Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? a systematic review and data synthesis.

Ghina Mumtaz, Nahla Hilmi, Willi McFarland, Rachel L. Kaplan, Francisca Ayodeji Akala, Iris Semini, Gabriele Riedner, Oussama Tawil, David Wilson, Laith Aburaddad

Research output: Contribution to journalReview article

Abstract

Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. MSM in the Middle East and North Africa (MENA) are a largely hidden population because of a prevailing stigma towards this type of sexual behavior, thereby limiting the ability to assess infection transmission patterns among them. It is widely perceived that data are virtually nonexistent on MSM and HIV in this region. The objective of this review was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA. This was a systematic review of all biological, behavioral, and other related data on HIV and MSM in MENA. Sources of data included PubMed (Medline), international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. This review showed that onsiderable data are available on MSM and HIV in MENA. While HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28% among certain MSM groups. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in several countries. The high levels of risk behavior (4-14 partners on average in the last six months among different MSM populations) and of biomarkers of risks (such as herpes simplex virus type 2 at 3%-54%), the overall low rate of consistent condom use (generally below 25%), the relative frequency of male sex work (20%-76%), and the substantial overlap with heterosexual risk behavior and injecting drug use suggest potential for further spread. This systematic review and data synthesis indicate that HIV epidemics appear to be emerging among MSM in at least a few MENA countries and could already be in a concentrated state among several MSM groups. There is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa. Please see later in the article for the Editors' Summary.

Original languageEnglish
JournalPLoS Medicine
Volume8
Issue number8
Publication statusPublished - Aug 2010

Fingerprint

Northern Africa
Eastern Africa
Middle East
HIV
Epidemiology
Biomarkers
Viruses
Risk-Taking
Testing
Organizations
Databases
Sex Work
Population
Pharmaceutical Preparations
Aptitude
Infectious Disease Transmission
Human Herpesvirus 2
Information Storage and Retrieval
Heterosexuality
Condoms

ASJC Scopus subject areas

  • Biotechnology
  • Biochemistry
  • Molecular Biology
  • Cell Biology

Cite this

Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? a systematic review and data synthesis. / Mumtaz, Ghina; Hilmi, Nahla; McFarland, Willi; Kaplan, Rachel L.; Akala, Francisca Ayodeji; Semini, Iris; Riedner, Gabriele; Tawil, Oussama; Wilson, David; Aburaddad, Laith.

In: PLoS Medicine, Vol. 8, No. 8, 08.2010.

Research output: Contribution to journalReview article

Mumtaz, G, Hilmi, N, McFarland, W, Kaplan, RL, Akala, FA, Semini, I, Riedner, G, Tawil, O, Wilson, D & Aburaddad, L 2010, 'Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? a systematic review and data synthesis.', PLoS Medicine, vol. 8, no. 8.
Mumtaz, Ghina ; Hilmi, Nahla ; McFarland, Willi ; Kaplan, Rachel L. ; Akala, Francisca Ayodeji ; Semini, Iris ; Riedner, Gabriele ; Tawil, Oussama ; Wilson, David ; Aburaddad, Laith. / Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? a systematic review and data synthesis. In: PLoS Medicine. 2010 ; Vol. 8, No. 8.
@article{399dcc0518474f3bbc661c7f1b532d35,
title = "Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: a systematic review and data synthesis.",
abstract = "Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. MSM in the Middle East and North Africa (MENA) are a largely hidden population because of a prevailing stigma towards this type of sexual behavior, thereby limiting the ability to assess infection transmission patterns among them. It is widely perceived that data are virtually nonexistent on MSM and HIV in this region. The objective of this review was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA. This was a systematic review of all biological, behavioral, and other related data on HIV and MSM in MENA. Sources of data included PubMed (Medline), international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. This review showed that onsiderable data are available on MSM and HIV in MENA. While HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28{\%} among certain MSM groups. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25{\%} in several countries. The high levels of risk behavior (4-14 partners on average in the last six months among different MSM populations) and of biomarkers of risks (such as herpes simplex virus type 2 at 3{\%}-54{\%}), the overall low rate of consistent condom use (generally below 25{\%}), the relative frequency of male sex work (20{\%}-76{\%}), and the substantial overlap with heterosexual risk behavior and injecting drug use suggest potential for further spread. This systematic review and data synthesis indicate that HIV epidemics appear to be emerging among MSM in at least a few MENA countries and could already be in a concentrated state among several MSM groups. There is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa. Please see later in the article for the Editors' Summary.",
author = "Ghina Mumtaz and Nahla Hilmi and Willi McFarland and Kaplan, {Rachel L.} and Akala, {Francisca Ayodeji} and Iris Semini and Gabriele Riedner and Oussama Tawil and David Wilson and Laith Aburaddad",
year = "2010",
month = "8",
language = "English",
volume = "8",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Public Library of Science",
number = "8",

