HIV in the Middle East and North Africa 2013 - 2015 Together for a Fast-Track Response UNAIDS Regional Support Team for the Middle East & North Africa Abdoul Razzak El-Sanhouri Street, 20 Nasr City Cairo, Egypt Tel: (+20) 222765257 Executive Summary some countries, stabilising in others, and increasing in a few. Similarly with AIDS deaths, the The HIV Epidemic in MENA regional total by 2014 has increased from 7500 in 2005 to 12,000, with 90 The UNAIDS Middle East and North per cent of these occurring in five Africa (MENA) region includes 21 countries (Iran, Sudan, Somalia, countries1 that are home to 445 Morocco and Djibouti). Some million people. The region has one countries have seen doubling and of the youngest populations in even tripling of the number of the world, with around 300 million estimated AIDS deaths in the past people aged 15-39, of whom 42 ten years, while in others it has million are aged between 15 and 19 decreased. years old. Significant numbers of people in The region represents wide diversity the region are still left behind in in terms of social and economic terms of treatment and prevention. development and political stability. In too many countries, stigma, MENA is also the setting for several discrimination and human rights humanitarian crises, both recent violations constitute significant and protracted, the repercussions barriers to progress. of which have been felt throughout the region in terms of massive displacement of people, within and between countries, and the Political, policy and consequent strains on resources programmatic achievements and services. The challenges facing the region In 2014, more than The overall adult HIV prevalence in as it addresses HIV and AIDS are 60% of all adult the region is estimated to be 0.1 significant. Nonetheless, there new infections per cent, with an estimated number has been significant progress in were amongs key of 240 000 [150 000 – 320 000] adults advancing political leadership, populations, of and children living with HIV by the improving the policy environment that figures, 57% end of 2014. Six countries (Iran, and programming focus and scale- among PWID, 27% Sudan, Somalia, Morocco, Algeria up. among MSM and and Djibouti) are home to 90 16% among FSW. per cent of all people living with HIV The political leadership of the in the region. League of Arab States and UNAIDS, has resulted in the While the number of new infections development and endorsement of The leadrshop role of League of Arab increased by 16 per cent from the Arab AIDS Strategy in March States and the 19 000 in 2005 to 22 000 in 2014, the 2014 and the Council of Arab Council of Arab rate of increase of new infections Health Ministers following up the is slowing. Previous reports have implementation of the Strategy Health Ministers is highlighted the fact that within the in all Member States in February key in fast-tracking MENA region there are several HIV 2015. This leadership is also clearly HIV resposne in the region. epidemics occurring simultaneously. reflected in theAlgiers Call for As a result, the trajectory of new Action on Advancing gender infections varies throughout the equality and the HIV response that region, with numbers declining in followed the High Level Meeting of Women Leaders in MENA, held 1 The MENA region, by UNAIDS definition, includes Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. 1 HIV in the Middle East and North Africa 2013 - 2015 Djibouti is the jointly by the Leagues, UNAIDS, Most of the countries in the first country UN Women and the Government of region have either updated or are ratifying the Arab Algeria in November 2014. updating their national strategic plans to be aligned with the Arab Convention on HIV The ratification of the Arab AIDS Strategy, 90-90-90 and Prevention and Convention on Preventing HIV Protection of the other Fast-Track targets. Financial and Protecting the Right of PLHIV, support from public and domestic Rights of People adopted by the Arab Parliament Living with HIV. sources comprise the majority of in 2012, took a decisive turn when the region’s resources, supported Djibouti became the first Arab by Global Fund grants and support country to ratify in October 2015. from other global and regional In an unprecedented step for civil donors. The six GCC countries totally finance their own HIV Civil Society society in MENA, the Regional responses. Algeria and Iran are networks at the Arab Network against AIDS already financing more than 90 regional level and (RANAA) signed a Memorandum country level are of Agreement in December 2015 per cent of their own responses. now an important with the League of Arab States In 2014, of a total regional spend partner in HIV on the role of civil society in the on HIV and AIDS of 140 million leadership and implementation of the Arab AIDS US dollars, 100 million came from response. Strategy. This