Middle East and North Africa

The number of people living with HIV in the Middle East and North Africa has risen to 460,000 and some 68,000 people were newly infected in 2006 alone. In a bid to curb the region’s growing epidemic, countries have been working with UNAIDS to secure additional funding to scale-up the AIDS response in the region.

Securing external funding is particularly challenging in the Middle East and North Africa due to limited support from external donors. One of the donors operating in the region is the Global Fund to fight AIDS, Tuberculosis and Malaria which has now become one of the main sources of AIDS funding for the region. The fund was created in January 2002 to attract, manage and disburse additional financing to support locally-driven strategies in response to AIDS, TB and malaria.

To date, the Global Fund has approved a total of US$ 6.6 billion to over 450 grants in 136 countries. Of the US$ 6.6 billion approved, US$ 2.9 billion has been disbursed to public and private recipients in 129 countries.

The grant application process can be complex and many countries in the region have solicited UNAIDS to assist in processing their applications. UNAIDS has played a role in raising awareness and creating a climate which has enabled countries to establish a country coordination mechanism thus making it possible to develop their grant proposals. UNAIDS facilitates provision of technical expertise to these areas and helps countries not only to develop their grant applications but also to implement the grants once approved.

In the most recent round of grants (Round Six) UNAIDS Regional Support Team and Country Offices in the Middle East and North Africa worked with five countries in the region to help formulate their proposals. Grants were approved for four out of the five countries with funding amounting to some US$ 26 million.

“UNAIDS works with countries at every opportunity to help ‘make the money work’ so that funds reach the people that need them most,” said Michel Sidibe, Director of UNAIDS Country and Regional Support Department. “As countries move towards the goal of universal access to HIV prevention, treatment, care and support, adequate funding from both external and domestic sources is absolutely vital.”

Currently, 13 out of the 22 countries in the Middle East and North Africa meet the eligibility criteria for Global Fund support and 10 out of 11 countries who have applied for Global Fund funding for AIDS to date have succeeded in obtaining funds, amounting to a total of US$ 127 million.

The UNAIDS Secretariat has provided assistance in developing 73% of all the proposals on AIDS in the region that have been approved between Rounds One and Six, including support to proposals from Algeria, Djibouti, Jordan, Morocco, Somalia, Sudan, and Tunisia.

As well as working with countries on grant proposals, UNAIDS also continues to support the implementation of grants and resolve major coordination and implementation difficulties or capacity-building challenges in all countries where grants were already in place from earlier rounds. Through the Global Implementation Support Team – GIST - UNAIDS, together with Cosponsors and the Global Fund headquarters, are providing a common action plan to support counties in solving bottlenecks, at the request of countries.

Typically the activities funded by the grants are wide-ranging and include development of second-generation surveillance and monitoring and evaluation; working with people most at risk of HIV infection such as young people, people who inject drugs and sex workers; reinforcing civil society––including non-governmental organisations, community-leaders and people living with HIV; increasing access to care, treatment, and psycho-social support of people living with HIV; and other specific interventions, such as coordination, blood safety, voluntary counselling and testing, and sexually transmitted infections.

“The availability of Global Fund resources in the region have created a new reality and represents a critical turning point in the national responses in the Middle East and North Africa,” said Oussama Tawil, Director of UNAIDS Regional Support Team for the Middle East and North Africa. “This is essential in particular in a context where the allocation of public resources remains relatively limited and primarily oriented to health care responses and other donor resources generally still represent limited support.”

The assistance UNAIDS provides to countries is coordinated with the World Health Organisation and other Cosponsors through an agreement which ensures complementary responses to countries and joint funding of regional training on the development of Global Fund proposals.

“Using the frameworks of the 'Three Ones' and 'Universal Access', UNAIDS will focus in 2007 on resolving bottlenecks, supporting the implementation process with scaled-up and diversified technical assistance ensuring that efforts in countries go beyond the 'project-mode' with regards to the Global Fund grants,” said Tawil.

Increasing access to HIV prevention, treatment, care and support services for drug users and their partners is crucial to addressing the issue of growing HIV infections related to injecting drug use in the Middle East and North Africa region.

This was the overwhelming conclusion reached by regional representatives from law enforcement agencies, national AIDS programmes, NGOs, researchers, community representatives, people living with HIV and UN organizations who joined at a regional workshop on the issue of HIV and drug use in the region, held in Cairo, Egypt from 5 – 8 November.

Throughout the 3-day discussions, participants from the Arab countries, Afghanistan, Iran and Pakistan affirmed that drug use is an important risk factor in facilitating spread of HIV that calls for immediate action. Joint efforts of police, national AIDS actors, NGOs, drug users and of people living with HIV were recognized as fundamental elements in the prevention of HIV among drug users and their partners.

While significant efforts are being undertaken in a number of countries to reach out with HIV preventive services to drug users communities, limited capacities coupled with discrimination against drug users hamper implementation of wider-scale programmes.

