Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: a systematic review and data synthesis
Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. The objective of this review is to demonstrate the evidence on the epidemiology of HIV among MSM in the Middle East and North Africa (MENA).
The paper notes that MSM in the MENA are a largely hidden population because of a prevailing stigma towards this type of sexual behaviour, thereby limiting the ability to assess infection transmission patterns among them.
The review shows that:
- while HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28% among certain MSM groups.
- it is worth mentioning that the very low HIV prevalence still found in some MSM populations is more likely due to their isolation rather than lack of epidemic potential.
- by 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in several countries.
- the high levels of risk behaviour, the overall low rate of consistent condom use and the relative frequency of male sex work suggest potential for further spread.
- similarly, the substantial overlap with heterosexual risk behaviour and injecting drug use voice additional reasons.
The authors conclude that MSM could materialise as the pivotal risk group for HIV sexual transmission in this region in the next decade. Thus, there is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services to prevent the worst of HIV transmission among MSM in the MENA.