Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon; Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
Lancet HIV. 2022 Jul;9(7):e506-e516. doi: 10.1016/S2352-3018(22)00093-5.
The Middle East and north Africa is one of only two world regions where HIV incidence is on the rise, with most infections occurring among key populations: people who inject drugs, men who have sex with men, and female sex workers. In this Review, we show a trend of increasing HIV prevalence among the three key populations in the Middle East and north Africa. Although the epidemic continues at a low level in some countries or localities within a country, there is evidence for concentrated epidemics, with sustained transmission at considerable HIV prevalence among people who inject drugs and men who have sex with men in over half of countries in the region with data, and among female sex workers in several countries. Most epidemics emerged around 2003 or thereafter. The status of the epidemic among key populations remains unknown in several countries due to persistent data gaps. The HIV response in Middle East and north Africa remains far below global targets for prevention, testing, and treatment. It is hindered by underfunding, poor surveillance, and stigma, all of which are compounded by widespread conflict and humanitarian crises, and most recently, the advent of COVID-19. Investment is needed to put the region on track towards the target of eliminating HIV/AIDS as a global health threat by 2030. Reaching this target will not be possible without tailoring the response to the needs of key populations, while addressing, to the extent possible, the complex structural and operational barriers to success.
中东和北非是全球仅有的两个艾滋病毒感染率呈上升趋势的地区之一，大多数感染发生在关键人群中：注射毒品者、男男性行为者和性工作者。在这篇综述中，我们展示了中东和北非三个关键人群中艾滋病毒流行率上升的趋势。尽管在该地区的一些国家或国内某些地区，疫情仍处于低水平，但有证据表明存在集中流行，在该地区有数据的一半以上国家中，注射毒品者和男男性行为者中持续存在着相当高的艾滋病毒流行率，而在一些国家中，性工作者也存在这种情况。大多数疫情是在 2003 年左右或之后出现的。由于数据持续存在缺口，几个国家的关键人群中的疫情状况仍不清楚。由于资金不足、监测不力和污名化，再加上普遍存在的冲突和人道主义危机，以及最近 COVID-19 的出现，该地区的艾滋病毒应对措施远远落后于预防、检测和治疗的全球目标。需要投资，以使该地区走上到 2030 年消除艾滋病毒/艾滋病作为全球健康威胁的目标。如果不针对关键人群的需求调整应对措施，同时尽可能解决成功的复杂结构和操作障碍，就不可能实现这一目标。
