The marginalised and criminalised populations of men who have sex with men and people who inject drugs are most affected by HIV in this region. Latest estimates indicate that there are over 300,000 people who inject drugs in the region. Injecting drug use is fuelling HIV epidemics in Iran, Bahrain and Libya and contributes to those in several other countries in the region.
Pilot harm reduction programmes are operating in several MENA countries. However, Iran remains the only country in the region where access to NSPs and OST has been significantly scaled up. 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 other countries in the region have NSP and a small number prescribe OST, none have responses sufficient to meet the needs.
Despite strong civil society in parts of the region, restrictions on the functions of non-governmental organisations in several countries continue to limit the harm reduction response.
* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
|Country/territory with reported injecting drug use||People who inject drugsa||HIV prevalence amongst people who inject drugs (%)||Hepatitis C antibodies (anti-HCV) prevalence among people who inject drugs (%)1||Hepatitis B surface antigen (anti-HBsAg) prevalence among people who inject drugs (%)1||Harm reduction responseb|
|Egypt||85,0002 (s)||6.5–6.82 e (s)||49.4
|Y (2) P||N|
|Iran||170,000–230,000f 3||15 (9.5–22.9)4||50.2
|Y(421)3 (P)||Y (3,373)g 3 (B,M)|
|Y (5)3||Y (B,M)|
|Lebanon||nk||05||52.86||2.5 (0-5)||Y(1-5) (P)||Y (1) (B)|
|Morocco||18,5002||11.4 (0.4–21.8)3||nk||nk||Y (6)3 (P)||Y(3)3 (M)|
|Palestine||nk||08 (s)||38.28 (s)||6.4||Y(1)||N|
|Saudi Arabia||10,0002||0.6h 3||49.8
|Syria||10,000i 2||nk||60.5||nk||N (P)||N|
|United Arab Emirates (UAE)||nk||nk||nk||nk||N||Y3 (BN)|
nk= not known
(s) = sub-national data
a Unless otherwise stated, data are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review, Lancet, 372( 9651):1733–1745.
b Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A & Strathdee SA for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage, Lancet, 375(9719):1014–28.
c The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.
d The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine.
e Sub-national data form 2010 behavioural/biological surveillance conducted in two cities: Alexandria and Cairo.
f Year of estimate: 2007.
g Includes sites in the community and in prisons.
h 2010–2011 estimate based on people who inject drugs (n=3441) enrolled in the detoxification centre at Al-Amal Hospital in Riyadh, and may not be representative of out-of-treatment and other populations of people who inject drugs.
i Population size estimate reported by NAP for 2011, but no information was available at the time of writing as to how this size estimate was arrived at.
1 Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D & Degenhardt L (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.
2 WHO Eastern Mediterranean Region (WHO EMRO) (2012) HIV Surveillance Systems: Regional Update 2011 (unpublished). Cairo: WHO EMRO.
3 Haghdoost A et al. (2012) Modelling of New IHIV Infections Based on Exposure Groups in Iran: Project Report. Kerman: Center for Communicable Disease Management, Regional Knowledge Hub for HIV/AIDS Surveillance at Kerman University of Medical Sciences (In press).
4 Haghdoost A et al. (2012) Bio-behavioural Surveillance of Injecting Drug Users 2010: Project Report. Center for Communicable Disease Management, Regional Knowledge Hub for HIV/AIDS Surveillance at Kerman University of Medical Sciences (In press).