HIV epidemics are emerging among people who inject drugs in several countries in the Middle East and North Africa

Though HIV infection levels were historically very low in the Middle East and North Africa, substantial levels of HIV transmission and emerging HIV epidemics have been documented among people who inject drugs in at least one-third of the countries of this region, according to research findings. The HIV epidemics among people who inject drugs (PWID) are recent overall, starting largely around 2003 and continuing to grow in most countries. In countries such as Afghanistan, Bahrain, Egypt, Iran, Morocco, Oman, and Pakistan, on average between 10% and 15% of PWID are HIV-positive. The HIV epidemics in these countries appear to be growing; in Pakistan, for example, the fraction of PWID who are HIV-infected increased from 11% in 2005 to 25% in 2011. "Not only have we found a pattern of new HIV epidemics among PWID in the region, but we found also indications that there could be hidden HIV epidemics among this marginalized population in several countries with still-limited data," said Ghina Mumtaz, lead author of the study and senior epidemiologist at the Infectious Disease Epidemiology Group at Weill Cornell Medical College-Qatar. "For example in Libya, the first study among people who inject drugs was conducted only recently and unveiled alarmingly high levels of HIV infection, suggesting that the virus has been propagating, unnoticed, among this population for at least a decade. Eighty-seven percent of PWID in Tripoli, the capital of Libya, were infected with HIV, one of the highest levels reported among PWID globally." The study estimated that there are about 626,000 people who inject drugs in the Middle East and North Africa. This translates into 24 people who inject drugs for every 1,000 adults in this part of the world. These individuals are typically involved in several types of behavior that expose them to HIV infection, such as sharing of needles or syringes, a behavior reported by 18% to 28% of injecting drug users during their last injection across these countries. "The levels of HIV infection among people who inject drugs tell only half of the story. We also see high levels of risky practices that will likely expose this population to further HIV transmission in the coming years," said Dr. Laith Abu-Raddad, principal investigator of the study and associate professor of public health in the Infectious Disease Epidemiology Group at Weill Cornell Medical College-Qatar. "We found that nearly half of people who inject drugs are infected with hepatitis C virus, another infection of concern that is also transmitted though sharing of needles and syringes."