Nascent HIV epidemics among men who have sex with men appear to be emerging in the Middle East and North Africa
G. Mumtaz1, N. Hilmi2, W. McFarland3, R. Kaplan4, F.A. Akala2, I. Semini5, G. Riedner6, O. Tawil5, D. Wilson7, L. Abu-Raddad1,8,9
1Weill Cornell Medical College – Qatar, Doha, Qatar, 2World Bank, Human Development Sector, Middle East and North Africa Region, District of Columbia, United States, 3San Francisco Department of Public Heath, San Francisco, United States, 4University of California at Los Angeles, Los Angeles, United States, 5Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt, 6Regional Office of the Eastern Mediterranean, World Health Organization, Cairo, Egypt, 7World Bank, Global HIV/AIDS Program, District of Columbia, United States, 8Weill Cornell Medical College, New York, United States, 9Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Cente, Seattle, United States
Background: Men who have sex with men (MSM) in the Middle East and North Africa (MENA) endure pervasive stigma and discrimination at the social and political levels, and there are widely held perceptions of virtually nonexistent data on MSM and HIV in this region. Our objective was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA.
Methods: This was a systematic review of all biological, behavioral, and contextual data on HIV and MSM in MENA. Sources of data included Medline using free text and MeSH headings, international organizations’ reports and databases, country-level reports and databases including governmental and non-governmental organizations publications, as well as various other institutional documents.
Results: This review showed that there is considerable data on MSM and HIV in MENA. The prevalence of HIV among MSM in MENA countries ranged between 0 and 15%. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in many countries. The high levels of risk behavior (2-42 partners on average in the last year) and of biomarkers of risks (HSV-2 at 3-54%), the overall low rate of consistent condom use (2-22%), the relative frequency of male sex work (20-76%), and the substantial overlap with heterosexual risk behavior and injecting drug use (up to 17% of MSM inject drugs and up to 37% of male injecting drug users exchange sex for money) suggest potential for further spread.
Conclusions: HIV appears to be spreading among MSM in at least a few countries and could be already in a concentrated state among several MSM groups. There is a need to expand surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in MENA.