voice of the community

An HIV Center in the Middle East and North Africa?
Striving to organize a regional HIV resource center to confront a growing epidemic

By Sherine Shawky, M.D., Dr.P.H.
Research Professor, The American University in Cairo

Since the first AIDS cases in the Middle East and North Africa (MENA) were declared in 1984, the HIV threat has been touching one country after another. Despite the fact that HIV prevalence is still believed to be relatively low, the epidemic’s growth in the MENA region is undeniable, and the possibility that it will spin to a generalized epidemic cannot be excluded.

The detection of increasing numbers of HIV cases, the identification of multiple routes of transmission, and the existence of several high risk and vulnerable groups indicate that the region is not immune against the spread of HIV. The conservative culture in the region has helped in slowing down the progression of the epidemic, but has also contributed markedly to the strong stigmatization of people practicing risk behaviors as well as people living with HIV. Cultural norms, coupled with lack of awareness of the multidimensional disasters created by AIDS, have excluded the HIV menace from the MENA policy agenda. Rigid stigma has also led to a widespread denial of HIV risk behaviors. As in other regions, the arrival and threat of HIV in the MENA region is blamed upon foreigners and outsiders. Within the region, conducting HIV behavioral research is perceived as opposed to cultural norms and as providing approval of risk behaviors.

This tendency to downplay the importance of HIV’s epidemic growth has resulted in lack of evidence, suppression of facts, and delayed interventions. Since the advent of the new millennium, HIV in the MENA region has attracted the attention of the international community, the national Ministries of Health and civil society, and there have been several national and regional activities. In several countries, a National AIDS program (NAP) is rooted in the Ministry of Health to monitor the epidemic, enhance HIV/AIDS reporting, and to ensure blood safety and infectious control measures. The NAP developed partnership with other national sectors, international agencies and people living with HIV to mount a multi-sector approach for addressing the HIV epidemic. Civil society has been increasingly vocal within the governmental processes and many NGOs have become more engaged in HIV-related efforts. Youth coalitions became active and youth interventions are running. Multiple international organizations are involved in supporting the NAP in developing national strategic plans, establishing voluntary counseling and testing units, building HIV capacities, implementing awareness campaigns and conducting research projects.

Despite these efforts, many countries still have no national strategies to halt the growth of the HIV epidemic. Even in the countries with HIV surveillance and awareness interventions, the efforts remain inadequate, irregular, fragmented, and far from effective. HIV knowledge and awareness remain weak in the region, and there is widespread and persistent stigma, with many misconceptions still prevailing. Condoms are used very little and are viewed as a family planning method rather than as an HIV prevention means.

The surveillance system is skewed towards the passive method, with active surveillance still rare. The available HIV data are insufficient and suspect to underestimation, and they do not allow for studying the epidemiology of the HIV epidemic or monitoring trends. Behavioral studies are still lagging behind and data on risk behaviors are few. There is almost no research to measure the HIV impact in the region, and the few available studies are sporadic. Compared to concentrated efforts in HIV case detection and treatment- oriented actions, there is limited HIV prevention outreach and social attention. Existing HIV managerial, research and technical capacities also cannot meet the need for HIV intervention.

The pernicious challenges posed by HIV call for integrated intra-regional efforts. HIV specialists need to share experience, mount multi-center HIV research, and learn from experiences in other regions. In the meantime, a long term vision is vital and there remains a need for capacity building and producing evidence to guide policy decision making and to raise awareness. National and international HIV activists are forcefully calling for sensitizing policy makers, researchers, community leaders and the media personnel on the HIV threat, since raising the awareness of the general public is a mainstay in the HIV prevention.

To meet these challenges, there is a need to found a regional HIV resource center to halt the HIV threat despite the perception of current low HIV prevalence. The center, by working in collaboration with the national Ministries of Health, academia, civil society and international agencies, would be a channel to assemble efforts and build national, regional and international partnerships. The center’s multidisciplinary approach to public health would strive to resolve the problems of insufficiency of data and inadequacy of human capacities by generating HIV knowledge, building HIV research and technical capacities, supporting research, and raising the regional awareness.

Starting in the year 2008, an exciting series of activities in the MENA were initiated by the HIV Center for Clinical and Behavioral Studies and the UCLA Program in Global Health. These are discussed in more detail in the lead feature story of this issue of the HIV Center E-Newsletter. We look forward to crowning them with a new MENA HIV center to enhance the quality of HIV prevention science in the region.

Sherine Shawky, M.D., Dr.P.H. is Research Professor at the Social Research Center at the American University in Cairo. She is the coordinator of a three-month training on “Research Methods for Guiding Policy and Evaluation” and she is involved with health research projects and development of educational material for research methods, health inequities, HIV surveillance, and HIV monitoring and evaluation.