Providing HIV services to key affected populations in MENA: outreach workers under threat P RESENTED BY D R. W ESSAM E L B EIH, COUNTRY COORDINATOR, E GYPT I NTERNATIONAL AIDS C ONFERENCE W ASHINGTON J ULY 2012

Estimated HIV prevalence (adults and children)

Estimated New Infections (adults and children)

Estimated deaths due to AIDS

HIV prevalence among key populations

Laws, regulations or policies that present obstacles to effective AIDS programmes

* Data from Country UNGASS 2010 reports submitted to UNAIDS Hindering Laws and Policies for an effective response in MENA MENA countries reporting having legal/policy obstacles to an effective response for populations at higher risk of HIV infection

N/A or no data No laws Controversial info Sodomy Laws Capital Punishment Countries in MENA with Sodomy Laws (Homosexual Activity is Illegal)

HIV Travel Restrictions on entry or stay

Implications of such policies Although individual countries have improved access to antiretroviral therapy (ART) (nearly a 25% increase, between 2009 and 2010), the estimated regional coverage remains low at 8%. Nearly 60% of the diagnostic HIV tests carried out between 1995 and 2008 were for migrant workers, while only 4% of tests were for the key populations Compromise to the ability of governments and civil society to provide services; and the ability of key populations to access services that are available

Universal Access to HIV prevention, care, support and treatment by 2015 ZERO NEW HIV INFECTIONS. ZERO DISCRIMNINATION. ZERO AIDS-RELATED DEATHS.

Prevention Programs for Key populations and PLHIV Civil society based programs- with varying government support in various countries Several models of outreach and service delivery to FSW, MSM, IDU and others Integrated in all National Strategic Plans with varying level of practical commitment

In most cases rely on external resources (global fund or bilateral donors) Excellent results in enrolling individuals, providing services and evidence of behavior change. (sustainable?) Often face significant and persistent stigma and discrimination within their local communities, and outreach work can come with considerable personal risk

Risks Civil society organizations Very successful pilot models Local advocacy with law enforcement authorities Sustainability and safety of facility- based service delivery models Means to ensure government backing up Challenge is to scale up ADVOCACY Mainstream service delivery models

BREAD. FREEEDOM. SOCIAL JUSTICE

Way forward Accountability and shared responsibility National Strategic Plans based on human rights Advocacy for multisector response Targeted interventions with high impact and lower financial resources Non traditional interventions ZERO NEW HIV INFECTIONS. ZERO DISCRIMNINATION. ZERO AIDS-RELATED DEATHS.

Zero New Infections. Zero Discrimination. Zero AIDS- Related Deaths Political declaration and targets set forth The Arab convention Alazhar declaration on personal freedoms Spirit of the Arab uprising- youth

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