This document provides an overview of the HIV/AIDS situation among men who have sex with men (MSM) in the Middle East and North Africa region. It finds that HIV prevalence among MSM ranges from 3-9% in studies from several countries. However, data is still limited overall in the region. Key challenges include criminalization of homosexuality, social stigma, insufficient funding, and lack of targeted prevention programs for at-risk groups like MSM. Some successes highlighted are increased treatment access in some countries and advocacy efforts by civil society organizations. The 2011 UN Political Declaration on HIV/AIDS set goals to reduce new infections among key populations by 50% by 2015.

1. HIV/MSM: General Overview on Current
Situation, New Initiatives/Success stories

2.  MENA region is among the top 2 regions in the world with the
fastest growing HIV epidemic.
 Data on HIV/AIDS epidemic is limited & subject of much
controversy, whether in the numbers or how it’s divided among
key populations.
 Estimated number of adults and children living with HIV in the
region increased from 330,000 [200,000-480,000] in 2001 to
580,000 [430,000- 810,000] in 2010
 In 2010, there were 84,000 [57,000-130,000] new HIV infections
and 39,000 [28,000-53,000] AIDS-related deaths

3.  HIV prevalence among MSM in studies with well-defined
methodologies (Selected Countries).
Country # of studies % of prevalence
Egypt 2 6%
Morocco 2 4%
Sudan 2 8-9%
Tunisia 1 5%
Lebanon 1 3-4%

4.  Quantity of data steadily increasing, yet still limited to
build trends.
 Shortage of data on HIV in countries across the region;
specifically in United Arab Emirates, Iraq, Kuwait, Libya,
Bahrain, Qatar and Saudi Arabia.
 The scope of the HIV epidemic and its impact in the
region continues to be underestimated.

5.  Ineligibility of countries for Global Fund grants
(which are particularly critical for work with
MSM).
 Insufficient national amount allocated to
AIDS (prevention or treatment).
 Small % of the AIDS funds used to tackle the
needs of key populations

6. 90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Syria Oman Algeria KSA Egypt Morocco
% spent on prevention
source: Country 2010 UNGASS reports

7. 90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Syria Oman Algeria KSA Egypt Morocco
% of prev budget spent on Vuln.Gps
source: Country 2010 UNGASS reports

8. Lack of customized national prevention
programs, targeting key population.
Source: Sarkar S, Menser N, McGreevey W. AIDS2031 Working Paper No.16. Cost-effective interventions that focus on
most-at-risk populations. 2009

9.  Outreach among MSM to seek out services
 Free condom distribution (field and project premises)
 Clinical services for diagnosis and treatment of STIs
(direct and/or referrals)
 VCT (test and pre and post counselling)
 Practical or psychological support for MSM living with
HIV
 Medical support for MSM living with HIV (direct or
referrals)
 Enabling access to ART
 Psychosocial support to MSM

10.  Free distribution of lubricants
 Support to MSM who suffer discrimination or
violence
 Activities and services for men who are sex
workers

11.  Condom social marketing that targets MSM
 Activities and services for transgender people
 Activities and services for partners or family of MSM
 Emphasis on peer education to provide appropriate
and needs-based support to MSM.
 Provision of safe and friendly spaces for MSM, with a
holistic range of support and services.
 Programs that recognize: the diverse identities and
needs of different MSM; and the cross-over of
vulnerability factors HIV (such as MSM who also sell
sex or use drugs).

12.  Most of HIV testing in the region is
mandatory.
 60% of HIV tests carried out between
1995 & 2008 were for migrant workers.
 4% of tests for key populations at higher
risk.
 Hard access to quality VCT.
 Lack of surveillance systems for other
STIs.

13. Reported diagnostic HIV tests conducted in the WHO Eastern Mediterranean Region from 1995 to 2008. The percentages are
the total HIV cases detected divided by the cumulative total HIV tests performed on each of the different population groups.

14.  25% increase, from 15 548 in 2009 to 19
483 in 2010 in one year.
 estimated regional coverage remains low
at 8%.
 Oman has the best estimated coverage
in the region, with 45% receiving
treatment at the end of 2010, followed
by Lebanon (37%) and Morocco (30%).

15. UNAIDS regional Report on AIDS | 2011

16.  Homosexuality criminalized in a way or
another in all countries
 Social stigma & discrimination of being
MSM
 Social
stigma & discrimination of living
with HIV

18.  HIV is not a political priority
 Low prevalence and lack of evidence
 Limitationsof infrastructure to provide
effective services
 National
policies (such as against
condom distribution in prisons)

19.  Policy-makers from the MENA region have recently
acknowledged the importance of HIV issues:
 The June 2010 Dubai Consensus Statement (universal
access)
 The Regional Health Sector Strategy 2011–2015,
endorsed by all Ministers of Health
 The September 2010 Declaration of Commitment and
Call for Action (mobile people, migrants)
 The April 2011 Riyadh Charter, endorsed by all Gulf
Cooperation Council members

20.  Civil
society plays a leading role in the
response
 Inthe UN general assembly (2011), was
able to influence the Arab policy
makers in relation to HIV epidemic

21. UNAIDS regional Report on AIDS | 2011

22. Country Legal CSO / PPLHIV Legal CSO / LGBT
Afghanistan NO NO
Bahrain NO NO
Iraq N/D NO
Kuwait NO NO
Libya N/D NO
Oman NO NO
Syria NO NO
UAE NO NO
Occupied Palestine NO YES

23. Country Legal CSO / PPLHIV Legal CSO / LGBT
Algeria YES NO
Djibouti YES NO
Egypt YES NO
Iran YES NO
Jordan YES NO
Lebanon YES YES
Morocco YES NO
Pakistan YES NO
Qatar YES NO
Saudi Arabia YES NO
Somalia YES NO
Sudan YES NO
Tunisia YES NO
Yemen YES NO

24.  Activists and organizations from Morocco, Algeria, Tunisia, Mauritania and
Lebanon with the support of MSMgf worked on a training tool (AALi SOUTAK =
Raise your Voice) on HIV and MSM with sponsorship of MSMGF. (to be launched
in this year’s WAC)
 Djibouti has a history of protecting the rights of people living with HIV. Unlike
many countries, it guarantees freedom and anti-discrimination legislation for free
movement of PPLHIV, including foreigners.
 In Lebanon, a Sexual Health Center have been initiated by Helem organization
and it became an independent legal NGO called “MARSA” that provides holistic
sexual health services(medical, psychological and Social), similar initiative have
been launched in Morocco (Al Borj – Marrakesh).
 Anti-stigma campaigns through various means are being encouraged in all MENA
countries to influence public opinion about AIDS. The recent Egyptian film,
Asmaa, that tells the true story of a woman overcoming fear and social rejection,
is an example to be followed more broadly in the region.

25.  The 2011 United Nations General Assembly Political Declaration
on HIV/AIDS has defined targets and elimination commitments
 The targets related to universal access to prevention or “zero new
HIV infections” set in the Political Declaration are:
o Reduce sexual transmission of HIV by 50% by 2015
o Reduce transmission of HIV among people who inject drugs by
50% by 2015
o Eliminate new HIV infections among children by 2015 and
substantially reduce AIDS-related maternal deaths

26. Johnny TOHME
Marsa – Sexual Healh Center
MSMGF Youth Reference Group
Beirut - Lebanon