150 2023 UNAIDS GLOBAL AIDS UPDATE
REGIONAL PROFILE
Middle East and
2022 DATA
• 61% increase in new HIV infections since 2010
• 16% decrease in AIDS-related deaths since 2010
• People living with HIV:
190 000 [160 000–220 000]
• New HIV infections:
17 000 [13 000–23 000]
• AIDS-related deaths:
5300 [4000–7100]
Testing and treatment cascade (all ages):
• % of people living with HIV who know their HIV status:
67 [58–79]
• % of people living with HIV who are on treatment:
50 [43–59]
• % of people living with HIV who are virally suppressed:
45 [39–53]
Financing of the HIV response:
• Resource availability for HIV:
US$ 200 million [82% gap to meet the 2025 target]
Only a third of children and half of adults living with HIV are on treatment in the Middle East and North Africa Figure 9.2 HIV testing and treatment cascade, by age and sex, Middle East and North Africa, 2022
Source: UNAIDS special analysis of epidemiological estimates, 2023.
People living with HIV who know their HIV status People living with HIV who are on treatment People living with HIV who are virally suppressed Total population
living with HIV 67
50 45
Women (aged 15+ years) living with HIV 63
49 44
Men (aged 15+ years) living with HIV 71
52 47
Children (0–14 years) living with HIV 44
34 32
Per cent
0 80 100
60
40
20
152 2023 UNAIDS GLOBAL AIDS UPDATE
Highest HIV prevalence in the region is reported among gay men and other men who have sex with men Figure 9.3 HIV prevalence among key populations compared with adults (aged 15–49 years), reporting countries in Middle East and North Africa, 2018–2022
Sources: UNAIDS Global AIDS Monitoring, 2023; UNAIDS epidemiological estimates, 2023 (https://aidsinfo.unaids.org/).
Notes: n = number of countries. Total number of reporting countries = 20.
The adult prevalence uncertainty bounds define the range within which the true value lies (if it can be measured). Narrow bounds indicate that an estimate is precise, while wide bounds indicate greater uncertainty regarding the estimate.
The median HIV prevalence among countries that reported these data in Middle East and North Africa was:
1.1% among sex workers.
6.6% among gay men and other men who have sex with men.
0.9% among people who inject drugs.
The estimated HIV prevalence among adults (aged 15–49 years) is 0.06% [0.05–0.07%].
How to read Sex workers
(n = 6) Gay men and other men who have
sex with men (n = 6)
People who inject drugs (n = 3)
Transgender people
(n = 0)
People in prisons
(n = 5)
Adults (aged 15–49 years) 1.1
6.6
0.9
0.2 0.06
Upper extreme
Upper quartile Mean Median
Lower quartile Whisker Lower extreme
0.2% among people in prisons.
Per cent
14
0 12
10
8
6
4
2
Marginalized and criminalized populations bear the brunt of the HIV epidemic in the region, and accounted for the majority of new HIV infections in 2022. Regional median HIV prevalence is 6.6% among gay men and other men who have sex with men (data from six countries), 1.1% among sex workers (data from six countries) and 0.9% among people who inject drugs (data from three countries) (Figure 9.3).
A lack of political will, limited funding, inadequate data, and severe stigma and discrimination towards people from key populations present major barriers, which are further compounded by ongoing conflicts and humanitarian crises in many countries in the region.
References
1 Mumtaz GR, Chemaitelly H, AlMukdad S, et al. Status of the HIV epidemic in key populations in the Middle East and north Africa: knowns and unknowns. Lancet HIV. 2022;9(7):e506–e516.
2 Impact report: Middle East Response Initiative. Geneva: Global Fund to Fight AIDS, Tuberculosis and Malaria; 2022 (https://www.theglobalfund.org/media/12029/impact_middle-east_report_en.pdf, accessed 18 July 2023).
3 Karbasi A, Fordjuoh J, Abbas M, et al. An evolving HIV epidemic in the Middle East and North Africa (MENA) region: a scoping review. Int J Environ Res Public Health. 2023;20(5):3844.
Extensive sociopolitical and economic crises, including armed conflicts and forced displacements, have affected the Middle East and North Africa over the past two decades and have had implications for the HIV response in the region. Countries affected by humanitarian emergencies, such as Somalia, Sudan, the Syrian Arab Republic and Yemen, are showing lower service coverage compared with more stable countries in the region.
Although the direct impact on HIV incidence and related morbidity and mortality has not been estimated, the effects on determinants of HIV risk and infection are evident (1).
Notably, recent conflicts, such as that in Sudan, have severely disrupted access to HIV services, with many health-care centres unable to operate.
As of May 2023, 70% of hospitals in Khartoum have closed. Countries affected by humanitarian emergencies must prioritize HIV within the humanitarian agenda and develop evidence-informed, rights-based and resilient HIV responses.
The Global Fund launched the Middle East Response Initiative in 2017 to better respond to the complex and acute emergency situations in many countries in the Middle East by providing essential HIV, TB and malaria services to people from key and vulnerable populations, including refugees, internally displaced people, women and children in Iraq, Jordan, Lebanon, the Occupied Palestinian Territory, the Syrian Arab Republic and Yemen (2). The aim of combining multiple programmes is to bring greater value for money, reach more people from vulnerable populations, and support stronger regional partnerships that can deliver health-care services in conflict-affected and hard-to-reach areas.
Improved data are crucial for achieving a more effective HIV response in the region (3). A few countries, notably Morocco, have made substantial investments in data generation and use. Enhanced biobehavioural survey and programme data, focused on key and priority populations, are needed to provide robust strategic information for programme and policy design, and for effective and sustainable resource mobilization and allocation. To get on track to achieve the 2025 targets, the HIV response in the region has to be tailored to the needs of key populations, including through community-led initiatives, and the complex structural and operational barriers to service provision have to be reduced.
154 2023 UNAIDS GLOBAL AIDS UPDATE
REGIONAL PROFILE