The Middle East is an area of low HIV prevalence, but not low risk. Prejudice and a lack of sex education seem to be directly affecting the rise of HIV infections in the Middle East.

After speaking to a patient who was from the Middle East, Medical Graduate Shaik Ashraf developed the app ‘Burnd’ in response to some concerns regarding the man’s fears about his own sexual health. The app calculates an individual’s risk of catching HIV by taking into account the person’s sexual orientation, sexual activity, whether they know if their partner has been tested, and the type of sex they have.

There is increasing concern about HIV/AIDS in the Middle East and North Africa region – the only two places where AIDS-related deaths continue to rise. As HIV diagnoses decline around the world, the Middle East is lagging far behind in achieving UNAIDS’ 90-90-90 targets, with cases of HIV/AIDS increasing. From 2010 to 2015, AIDS-related deaths rose from 9,500 to 12,000 and according to UNAIDS data on the MENA region, there is also a steady rise of new HIV infections each year.

Problems that are hindering this region’s progress include:

  • A lack of appropriate surveillance systems
  • Low access to HIV care facilities
  • Socioeconomic and geopolitical situations
  • Stigma and discrimination against key populations who are most at risk.

People who are most at risk of HIV engage in activities that are condemned by society and the law. The stigma associated with those activities is also preventing them from seeking help. The key populations that are most at risk include:

  • Female sex workers
  • Men who have sex with men
  • Injecting drug users.

The spread of HIV from these populations to the general public is highly likely due to the lack of access to prevention and treatment services in the Middle East. Some cultural practices also contribute to the worsening of the HIV epidemic in this region such as polygamy, prohibitions against condom use, and the link between HIV and the concept of immorality.

HIV testing in the Middle East is also limited despite being one of the biggest factors in HIV prevention programmes. Even though there are key populations that are most at risk of catching HIV, the virus can affect anyone.

HIV does not discriminate against sexual orientation, race, ethnicity, gender or age. Your personal risk of HIV depends on the type of exposure. Some exposures carry a higher risk of transmission than others. If you are worried about HIV at all, you should get tested.

Am I at risk of HIV?

Examples of behaviours that increase your risk of HIV include:

  • Unprotected anal and vaginal sex
  • Sharing needles and syringes.

HIV is transmitted through infected bodily fluids such as blood, vaginal fluids, semen, rectal fluids and breast milk. These bodily fluids must be exchanged to result in infection, which means there needs to be a route for the virus to enter your body.

This includes breaks in the skin that can happen through certain sexual activities; anal sex carries the highest risk of HIV transmission. You can also catch HIV through oral sex in cases where you or your partner have any cuts, sores or lesions in the mouth or on the genitals. These openings in the skin enable the virus to enter your system.

Sharing needles and mother-to-child transmission are also viable routes for the virus to enter your system. Women can pass on HIV to their baby during pregnancy, at birth or through breastfeeding. Having an existing sexually transmitted disease (STD) also increases your risk of catching HIV.

Knowing your HIV status enables you to decide how to better protect yourself from both catching an infection or transmitting the virus to others. Methods of HIV prevention include:

  • Using condoms
  • Abstaining from high-risk activities
  • PrEP for those with partners who are HIV positive
  • Receiving treatment if you are diagnosed with HIV.

Read more about HIV testing on the Better2Know website.

Sources

[1] Avert: HIV and AIDS in the Middle East and North Africa (MENA)

[2] CDC: HIV Risk Behaviours

[3] Dianatinasab, Mostafa & Joulaei, Hassan & Shooshtarian, Sowgol. (2018). Is UNAIDS 90-90-90 target a dream or a reality for Middle East and North Africa region on ending the AIDS epidemic? A review study. AIDS reviews. 20. 1-12.

[4] Free Malaysia Today: Medical grad develops app to calculate risks of contracting HIV

[5] HIV.gov: Who Is at Risk for HIV?

[6] National AIDS Trust: Do I understand HIV?

[7] UNAIDS: Middle East and North Africa

[8] Verwell Health: High vs. Low Risk Activities for HIV Transmission

[9] Vice: Deadly Stigma: HIV Infections in Middle East on the Rise

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