“From my personal experience and my field work on reducing harm related to drug use, I suggest training more drug users and ex-drug users –to build their skills in order to promote and implement [HIV preventive] programs in the region,” an ex-drug user and outreach worker said in the workshop.

New initiatives for building capacities of civil society actors on implementing harm reduction measures and networking in the region were discussed and examined.

“Participation in this workshop has allowed an exchange of international experiences among NGOs and governments, and a discussion of the strategic approaches to planning at the national level to protect against the harms and risks of drugs and related HIV. It has created cooperation between [national stakeholders]…and encouraged civil society actors to assist and support alternative programs for drug users,” police participants from one of the Gulf countries said.

As part of the workshop, UNAIDS and UNODC launched the finalized Rapid Situation Assessment on Drug Use and HIV in Algeria and Morocco, as well as facilitate consensus on programmatic follow up for all participating countries. WHO and the International Harm Reduction Association launched a project on strengthening the role of civil society in harm reduction for injecting drug users in the Middle East and North Africa.

Although the main mode of HIV transmission in the Middle East and North Africa remains unprotected sexual contact, injecting drug use is an increasingly important factor in the region’s epidemics.

Although the main mode of HIV transmission in the Middle East and North Africa remains unprotected sexual contact, injecting drug use is an increasingly important factor in the region’s epidemics.

The spread of HIV among drug users appears to be closely related to evolving patterns of drug use in the region in recent decades. Evidence suggests increase in number of drug users, decrease in the age at first use of drugs and some indication of an increased percentage of women using drugs in several countries.

The United Nations Office of Drugs and Crime (UNODC) estimates there are 400,000 injecting drug users in Arab countries and approximately 200,000 in Iran. These figures do not include a recent increase in numbers in Afghanistan which have been observed.

The sharing of contaminated injecting equipment among injecting drug users has become the predominant route of HIV infection in at least two countries since the mid to late 1990s – Iran and Libya –where a concentrated epidemic now appears to be well established.

“This is a real and growing issue for countries in the Middle East and North Africa. And although we are seeing increasing willingness to introduce HIV prevention and treatment programmes for drug users, focused efforts are needed urgently to ensure access to services for all drug users and their partners,” said Oussama Tawil, Director of UNAIDS’ Regional Support Team, Middle East and North Africa.

Over the last years, UNAIDS and UNODC have supported assessments on drug use and HIV-related risks in Algeria, Egypt, Libya, Morocco, as well as in Oman and Syria, as part of efforts to better understand trends and dynamics of the epidemics in the region and to increase HIV prevention efforts.

Main findings ensued suggest that needle sharing, ranging from 40 to 60%, coupled with low knowledge on AIDS, limited access to health and HIV-related services, stigma and discrimination, and other associated risk factors, are among some of the challenges faced by the region to reduce HIV risks and vulnerability among injecting drug users.

Within the assessments, researchers spoke to drug users about their thoughts and fears: “If I enter [a treatment center] I'll be marked, and my future is over. I will not be able to do anything, neither work nor life," said one of the participant.

“Drug use and other risk behaviors remain stigmatized in the region, which is why we must forge strong partnerships with different sectors, such as the national AIDS programmes, non-governmental organizations, drug users, people living with HIV and law enforcement agencies, to be able to better understand the epidemic and implement concrete solutions,” said Mr Tawil.

Foundations for an increased response to address HIV risks and vulnerability among drug users have been established in some countries and are underway in others. In Iran – considered a global best practice model – HIV-related initiatives for injecting drug users inside and outside prisons are now being scaled up beyond the pilot levels.

In an example of a bold movement to better tackle the issue of HIV and drug use in the region, representatives from law enforcement agencies, national AIDS programmes, NGOs, researchers, community representatives, people living with HIV, UN organizations and other partners will join at a regional workshop to be held in Cairo, Egypt from 5 – 8 November.

The workshop— “Towards Implementation of a Comprehensive HIV response and AIDS Response Among Drug Users in the Middle East and North Africa”— convened by UNAIDS and its cosponsors UNODC and the World Health Organization (WHO) as well as the German Technical Coorperation (GTZ), will welcome participants from 16 countries and aims to build capacities on programming and implementing HIV prevention, treatment and care interventions among drug users.

As part of the workshop, UNAIDS and UNODC will launch the finalized Rapid Situation Assessment on Drug Use and HIV in Algeria and Morocco, as well as facilitate consensus on programmatic follow up for all participating countries. WHO and the International Harm Reduction Association will also launch the project on strengthening the role of civil society in harm reduction for injecting drug users in the Middle East and North Africa.

“This gathering bringing together wide diversity of partners is unique for the region and a turning point for action on drug use and HIV in the region” Mr. Tawil said.

