Compared to other regions in the world, the figures about HIV/AIDS have always been very low in the region. How do you explain that?

It is a fact that this region has produced less research than other regions in relation to HIV to produce figures, but this is only a small part of the story. The main reason for lack of figures is simply that studies are not normally published or disseminated in usual channels such as scientific publications. Countries conduct studies, but put the studies in some drawer in the health ministry and the study is basically lost. Academic research continues to be weak. Sometime sensitivity about the data prevents dissemination of the study. Through the MENA HIV Synthesis Project we managed to gather thousands of documents, studies, and databases related to HIV by working with countries and other stakeholders and collecting these studies and synthesizing them.

Do you think that religion plays a positive role in the prevention of the HIV scourge?

Not as simple of a question. The region has lower HIV problem than other regions and in part this is due to male circumcision and the sexually conservative norms; both of which are dictated by religion. So religion did play a role in limiting the HIV problem in this part of the world.

In the other hand however, there is an HIV problem in this region; though it is not as extensive as in other regions. Addressing this problem requires working with high risk populations (men who have sex with men, injecting drug users, and female sex workers and their clients). The views of most religious scholars as well as the general population are a barrier to HIV prevention within these high risk populations and contribute to HIV stigma in this region. Most cannot accept the logic of harm reduction and that there is an HIV problem within MENA societies.

In sum, the religious background of this region contributed to its lower HIV problem, but the views of most religious scholars and population are putting barriers to HIV prevention. There are however promising trends as we increasingly find more religious scholars who are becoming more understanding of HIV and the nature of the problem and are contributing positively to HIV prevention efforts. These scholars assert that there is room for HIV prevention within the fabric of MENA culture and that HIV prevention does not contradict with religion.  Iran provides an example of where such a change has occurred to some extent and contributed to developing world class programs on harm reduction.

You put out the fact that AIDS is limited but high in at-risk populations (MSM, women sex workers). Are MENA countries operational to respond to an explosion of infections in these very populations?

The epidemic potential is highest among MSM and IDUs, and to lesser extent among female sex workers and their clients. Few countries have made substantial improvements in dealing with the HIV problem and developed systems to prevent further spread among the high risk populations. Examples include Morocco and Iran. However generally speaking MENA countries are far below the level of preparedness to handle the potential for HIV epidemics among high risk groups in this region.

Is AIDS a time bomb for the MENA countries if nothing is done?

Not exactly. The main potential for HIV spread is among high risk groups (IDUs, MSM, FSWs and clients), which are small part of the population, and their sexual partners such as spouses. Here we could have small up to explosive epidemics (we have already seen so in several countries such as the epidemics among IDUs in Iran and Pakistan which were pretty explosive). However outside these groups there is limited potential for much HIV spread.

In sum, there is an HIV problem and this HIV problem is steadily increasing and is a real public health challenge in MENA. However, it is unlikely that one day this challenge will ever become close to what it is in areas heavily affected by HIV such as in sub-Saharan Africa.