}

TY - JOUR

T1 - Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?

T2 - a systematic review and data synthesis.

AU - Mumtaz, Ghina

AU - Hilmi, Nahla

AU - McFarland, Willi

AU - Kaplan, Rachel L.

AU - Akala, Francisca Ayodeji

AU - Semini, Iris

AU - Riedner, Gabriele

AU - Tawil, Oussama

AU - Wilson, David

AU - Aburaddad, Laith

PY - 2010/8

Y1 - 2010/8

N2 - Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. MSM in the Middle East and North Africa (MENA) are a largely hidden population because of a prevailing stigma towards this type of sexual behavior, thereby limiting the ability to assess infection transmission patterns among them. It is widely perceived that data are virtually nonexistent on MSM and HIV in this region. The objective of this review was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA. This was a systematic review of all biological, behavioral, and other related data on HIV and MSM in MENA. Sources of data included PubMed (Medline), international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. This review showed that onsiderable data are available on MSM and HIV in MENA. While HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28% among certain MSM groups. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in several countries. The high levels of risk behavior (4-14 partners on average in the last six months among different MSM populations) and of biomarkers of risks (such as herpes simplex virus type 2 at 3%-54%), the overall low rate of consistent condom use (generally below 25%), the relative frequency of male sex work (20%-76%), and the substantial overlap with heterosexual risk behavior and injecting drug use suggest potential for further spread. This systematic review and data synthesis indicate that HIV epidemics appear to be emerging among MSM in at least a few MENA countries and could already be in a concentrated state among several MSM groups. There is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa. Please see later in the article for the Editors' Summary.

AB - Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. MSM in the Middle East and North Africa (MENA) are a largely hidden population because of a prevailing stigma towards this type of sexual behavior, thereby limiting the ability to assess infection transmission patterns among them. It is widely perceived that data are virtually nonexistent on MSM and HIV in this region. The objective of this review was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA. This was a systematic review of all biological, behavioral, and other related data on HIV and MSM in MENA. Sources of data included PubMed (Medline), international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. This review showed that onsiderable data are available on MSM and HIV in MENA. While HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28% among certain MSM groups. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in several countries. The high levels of risk behavior (4-14 partners on average in the last six months among different MSM populations) and of biomarkers of risks (such as herpes simplex virus type 2 at 3%-54%), the overall low rate of consistent condom use (generally below 25%), the relative frequency of male sex work (20%-76%), and the substantial overlap with heterosexual risk behavior and injecting drug use suggest potential for further spread. This systematic review and data synthesis indicate that HIV epidemics appear to be emerging among MSM in at least a few MENA countries and could already be in a concentrated state among several MSM groups. There is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa. Please see later in the article for the Editors' Summary.

UR - http://www.scopus.com/inward/record.url?scp=84856379893&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856379893&partnerID=8YFLogxK

M3 - Review article

C2 - 21829329

VL - 8

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 8

ER -