represents the first domestic resources. Over the past partnership within the region two years, 80 million US dollars have between civil society and such a been secured for three countries significant intergovernmental body. through the GF New Funding Mechanism and concept notes for A regional dialogue took place in other countries are in development. Cairo in October 2015 to mobilize political leadership and partnerships More than 70% for a resilient HIV response for Progress on access to HIV of people who affected countries in MENA in order prevention services inject drugs have to achieve the fast-track targets by In MENA, effective prevention used safe injection 2020 and to address the emerging depends upon reaching and equipment in Iran, priorities in rapidly changing engaging meaningfully with key Lebanon, Morocco regional and local environments. populations. and and Tunisia The protection of people affected Iran Morocco have expanding opioid substitution by humanitarian emergencies, therapy (OST) programmes at including refugees, asylum seekers communities and in prisons and internally displaced people, and is expanding its was identified as a key priority for Lebanon community OST programme. the region. Access to sterile injecting Also in January 2015, a group of equipment through needle and young leaders working on sexual syringe programmes (NSPs) has and reproductive health and rights, resulted in safe injection by more harm reduction, and HIV came than 70 per cent of people who together to establish a Regional inject drugs in Iran, Lebanon, Alliance for Youth Sexual and Morocco and Tunisia. Access to Reproductive Health Rights and OST and sterile injecting equipment HIV Advocacy which will enable has to be sustained and rapidly advocates throughout MENA scaled up in major urban centres to collaborate and ensure that in all countries throughout the the post-2015 agenda includes region, and particularly in Algeria, consideration of the needs and Egypt, Lebanon, Tunisia and the rights of young people. Gulf Cooperation Council countries. Libya, with very high prevalence 2 of HIV among PWID, needs to offers another example of good identify and implement innovative coverage, with nearly two-thirds of approaches that can deliver services female sex workers knowing their in a context of ongoing conflict. status. In Algeria, Morocco, Tunisia In Lebanon, 75% and Iran, the respective figures of men who have Programmes for men who have sex are between 20 and 33 per cent. sex with men with men in the region have shown Rights-based, focused interventions know their HIV impact where services demonstrate have the potential to reverse the status respect for beneficiaries’ rights and trajectory of new infections in the dignity and when civil society and region. other partners are able to provide focus and saturation. Lebanon is an example of such success, with 75 Progress on elimination of In Algeria and per cent of MSM in Beirut reporting mother to child transmission Lebanon, more both knowledge of their HIV status than 80% of sex Elimination of mother to child and condom use. In Morocco and workers have transmission of HIV is a particular Tunisia, coverage by testing and reported condom challenge in HIV epidemics that condom use are increasing but use with their last are characterized by infection have not yet passed 50 per cent. client. Countries need to scale up good occurring mostly among members practices that currently have limited of key populations and their scope, overcome the obstacles that partners. However, this challenge prevent access and utilization of HIV has not prevented countries in the combination prevention services region from progressing towards Oman and United (including pre-exposure prophylaxis elimination. For example, Oman Arab Emirates (PrEP)) by MSM population across and the United Arab Emirates are the close the region. Algeria, Egypt, Iran, have become the first and second to eliminating Sudan and Yemen need to follow countries respectively to integrate mother to child the examples of good practices their eMTCT programme within transmission in the in the region and need to reach maternal and child health services region. Algeria, sufficient levels of coverage to and reach most of their elimination Djibouti, Iran, deliver impact in large cities and targets. Other GCC Countries, Morcco and Tunsia urban areas. notably Saudi Arabia and Kuwait, are moving on that are moving in a similar direction. direction. Prevention programmes with Djibouti, a low-income country, female sex workers and women is also progressing towards engaged in transactional sex elimination, through integration across the region also demonstrate of PMTC within antenatal care, success, with several countries while in middle-income countries - reporting high rates of condom use Algeria, Iran, Morocco and Tunisia among sex workers.