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AIDS: North Africa & Middle East - Low Prevalence Does Not Mean Low Risk - 2003-11-27

The prevalence of HIV/AIDS in North Africa and the Middle East is far below that of sub-Saharan Africa, South Asia and the Caribbean. But a new World Bank report says, “Low prevalence does not mean low risk.”

The United Nations AIDS agency, UNAIDS, says up to 28-million people may be living with HIV/AIDS in sub-Saharan Africa. Compare that to the Middle East and North Africa, where the uppermost estimate is 730-thousand. That’s only about three-tenths of one percent of the adult population.

But a new World Bank report warns of the “costs of inaction.” In 2002, there were 83-thousand new HIV infections in the region. And the number of AIDS deaths “has increased almost six fold since the early 1990’s.”

Francesca Ayodeji Akala is a public health expert for the World Bank. She says the Middle East and North Africa – called the MENA region – has many risk factors for HIV infection.

She says, "The region has a very high number of young people. There are high unemployment rates. You have a lot of migration, of people coming to work in the region, people going to work outside the region. You also have the fact that the region is positioned in such a way you have a lot of migration from sub-Saharan Africa on their way to Europe. It’s bordering Western Europe. It’s bordering countries like Afghanistan, India. It’s surrounded by other regions where the prevalence rates are higher and there are more risk factors." She also says gender inequality contributes to the spread of HIV.

Bachir Souhlal is a social development specialist and expert on HIV/AIDS at the World Bank. He says the MENA region faces the same obstacles as other areas when it comes to HIV prevention.

He says, "Like any other region in the world, talking about HIV/AIDS is not easy because it concerns death and sexuality. And in no culture it’s easy. But in MENA there is a window of opportunity."

Ms. Ayodeji Akala says taking advantage of that window of opportunity means, in part, working within the Muslim culture.

"The fact that the Muslim religion advocates abstinence before marriage is not something that is going against their religion. And it’s actually something that would help the prevention of HIV/AIDS. So, it’s just finding the right messages that fit the context, that fit the cultural context, the social context, the economic context of each particular region," she says.

The World Bank report says no country in the region “systematically screens high risk groups such as intravenous drug users, sex workers and migrants.” It says, “Over confidence in social and cultural conservatism has led to a continued perception of low risk and low priority.” Mr. Souhlal says a lack of leadership is partly to blame.

He says, "Like many other countries, when the prevalence rate is moderate people have a tendency to ignore. And this is also reflected by maybe the lack of commitment from leaders. When I talk of leadership I’m talking of leadership at all levels, not only the political level – but traditional chiefs, at the municipal level, leadership in church or mosque. I think all of them need to be much more aggressive and need to be able to confront the risk."

The report says the hardest hit country in the Middle East and North Africa is Djibouti, followed by Oman, Qatar, Bahrain, Kuwait, Tunisia and Morocco. Some of these countries have launched programs offering education, counseling and testing.

In economic terms, The World Bank says HIV/AIDS could cost the region about “one-third of today’s GDP - Gross Domestic Product - by the year 2025.”

The World Bank recommends mobilizing political and social leadership because HIV/AIDS is more than a health issue. It’s also a developmental issue. Other recommendations include improving HIV/AIDS surveillance, identifying the social and cultural factors contributing to the spread of the disease, and promoting both prevention and treatment programs.