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Middle East and North Africa - Regional Overview
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The marginalised and criminalised populations of men who have sex with men and injecting drug users are most affected by HIV in this region. Injecting drug use is fuelling HIV epidemics in Iran and Libya and contributes to those in several other countries in the region. Drug-related offences result in severe penalties in this region, including the death penalty in many countries, and prison populations include many people with a history of drug use. Elevated HIV prevalence is reported in prison populations in Yemen, the United Arab Emirates and Libya, although data on HIV in prisons are unavailable in much of the region. Several countries in this region fall along heroin transhipment routes from Afghanistan. The impact of this is most pronounced in Iran, where it is estimated that 1.2 million people smoke, inject or ingest opiates (2.8% of the population).
Faced with a growing HIV epidemic among people who inject drugs, the Iranian government has embraced a harm reduction approach and dramatically scaled up access to both needle and syringe programmes (NSP) and opioid substitution therapy (OST). Iran is also one of the few countries worldwide where NSPs are available in prisons, albeit only in a small number of institutions. While several countries (including Iran) have NSP and a small number prescribe OST, none have responses sufficient to meet the needs.
Across the region, there is a low awareness of risks associated with injecting drug use. Few civil society organisations are working on harm reduction in the region, and restrictions on the functions of such organisations in several countries further limit the harm reduction response from civil society.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in the Middle East and North Africa.
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The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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Few countries in this region have an explicit supportive reference to harm reduction in their national policies on HIV and/or drugs. These are illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are available in some countries in this region, as illustrated in the maps and table below. Even where services exist, coverage remains insufficient and repressive legal and policy frameworks present a substantial barrier to effective harm reduction implementation exist in this region.
Prison-based needle and syringe exchange and opioid substitution therapy are currently only available in Iran.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without government support.
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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The map below shows which countries have prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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