18 research outputs found

    Are HIV Epidemics among Men Who Have Sex with Men Emerging in the Middle East and North Africa?: A Systematic Review and Data Synthesis

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    A systematic review by Laith Abu-Raddad and colleagues collates and analyzes the epidemiology of HIV among men who have sex with men in Middle Eastern and North African countries

    HIV-1 molecular epidemiology evidence and transmission patterns in the Middle East and North Africa.

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    The distribution of HIV-1 subtypes in a population tracks the spread and evolution of the epidemic. This study is a systematic review of all available evidence on HIV-1 molecular epidemiology and subtype distribution in the Middle East and North Africa. Sources of data included Medline and various institutional documents and databases. In several countries, a diverse distribution of HIV-1 subtypes was observed principally reflecting travel-related exogenous exposures. A trend for a dominant HIV-1 subtype was observed in a few other settings and was often linked to HIV transmission within specific high-risk groups such as subtype A and CRF35_AD among injecting drug users and subtype C among commercial sex networks. Multiple exogenous introductions of HIV-1 variants seemed common to all countries, as observed from the high diversity in subtypes, or the high genetic divergence among any specific subtype even if predominant. In several countries though, epidemic-type clustering of specific subtypes suggests established or nascent HIV epidemics among classic core risk groups for HIV infection. HIV prevention efforts in MENA must be prioritized for these high-risk groups

    Epidemiology of HIV infection in the Middle East and North Africa.

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    OBJECTIVE: The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by delineating a data-driven overview of HIV epidemiology in this region. METHODS: A comprehensive systematic review of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific literature published in nonindexed local and regional journals, international organizations reports and databases, country-level reports and database including governmental and nongovernmental organizations publications, as well as various other institutional documents. RESULTS: Over 5000 sources of data related to HIV and STIs were identified and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in bridging the HIV infection to the general population was found to be very limited. CONCLUSION: Although they do not provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the region, in large part, is unprepared for

    Solar process heat plant in Pisticci/Southern Italy

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    In cooperation with AGIP SpA, Milan (IT)SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

    Contribution of injecting drug use as a mode of HIV transmission to the total HIV/AIDS cases by country as per various studies/reports and countries' case notification reports [126],[190].

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    <p>Only the most recent available report was used.</p>a<p>Except for Bahrain, Egypt, and Iraq (2010 report) and Pakistan (2008 report).</p><p><i>n</i>, number of positive cases that are PWID; <i>N</i>, total number of positive cases; Percent, percent of positive cases that are PWID out of the total number of positive cases; UAE, United Arab Emirates.</p

    Map of the Middle East and North Africa region.

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    <p>The defintion adopted in the review includes the following 23 countires: Afghanistan, Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, OPT, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan (including the newly established Republic of South Sudan), Syria, Tunisia, United Arab Emirates (UAE), and Yemen.</p

    HIV prevalence among people who inject drugs in the Middle East and North Africa as extracted from reports included in the systematic review.

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    a<p>Population-adjusted estimate.</p>b<p>Self-report.</p><p>CS, convenience sampling; ID, infectious disease; MSCS, multi-stage cluster sampling; RCS, random cluster sampling; RDS, respondent driven sampling; SBS, snow ball sampling; SRS, simple random sampling; TLS, time location sampling; VCT, voluntary counseling and testing.</p

    Summary of the HIV biological evidence per country.

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    a<p>With reports available.</p><p>Afg, Afghanistan; Alg, Algeria; Bah, Bahrain; Dji, Djibouti; Egy, Egypt; Irn, Iran; Irq, Iraq; Jor, Jordan; Kuw, Kuwait; Leb, Lebanon; Lib, Libya; Mor, Morocco; Oma, Oman; Pak, Pakistan; QA, Qatar; SA, Saudi Arabia; Som, Somalia; Sud, Sudan; Syr, Syria; Tun, Tunisia; UAE, United Arab Emirates; Yem, Yemen.</p
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