November 29, 2005 -- For the countries of the Middle East and North Africa, the World Bank says the choice is straightforward. The countries can choose to act now, and for a relatively small cost, curb the spread of HIV, or they can wait for the epidemic to take hold, an option which will result in much higher economic and social costs. According to Bachir Souhlal, a World Bank lead social development specialist, the Middle East and North Africa region is in a unique situation to halt the spread of HIV/AIDS. The regional prevalence rate now stands at about 0.2%, with the epidemic concentrated within certain groups at high risk, such as commercial sex workers and their clients, and injecting drug users. "Low prevalence of HIV/AIDS does not equate to low risk, and action now can prevent a probable epidemic," Souhal says. "The region is lagging in its defense against this devastating epidemic, but it may also have the advantage of time. Timing is crucial and the window of opportunity that exists now must not be wasted. "The countries should act now because unlike in other regions where the action took too long to get organized and the prevalence rose to high levels, the prevalence rate in the region is still low. This is in addition to the fact that there is better understanding of the epidemic, knowledge of what works and many successful experiences to draw from. "Do you know that with a prevalence rate of 0.2% this means that 99.8% persons are not HIV positive? Therefore prevention is the key pillar, but to effectively act on prevention, it is crucial to have more accurate information on the extent, nature and dynamics of the epidemic and to focus the interventions to the groups at risk." A World Bank report, Preventing HIV/AIDS in the Middle East and North Africa, lays out a strategy of how the governments in the region can step up prevention efforts and utilize Bank and other international expertise to put these plans in place. The report points out the region has all the core factors which make it vulnerable to an HIV/AIDS epidemic. These include inadequate surveillance systems, a large youth population and unemployment, significant migration, inadequate knowledge of preventive measures, widespread stigma and fear, insufficient security and conflicts, cultural and social values, and insufficient access to information in many countries.  |  |  | A women's group discusses health issues in Upper Egypt. Photographer:
G.Pirozzi. Courtesy of UNAIDS. |
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Two years ago, the number of people newly infected with HIV was about 62,000. In 2005, 67,000 people became infected in the region, with 58,000 deaths occurring due to AIDS. The total number of persons living with HIV is 510,000 for 2005, according to UNAIDS statistics. A Culture of Silence According to Souhlal, countries in the region must increase their advocacy efforts and engage key political, religious and other leaders in society to raise awareness about HIV/AIDS. "The World Bank urges leadership at the highest levels. This is important in developing a national multisectoral strategy, involving key ministries, civil society and the community. Taking such crucial action now has substantial future pay-offs. Souhlal says it's vital for political and social leaders to break the wall of silence, fear and stigma surrounding HIV/AIDS. "We have to demystify it. In no culture is it easy to speak about sexuality and death but we have to. We've been so lucky to learn what is happening in other regions and how they have been able to curb the epidemic," he says. Improving Surveillance Another key issue is improving surveillance systems for better monitoring of the HIV epidemic. As Souhlal says most countries don't have good data on the nature and dynamics of their HIV epidemics. "A well-functioning surveillance system is central to any preventive effort," he says. "Without adequate surveillance systems, there will be no early warning systems to alert public health officials to detect outbreaks among groups at risk - a situation that could allow the infection to spread to the general population, and interventions might be poorly targeted, resulting in an inefficient use of limited resources." |
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