AIDS in Middle East and North Africa: The cost of inaction

The Middle East and North Africa region includes 22 countries including the Gulf countries. Sudan, Egypt, Jordan, Morocco, Tunisia, Saudi Arabia and others are part of this region. The World Health Organization (WHO) includes South Sudan, Afghanistan and Pakistan in this region. Between 2001 and 2011, the estimated number of people living with HIV increased from 319,000 to 579,000. Since 2001, the number of people newly infected with HIV has increased by 89 percent, from 45,000 to 85,000. AIDS-related deaths also increased by 95 percent, from 19,000 to 39,000 during the same period. In 2011, 22,985 people living with HIV receiving treatment when the estimated number needing treatment was 197, 000 — only 12 percent. Only 8 percent pregnant HIV-positive women receive treatment. The region has the highest rate of HIV increase.
 
The HIV-infected numbers are low in this region when compared to Sub-Saharan Africa or Asia. This is why most countries do not take HIV/AIDS situation seriously. There was a time when many countries in Africa also ignored the initial low numbers of HIV-positive people. Very soon they ended up with a challenge that needed massive infusion of external resources to put people on treatment and reduce the level of infection. However, the damage to the population and national economies has been done. Millions died and millions of children were orphaned. Economic development suffered.
 
The U.S. government is a major donor to international fight against HIV/AIDS. The Global Fund is the largest financing organization, receiving major contributions from U.S. sources. Both donors have not prioritized their investment for the region. Very little petro dollars are invested to protect the people. Most international organizations are afraid to initiate bold programs to address stigma, discrimination and access to treatment services. You cannot talk about condom use openly.
 
We can see the political challenges of the region every day in the media. Conflicts, displaced people and migration are exposing millions to high risk situations. Hundreds of females are raped and many young men are sexually abused. Increasing numbers are engaged in commercial sex for their survival. Conflicts and poor economic conditions are also contributing to high-risk behaviors. Drug use and commercial sex are on the rise. Preventive measures are not widely used. More than 60 percent people living with HIV discontinue treatment. Most AIDS patients seek treatment very late, thus mortality is high.
 
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Almost 20 percent of the populations are under 24 years of age. Forty percent of the population in Iraq, Yemen and Palestine are under 24 years. Youth unemployment is high, which forces young people to engage in high risk behaviors such as drug use, unprotected sex, etc. By 2035, this region will have 100 million youths.
 
Stigma and discrimination are key reasons for low coverage of treatment for HIV/AIDS people. Women are severely discriminated against when it comes to accessing testing and HIV treatment. In a number of places, women are not allowed to visit testing and counseling centers. Millions of migrant workers work in the Gulf. Most countries deport migrant workers who are tested HIV-positive. Most countries deny the existence of men having sex with men, and do not facilitate access to services for them — and most are afraid to seek treatment. Most people do not know their HIV status. Most women do not know the HIV status of their husbands, thus husband-to-wife transmission is increasing. Rights of sexual minorities as well as women are denied.
 
Street children are engaged in commercial sex. According to a World Bank report, over 70 percent of the male street children in Egypt are engaged in commercial sex.
 
HIV/AIDS among injecting drug users vary from 7 percent in Egypt to 21 percent in Pakistan. HIV among men who have sex with men ranges from 6 percent in Egypt to 37 percent in Pakistan.
 
The U.S. and international community must act quickly and set ambitious targets to put people on treatment. Treatment is proven to be effective prevention and can reduce the cycle of infection. We cannot be deterred by Islamic conservatism.
 
If the countries and international community act now, we will avoid a major future epidemic.  Cost of action is low now and most countries can afford to cover the costs. However, if we do not act decisively, the infection will spill over into general population, thus requiring billions of dollars to fight a larger epidemic. Thousands will die without being reported or known to the world. Large number of young people could be infected, thus putting the economic development, in an already strained region, in more trouble.
 

Rahman has more than 15 years of experience in HIV/AIDS programs and has recently worked in the Middle East and North Africa for lthe ast several months for a U.N. agency.