HIV in MENA Johnny TOHME IAC - Melbourne July 2014

 MENA region is among the top 2 regions in the world with the fastest growing HIV epidemic.  Data on HIV/AIDS epidemic is limited & subject of much controversy, whether in the numbers or how it’s divided among key populations.  Estimated number of adults and children living with HIV in the region increased from 330,000 [200, ,000] in 2001 to 580,000 [430, ,000] in 2010  In 2010, there were 84,000 [57, ,000] new HIV infections and 39,000 [28,000-53,000] AIDS-related deaths

 HIV prevalence among MSM in studies with well-defined methodologies (Selected Countries). Country # of studies % of prevalence Egypt26% Morocco24% Sudan28-9% Tunisia15% Lebanon13-4%

 Quantity of data steadily increasing, yet still limited to build trends.  Shortage of data on HIV in countries across the region; specifically in United Arab Emirates, Iraq, Kuwait, Libya, Bahrain, Qatar and Saudi Arabia.  The scope of the HIV epidemic and its impact in the region continues to be underestimated.

 Ineligibility of countries for Global Fund grants (which are particularly critical for work with MSM).  Insufficient national amount allocated to AIDS (prevention or treatment).  Small % of the AIDS funds used to tackle the needs of key populations

 Outreach among MSM to seek out services  Free condom distribution (field and project premises)  Clinical services for diagnosis and treatment of STIs (direct and/or referrals)  VCT (test and pre and post counselling)  Practical or psychological support for MSM living with HIV  Medical support for MSM living with HIV (direct or referrals)  Enabling access to ART  Psychosocial support to MSM

 Free distribution of lubricants  Support to MSM who suffer discrimination or violence  Activities and services for men who are sex workers

 Condom social marketing that targets MSM  Activities and services for transgender people  Activities and services for partners or family of MSM  Emphasis on peer education to provide appropriate and needs-based support to MSM.  Provision of safe and friendly spaces for MSM, with a holistic range of support and services.  Programs that recognize: the diverse identities and needs of different MSM; and the cross-over of vulnerability factors HIV (such as MSM who also sell sex or use drugs).

 Most of HIV testing in the region is mandatory.  60% of HIV tests carried out between 1995 & 2008 were for migrant workers.  4% of tests for key populations at higher risk.  Hard access to quality VCT.  Lack of surveillance systems for other STIs.

 25% increase, from in 2009 to in 2010 in one year.  estimated regional coverage remains low at 8%.  Oman has the best estimated coverage in the region, with 45% receiving treatment at the end of 2010, followed by Lebanon (37%) and Morocco (30%).

 Homosexuality criminalized in a way or another in all countries  Social stigma & discrimination of being MSM  Social stigma & discrimination of living with HIV

 HIV is not a political priority  Low prevalence and lack of evidence  Limitations of infrastructure to provide effective services  National policies (such as against condom distribution in prisons)

 Policy-makers from the MENA region have recently acknowledged the importance of HIV issues:  The June 2010 Dubai Consensus Statement (universal access)  The Regional Health Sector Strategy 2011–2015, endorsed by all Ministers of Health  The September 2010 Declaration of Commitment and Call for Action (mobile people, migrants)  The April 2011 Riyadh Charter, endorsed by all Gulf Cooperation Council members  The March 2014 league of Arab States new strategy

 Activists and organizations from Morocco, Algeria, Tunisia, Mauritania and Lebanon with the support of MSMgf worked on a training tool (AALi SOUTAK = Raise your Voice) on HIV and MSM with sponsorship of MSMGF. (to be launched in this year’s IAC)  Djibouti has a history of protecting the rights of people living with HIV. Unlike many countries, it guarantees freedom and anti-discrimination legislation for free movement of PPLHIV, including foreigners.  In Lebanon, a Sexual Health Center have been initiated by Helem organization and it became an independent legal NGO called “MARSA” that provides holistic sexual health services(medical, psychological and Social), similar initiative have been launched in Morocco (Al Borj – Marrakesh).  Anti-stigma campaigns through various means are being encouraged in all MENA countries to influence public opinion about AIDS. The recent Egyptian film, Asmaa, that tells the true story of a woman overcoming fear and social rejection, is an example to be followed more broadly in the region.