In most people in the Middle East and North Africa who have sex with men (MSM ) face severe stigma and harsh laws, creating a hidden population that researchers of HIV / AIDS and social workers have difficulty reaching. Now, review the most comprehensive yet in the spread of HIV among MSM living in the region reveals that there are several hidden epidemics, too, with a prevalence of up to 28% in some groups.
Epidemiologists Ghina Mumtaz and Laith Abu-Raddad, both of Weill Cornell Medical College in Qatar, conducted the study, over the past eight years has chosen the highest quality reports on HIV / AIDS they have found in the scientific literature, government documents and the non-governmental organization (NGO) surveys. Although the discovery of widespread HIV among MSM in the region could reflect a longstanding epidemic that surfaced only now because of the increased research, Mumtaz and Abu-Raddad argue that this is not a case of bias detection. "The data suggest that these epidemics are recent," said Mumtaz, who explains that several countries have documented a steady increase in prevalence over time.
As they detail in the August issue of PLoS Medicine , less than 25% of MSM in most places has reported consistent condom use, and exchange of sex for money was common, as is sex with females. Although that MSM generally knew about HIV, many do not think they were at risk of being infected. a key message of the study is that although the dominant Muslim region has a strong conservative, about 2% to 3% of men in the two dozen countries analyzed have anal sex with men, which is similar worldwide.
"We are all pretty much the same thing," said epidemiologist David Celentano of public health Johns Hopkins Bloomberg School in Baltimore, Maryland. "Everyone says Muslims will never tolerate that, but if you come back in ancient history, there are many same-sex sex. People profess to have these strong beliefs, but do not govern their behavior at all . "
study also challenges what the authors call "widespread perception" that the epidemiological data of HIV / AIDS on MSM in the region are "virtually absent." Reading documents in English, Arabic and French, they concluded that there is "considerable and increasing epidemiological evidence on HIV and risk behavior among MSM in this region." Although the quality of the studies varied, they found "significant improvement" in data collection since 03 in Morocco, Egypt, Lebanon, Iran, Tunisia, Sudan and Pakistan. Several countries also have mandatory HIV testing for all workers who want to work abroad or for couples seeking a marriage license. "This is really a case of if you do not try, you can not find it," says Celentano. "I think these guys did a great job digging."
Although the data can provide data on the exact prevalence of HIV, the authors stress that the studies they relied on often sampled most visible MSM populations, which may introduce bias. In particular, the highest documented prevalence occurred among transgender sex workers and homeless MSM. Data can also tilt the men who consider themselves gay, underestimation of HIV in the population of men, especially if they are the "top" in anal sex with a man, do not identify themselves as homosexuals.
Abu-Raddad said the advent of the Internet and the growth of civil society and activism in many Arab countries is that it is easier to study HIV among MSM. "It was ten years ago, people thought it would be impossible to work with MSM in this region is the MSM would be willing to participate in because of fear studies," he said. "But NGOs have created bridges between governments and populations. NGOs rely on recruiting peer and not have to find these groups. They come to them. "
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