1. There is no single epidemic in the Middle East and North Africa – learning from facts to shape the AIDS response UNAIDS Secretariat, the World Bank and WHO 7 th August 2008

2.  Socio – Political Context in MENA  HIV epidemic – trends, patterns  Snapshot of the response to AIDS in the region - socio-cultural and political context related to HIV  Main challenges, opportunities Outline

3. Socio – Political and Economic Context in MENA  431 million people in 22 countries: One third of the population in the region is below 15 years old  Gender differences are still considerable: education, work opportunities, public life  Diverse development indicators  Life expectancy – 43 to 79 years old age range  Contrasting economic situation: low income to high level income  Pervasive conflict, political instability and insecurity – threatening the developmental gains made 

4. Summary of Situation, December 2007  There is no single epidemic in MENA: HIV prevalence estimated 0.3% with notable variations  Low prevalence  Concentrated among IDUs  Generalized  Estimated 40 000 new infections  Diverse epidemic situations  Sexual transmission is the main mode of infection  Drug injecting-related transmission in Afghanistan, Iran, Libya with variations and diversity within the country  Increasing MTCT data in a few countries

5. Diversity and Patterns of Epidemic  Increased evidence of diverse epidemics across geographical areas within the country  Higher level of infection and risk behaviors among most at risk of populations  Low level of condom utilization among sex workers and limited availability and access to adapted HIV prevention services  Increased concern with HIV prevalence rates among men who have sex with men [6.2% in Egypt, 9.3% in Sudan, etc]  Evidence of overlapping risks between different patterns of sexual transmission as well as with drug injection  Evidence of emergence of concentrated epidemics among populations and specific settings in MENA

6. Other Aspects of Vulnerability  Changing norms of behavior of young people  Prison setting – high risk behaviors and document elevated HIV prevalence in a few countries  Mobility and migration  Economic within the region and across the region  Conflict and instability  E.g. North Africa, Red Sea and Gulf of Aden, Gulf countries  Socio-economic and gender disparities

7. Example of risks and vulnerability -Needle Sharing  Emergence of drug injecting as a potential important driving factor of the epidemic Elevated levels of needle sharing

8. Risk of overlapping risks and bridging populations Sex work IDU MSM e.g. 20 – 87% have female partners Partners

9.  MENA an Opportunity to avert the epidemic and reach Universal Access

10. Snapshot of the Response ‘ Comprehensive’ response – recognize HIV within national priorities and have embraced Universal Access  Algeria, Djibouti, Morocco, Somalia, Sudan, Iran  Relative visibility of epidemic, link between HIV and politically important concerns (IDU in Iran) Adapted and potentially effective responses – frame AIDS as a programmatic priority and have adopted Universal Access  Jordan, Lebanon, Oman, Tunisia, Yemen  Efforts to adapt and focus the response to the prevalence settings (MARPs, people living with HIV, scaling up) Overcoming key political obstacles – stage of the response coupled with political constraints on how AIDS is positioned  Egypt, Gulf Countries, Libya  Limited profile of the AIDS response due to related concern of political considerations

11. Snapshot of the Response Security and post-conflict context – facing devastating impact of conflicts, humanitarian crisis and security challenges - Afghanistan, Iraq, and Occupied Palestinian Territories, Somalia Yemen, UNHCR

12. Snapshot on HIV response in MENA Prevention: Increased focus on those most in need, establishment of programmes for key populations in several countries (sex work, IDUs, MSM, migrants and specific groups) Treatment, care and support: Increased access to treatment but far from sufficient – 7% of those in need receive treatment Resources: Approx. US$ 431 million from GFATM for HIV in MENA over the last four years Services: Increased coverage in terms of availability of services – establishment of VCT sites at decentralized level, treatment sites Civil Society and Associations of people living with HIV:  Regional network revitalized, increased involvement of NGOs in the response  Invigorated associations and support groups of people living

13. Morocco Algeria Tunisia Libya Sudan Somalia Djibouti Egypt Iran Afghanistan Yemen Saudi Arabia Iraq Oman UAE Bahrain Qatar Syria Lebanon Jordan OPT Emergence of actions and programmes for Sex work and HIV ’ 90s ’99 - 2000 2005 Regional Training on Sex Work

14. Multi sector response, reaching most at risk and vulnerable groups, involvement of civil society and PLHIV Scaling up Towards Universal Access to HIV Prevention, Treatment, Care and Support Political Commitment -NACs -Public resources to AIDS Social Stigma Discrimination -MARPs -People living with HIV -Travel restrictions & other policies Know your Epidemic Scale up the response -Effectiveness, coverage, sustainability, resources Challenges

15. Scaling up towards Universal Access for all in the Middle East and North Africa