................................................................................74 Bibliography .......................................................................................................................................75 Chapter 7 Further Evidence Related to HIV Epidemiology in MENA......................................................................81
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