HIVAIDS Situation and Response in the Middle East and North Africa

1
HIV/AIDS Situation and Response in the Middle
East and North Africa

• UNICEF/MENA Regional Management Team Meeting, 27
  29 May 2002, Amman

2
HIV/AIDS Worldwide

• An estimated 40 million people were living with
  HIV/AIDS by 2001, over one-third are between
  15-24 years old
• Sub-Saharan Africa, Asia and parts of Latin
  America are worst affected regions
• One of every 10 persons infected worldwide is a
  child
• Average risk of mother-to-child transmission
  (MTCT) from an infected women to her child is 30
• HIV/AIDS has had a substantial Impact on
  demography, education, socio-economics and health
  sector

3
HIV/AIDS in the Region

• Estimated 440,000 people living with HIV/AIDS by
  2001, representing around 1 of total worldwide
• Overall adult prevalence rate is 0.2
• Average age of Infection is 20-40 years, women
  constitute 40 of all cases
• Predominantly sexual transmission (82), but drug
  injecting, blood transfusion and MTCT remain
  important

4
HIV Trends in the Region

• HIV increase over time, with diversity between
  countries generalized, concentrated and
  low prevalence
• Greater than 1 in some countries (Djibouti,
  Sudan) evidence of over 1 in certain localities
  of other countries (Algeria, Morocco)
• Drug injecting and HIV/AIDS (Iran, Libya)
• Recognition of existence of risk behavior in low
  prevalence countries (i.e. sex work, same-sex
  contacts, pre-marital sex)
• Decrease in male to female ratio of HIV infection
  (range 81 in Palestine to 11.2 in Djibouti
  e.g. 51 in late 1980s to 21 in 2000 in Algeria)

5
Determinants of Vulnerability

• Changing norms and practices among young people
• Drug use,including drug injecting practices
• Mobility, migration, displacement and refugee
  situations
• Limited access to health and social services,
  information as well as to economic resources
• Stigma and prevailing social attitudes

6
Evolution of the National Response

• National AIDS Programs (NAP) established in late
  1980s identify objectives and develop plan
• Focus on surveillance, infection control, blood
  safety, general awareness, media and health care
  (including ARV treatment)
• Challenges in behavior change, vulnerable groups,
  sustaining efforts among young people, voluntary
  counseling and testing, and support for people
  living with HIV/AIDS

7
Evolution of Partnership

• UNAIDS in 1996 establishment of UN Theme Groups
  on HIV/AIDS (UNTG) and continuity of country
  support
• Growth of NGO and civil society response in some
  countries (e.g. Morocco, Lebanon, Algeria, Sudan,
  Tunisia), although static in others
• Mobilization of UN Cosponsors in 2001-2002
  interagency regional process (Cairo, November
  2001 Beirut, April 2002), UNGASS and internal
  mechanisms
• Strategic planning process (e.g. Morocco,
  Algeria) and development of multi-sectoral
  response

8
Current UNAIDS efforts Co-sponsors and
Secretariat

• Consensus, coordination and integrated support to
  key issues at regional level (drug injecting,
  young people, advocacy, sub-regional initiatives)
• Resource mobilization at regional and country
  level co-sponsors and secretariat resources
  (over 4 million in the Unified Budget and
  Work-plan), country funds and other potential
  resources
• Cosponsor focus on HIV/AIDS through their
  mandates UNICEF, UNDCP, UNDP, UNESCO, ILO, WHO
  and World Bank
• Secretariat work-plan involves support to
  strategic planning, vulnerable populations,
  sub-regional initiatives, capacity-building and
  information-sharing

9
Funding through PAF by Region
US 000
10
Challenges

• Limited human resources in UN agencies and among
  other partners at regional and country levels
• Lack of UNAIDS Country Advisers or Focal Points
  in countries
• UNTG mechanism is generally not sufficiently
  participative nor always operational
• NAP, and by extension the health sector, are seen
  as only real actors
• Lack of adapted surveillance system and
  information on risk factors and effectiveness