Study Shows HIV Rates Skyrocketing in Middle East

A new study by the Public Library of Science (PLoS) indicates that HIV rates are spiking in Middle Eastern countries, driven by young male sex workers, long-haul truckers, incarcerated men, and men who identify as heterosexual but seek out other men for sexual encounters, as well as gays, transgender men, and bisexuals, demographics collectively known to health professionals as "Men who have Sex with Men" (MSM).

The study, titled "Are HIV Epidemics among Men Who Have Sex with Men Emerging in the Middle East and North Africa?," was conducted by researchers at Qatar's Weill Cornell Medical College. The study surveyed nearly a decade's worth of reports on HIV and AIDS in the Middle East, according to an Aug, 3 report at NewsMedical.net.

Though the percentage of men in the region who have anal intercourse is the same as for other areas around the globe -- 2 to 3 percent -- a number of factors have conspired to drive up the transmission rate, the study suggested.

The rate of HIV has topped 5 percent in several Middle Eastern countries among the MSM population, the study noted. That means that HIV can now be considered at epidemic proportions in that group. Sudan, Egypt, Pakistan, and Tunisia are among the nations where the transmission rate has exceeded the 5 percent mark. In at least one area of Pakistan, the rate of HIV has hit 28 percent among MSM.

"Based on multiyear analysis of thousands of data sources, we documented a pattern of new HIV epidemics that have just emerged among men who have sex with men in the last few years in several countries of the region," the study's principle author, Ghina Mumtaz, told the media.

Of the nations surveyed, "Only a few countries have started in the right direction," said the study's principal investigator, Laith Abu-Raddad. "The majority of countries still haven't really acted."

Among other findings, the report noted that many men having sex with other men were not using condoms. Mumtaz urged prompt attention to the health crisis, telling the media, "Since we have this high-risk behavior and this potential for further spread, if HIV is introduced we might see growing epidemics."

"The level of HIV infection among men who have sex with men tells only half of the story," Abu-Raddad said. "We also documented high levels of risky practices that will likely expose this population to further HIV transmission in the coming years."

Health advocates working to counter the spread of HIV have long warned that regions where gays are stigmatized and persecuted risk seeing increased levels of HIV transmission. Social stigma and the criminalization of homosexuality serves to drive sex between men underground, and MSMs are often reluctant to seek testing or treatment.

Though the chances of transmitting HIV fall sharply for those who are on an effective drug regimen, those who are left untreated are much more likely to spread the virus. Attitudes that HIV and AIDS are "gay" health problems do not protect those who are exposed.

Education efforts are also hampered in such environments; it is not unknown for police to raid clinics that offer counseling and condoms and seize medical information about STIs. Such literature has, in some cases, been cited as evidence that clinic workers are distributing "pornography."

"There is a narrowing window of opportunity to prevent further epidemics," warned Mumtaz. "Policy-makers in the Middle East and North Africa should address this growing health challenge from a public health perspective."

The study also showed some overall patterns of conduct that are common in regions where gays are persecuted and same-sex encounters driven underground. Many MSM had a large number of sexual partners, and had sex with both men and women. Also, there was a higher rate of intravenous drug use among the region's MSM.

Those patterns are consistent with reported behavior elsewhere. Even in relatively accepting parts of the world, studies have indicated a correlation between anti-gay stigma and higher rates of smoking, drinking, drug use, and promiscuity.

Moreover, much of the sexual activity happening between men in the region took place as a business transaction, with money changing hands for sex.

"It's really time for action, for policy makers to think about it and also for them to know there are creative ways to dealing with the issue, even within the socially conservative context of this region," added Abu-Raddad.

"This is the first survey that describes the state of HIV among gay and bisexual men in a region where same-sex intercourse is often criminal and the stigma associated with it can hinder efforts to prevent transmissions, the researchers said," the article reported.

"Though HIV infection levels were historically very low in the Middle East and North Africa, substantial levels of HIV transmission have been found, beginning in 2003, among men who have sex with men, a hidden and stigmatized population in this part of the world," noted an Aug. 2 Science Daily article.