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HIV epidemics increased among IDUs in Middle East, North Africa
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In the past decade, HIV epidemics appear to have surfaced among injection drug users in the Middle East and North Africa and are continuing to grow, according to recent findings.
“Not only have we found a pattern of new HIV epidemics among [people who inject drugs] in the region, but we also found indications that there could be hidden HIV epidemics among this marginalized population in several countries with still-limited data,” study researcher Ghina Mumtaz, MD, senior epidemiologist at the Infectious Disease Epidemiology Group at Weill Cornell Medical College-Qatar, said in a press release. “For example, in Libya, the first study among people who inject drugs was conducted only recently and unveiled alarmingly high levels of HIV infection, suggesting that the virus has been propagating, unnoticed, among this population for at least a decade.”
In a systematic review, Mumtaz and colleagues queried PubMed, Embase, regional and international databases, and country-level reports in search of studies assessing the prevalence of HIV, other sexually transmitted infections or hepatitis C virus in injection drug users (IDUs) for 23 countries in the Middle East and North Africa. Also included were studies addressing the prevalence of drug injection, risky sexual behaviors and HIV awareness levels in IDUs, as well as the number or proportion of IDUs in this region.
Based on these reports, the researchers determined that the Middle East and North Africa region has approximately 626,000 IDUs (range, 335,000-1,635,000), with a prevalence of 0.24 per 100 adults.
At least one-third of the countries in the region exhibited evidence of HIV epidemics among IDUs; most of these epidemics are considered “emerging, concentrated epidemics,” with overall HIV prevalence ranging from 10% to 15%, according to the researchers. Some epidemics have reached alarming proportions, however, marked by some of the highest global rates of HIV among IDUs (87.1% in Tripoli, Libya). The region was determined to have a relatively high prevalence of high-risk behaviors, including the following: needle-sharing (18%-28% in the last injection); low rates of condom use (20%-54% had used condoms ever); high rates of sex with prostitutes (15%-30% within the past year) or men having sex with men (2%-10% within the past year); and high rates of prostitution (5%-29% in the past year). Additionally, the incidence of HCV (31%-64%) and STIs reflected an overall high rate of risky behavior, which may lead to increased emergence of HIV epidemics.
According to Mumtaz, these findings suggest that the full impact of HIV epidemics among IDUs in this region are yet to be revealed.
“It is of priority that countries in the region expand HIV surveillance systems among [people who inject drugs] to detect and monitor these budding and growing HIV epidemics,” she said. “About half of the countries of the region still lack sufficient data to assess the levels of HIV infection among this population, and we continue to discover these epidemics several years after their onset. We need to be ahead of the epidemic to prevent a public health burden that this region is largely not prepared to handle.”
Disclosure: The researchers report no relevant financial disclosures.
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