Mideast HIV Epidemic Emerging as Sex Between Men Fuels Infection

Sex between men is responsible for more than a quarter of new HIV infections in parts of the Middle East and North Africa, according to a study that shows epidemics of the AIDS-causing virus are emerging in the region.

High-risk sex between truck drivers in Morocco and Pakistan, prisoners in Lebanon and street children in Egypt are fueling the spread of HIV among those groups, researchers in Qatar found in a study of data from 23 nations published yesterday by the Public Library of Science in its journal PLoS Medicine.

The survey is the first to describe 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. They hope the findings will spur governments to curb the epidemics, said Laith Abu-Raddad, an associate professor of public health at the Weill Cornell Medical College in Qatar who led the study.

“Only a few countries have started in the right direction,” Abu-Raddad said in a telephone interview from Doha, citing Morocco, Pakistan and Lebanon. “The majority of countries still haven’t really acted.” He declined to say which nations are lagging behind, saying the matter is sensitive.

New HIV infections in the Middle East and North Africa more than doubled to 75,000 in 2009 from 36,000 in 2001, according to the Joint United Nations Programme on HIV/AIDS, or UNAIDS. Reliable data on epidemics in the region are scant, the Geneva-based agency said on its website.

Pakistan’s Male Prostitutes

Abu-Raddad and colleagues compiled data from 95 studies and articles. In most countries, fewer than 10 percent of gay and bisexual men have HIV, they found, less than western nations such as the U.S., where the rate is 21 percent. Infections were highest among a group of male prostitutes in Pakistan, where 28 percent have the virus.

Sex between men was responsible for more than half of Lebanon’s new HIV infections in 2008, compared with 13 percent of all infections in that nation since the first cases were detected. Gay sex accounted for 20 percent of new infections in Egypt, and at least a quarter in Oman and Syria, the study found.

Risky sex between men threatens to worsen the epidemics and create new ones as the virus spreads into populations it hasn’t reached before, the researchers said. The men had between four and 14 sex partners in the past six months on average, and fewer than 25 percent said they regularly used condoms.

“Since we have this high-risk behavior and this potential for further spread, if HIV is introduced we might see growing epidemics,” said Ghina Mumtaz, a senior epidemiologist who was the lead author on the study. “This is why it’s important to act quickly.”

Social, Religious Taboos

About 2 percent to 3 percent of men in the region engage in sex with other men, the researchers said, similar to the rate in other regions.

While legal, social and religious taboos against homosexual sex in the Middle East and North Africa can make it difficult for governments to tackle HIV among gay and bisexual men, some are getting around the problem by supporting non-governmental organizations that provide testing, counseling, condoms and other support to men at risk of acquiring the virus, Abu-Raddad said.

“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,” he said.

The study was funded by the World Bank, UNAIDS and the World Health Organization. Weill Cornell Medical College in Qatar is a partnership between the Qatar Foundation and Cornell University in Ithaca, New York.

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