Caravanning in Morocco has taken a whole new meaning with a special summer caravan travelling around the country in a quest to raise awareness about HIV prevention among young people.

Parking at some of Morocco’s most popular resorts from the Atlantic and Mediterranean coasts to the remote Atlas Mountains sites, the caravan has visited 19 youth campsites where more than 7000 young men and women have stayed during their holidays.

The SIDAmobile initiative’s caravan is run by the Moroccan-based organization ‘Association de Lutte Contre le SIDA’ in Morocco (ALCS) and the Ministry of State for Youth.

“In Morocco, we are very sensitized to the importance of intensifying prevention efforts towards young people because they are particularly vulnerable to HIV infection and also because they represent the future,” said President of the ALCS, Hakima Himmich.

At each stopover, the facilitators –all doctors who have been specially trained to work with young people on the issue of HIV— initiated open and frank discussions about sex and sexually transmitted diseases (STDs). In less than a month, the caravan distributed some 35 000 flyers on HIV and 15 000 condoms were given to young people at their request. Also more than 700 people asked for, and received, a confidential HIV test with counselling.

“It’s the first time I have done an HIV test”, said a participant of the summer camp Assilah Corniche. “There is nothing wrong about it but it’s not very common in my neighborhood to be open about sex, especially for girls.”

“It’s good to learn about HIV and how it spreads,” added another young woman in the same campsite. “Now I know how people become infected with HIV and I learned how to protect myself,” she added.

In Morocco, only an estimated 12% of women aged 15 to 24 are able to identify ways to prevent HIV. “We are trying to create an environment that enables people, especially the younger ones, overcome some of the taboo associated with sex and give them an opportunity to talk about their concerns and ask questions,” said My Ahmed Douraidi from ALCS and coordinator of the SIDAmobile initiative. “This is the first step for any HIV prevention work,” he added.

Praising this grass root prevention initiative and recognizing the importance of high level leadership and commitment, Kamal Alami from UNAIDS office in Morocco said that “HIV prevention on the ground is far more effective when programmes are tailored to audiences”.

“In Morocco, the high level support we receive creates many opportunities, such as music festivals, popular celebrations etc. that we can seize to disseminate prevention messages among young people,” he added.

The summer caravan stems from a collaborative effort between ALCS, the State Secretary for Youth and the United Nations Population Fund (UNFPA)

Related links
United Nations Population Fund (UNFPA) 
Association de Lutte Contre le SIDA (ALCS)

 

Geneva, 12 July 2007 - The Joint United Nations Programme on HIV/AIDS (UNAIDS) expresses serious concern over the verdict delivered by the Libyan Supreme Court to uphold the death sentences imposed on six health care professionals.

UNAIDS is concerned that certain scientific evidence appears to have not been taken into consideration raising serious doubts regarding the conclusion reached by the court.

UNAIDS strongly urges Libya’s High Judiciary Council to review the Supreme Court’s decision when they meet on Monday, taking into consideration all relevant and available scientific evidence related to the case.

The six health care professionals (five Bulgarian nurses and one Palestinian doctor), imprisoned since 1999, are accused of deliberately infecting 426 children with HIV whilst working at a hospital in Benghazi, Libya. Since 1999, 56 of the children found to be infected with the virus have died.

UNAIDS also expresses its deep concern and empathy for the children affected and for their families, and urges the Libyan Government and international partners to ensure that HIV treatment, care and support are provided to these children and that the human rights of all are respected.

UNAIDS reiterates its support to the Government of Libya for a comprehensive response to prevent the transmission of HIV; to provide for treatment, care and support for those living with HIV; and to protect the rights of those affected by HIV.

GENEVA, 2 August 2013—United Nations Secretary-General Ban Ki-Moon has appointed Speciosa Wandira-Kazibwe of Uganda as his Special Envoy for HIV/AIDS in Africa. 

Ms Wandira-Kazibwe is currently Senior Adviser to the President of Uganda on Population and Health and coordinating the development of reforms for Uganda’s health system.

From 1994 to 2003, she served as Vice-President of Uganda, the first woman in Africa to hold such a position. A surgeon with a science doctorate in global health and population from the Harvard School of Public Health, Ms Wandira-Kazibwe also serves as a member of the Champions for an HIV-Free Generation initiative.

As Special Envoy for HIV/AIDS in Africa, Ms Wandira-Kazibwe will help advance the AIDS response in Africa by advocating for the proactive engagement and involvement of all sectors of society.

“I am honoured and very delighted to take on this new and challenging role in this crucial time of the AIDS response,” said Ms Wandira-Kazibwe.

“We look forward to working closely with such an experienced leader like Ms Wandira-Kazibwe,” said UNAIDS Executive Director Michel Sidibé. “I am convinced that her tireless effort and commitment will help make change happen across Africa.”

Africa continues to be more affected by HIV than any other region of the world, accounting for 69% of people living with HIV globally. Despite positive trends, in 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.