World AIDS Day is 1st December 2010. It already affects 41 million people worldwide, 2.6 million more than in 2009. Although this increase is 20% less than in years 90 and that infections are generally declining, populations at risk are the most affected. But the Mashreq-Maghreb countries, whose overall AIDS rates remain below those in the West, are silent about the pandemic. Hoax or info?

As noted by the New York Times, prevention requires a radical change in behavior, particularly intensified for certain populations such as sex workers, Men who have Sex with Men or injection drug users

Lack of statistics in MENA region?

When looking at the data on the Middle East and North Africa , the user is surprised by the weakness of official data.

AIDS for a long time and still today, remains a big taboo society seen as a punishment from God for those who do not respect the religious ethics rules. Three main causes explain this fact: drug use, homosexuality and fornication, important vectors of the pandemic and prohibited by religious rules. Spared by the virus, MENA countries ignore these public health problems and patients remain marginalized.

A 2009 study, leaded by Dr. Adrian Smith on the spread of the virus in sub-Saharan homosexual populations revealed that they were either ignored, or marginalized by health policies or research studies. People with HIV suffer from this denial, especially when MSM are already stigmatized in the country. The disease is hidden and one of the main challenges in the region remains AIDS-related stigma and discrimination against people living with the virus.

For an Islamic country, publishing data on AIDS comes to admit that his society does not respect the religious imperatives.

The protective role of conservative cultural norms

In July 2010, Dr. Laith Jamal Abu Raddad¹ has identified all the available epidemiological data in the 23 MENA countries. His conclusion is amazing: data on AIDS are extremely abundant (more than 5000 sources) and the scourge is still very limited to populations at risk (no contagion of the general population): injecting drug users (in Iran and in Afghanistan), MSM (in Tunisia or in Egypt where the prevalence is higher than among sex workers).

For him, “ Although they do not provide complete protection against HIV spread (…) 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 (…) 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.”

If Arab society suffers from a major taboo on AIDS and from the behaviors associated with them, religion may play a positive role in the prevention and containment of the disease. However, populations at risk remain, infected or not, largely marginalized. As recalled in the UNAIDS report, across Maghreb-Mashreq, prostitution is largely illegal, and only Iraq, Jordan and Egypt do not condemn homosexual relationships.

1. “Epidemiology of HIV infection in the Middle East and North Africa”, AIDS, July 2010 – Volume 24 – Issue – p S5–S23 [↩]