Academic journal article
By Cheemeh, Parvaneh Ehsanzadeh; Montoya, Isaac D.; Essien, E. James; Ogungbade, Gbadebo O.
The Journal of the Royal Society for the Promotion of Health , Vol. 126, No. 4
Key words Behavior; HIV/AIDS; leadership; Middle East; socio-cultural factors
After 24 years of being declared an epidemic, the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has found its way to the remote parts of the Middle East. There are no fastidious HIV/AIDS epidemiological data available specific for the Middle East and insufficient surveys have been conducted in a larger area including the Middle East and North Africa. Currently the total number of people living with HIV in the Middle East and North Africa is 540,OOO.1-3 About 92,000 individuals were newly infected in 2004 and 28,000 people have died of AIDS during the same time period.2 With increasing spread of sexually transmitted infections (STIs), injection drug users (IDUs), numbers of unemployed youth, a conservative culture and low awareness of HIV4 the region is especially vulnerable to a largescale epidemic. In this age of globalization the rapid spread of HIV along with highly virulent and multi-drug-resistant HIV strains that progress rapidly to AIDS, the more difficult and expensive prevention efforts and treatment regimes become. Complicating the issue there are many unresolved socio-economic conflicts in the Middle East.5,6 Valid and reliable HIV/AIDS epidemiological data, to facilitate policy formulation and to effect urgent prevention intervention is inadequate. This article identifies numerous gaps and shortfalls in the existing programs, elucidates the reasons behind the lack of information, and provides suggestions for taking actions.7,8
HIV/AIDS is a socio-medical morbidity of great public health concern that came to light in the early 1980s. The spread of HIV and the associated fullblown AIDS continues world-wide without abatement or full understanding of the factors associated with its morbidity and mortality in any country. Behavior,9 lifestyles and migration are forces driving the spread of the pestilence. According to the United Nations Program on AIDS and the World Health Organization (UNAIDS/WHO), the total number of people living with HIV rose in 2004 to reach its highest level ever: an estimated 40 million people are living with the virus. This figure includes the estimated 5 million people who acquired HIV in 2004. The global AIDS epidemic killed an estimated 3 million people in 2003.1-3 More than 95% of the HIV-infected people live in the developing world. Because of cultural beliefs and practices, and often an inadequate knowledge of reproductive health, HIV/AIDS and sexually transmitted infections (STIs), Middle Easterners are at increased risk of contracting HIV. It is known that HIV is transmitted through the exchange of body fluids (semen and vaginal secretions) as in sexual intercourse, transfusion with blood from an infected person, contaminated needle sharing among intravenous drug users, breast milk, and vertically from infected mother to infant during pregnancy and at birth. In the Middle East, HIV is transmitted predominantly through three modes: heterosexual intercourse, men having sex with men (MSM) and IDU. HIV/AIDS is therefore contracted by individual and interpersonal behaviors and lifestyles.9
The notion of risk underlying the concept of vulnerability implies that everyone is potentially vulnerable (or at risk), that is, there is always a chance of developing HIV, STIs or other infectious diseases. The risk is, however, greater for those with the least social status, social capital and human capital resources to either prevent or ameliorate the origins and consequences of poor physical, psychological or social health.6,10 'Risk' has been defined as 'the risk of encountering an infected person, modified by the risk associated with any sexual contact with that person'.11 'HIV Risk' as used here is defined as unprotected anal and/or vaginal intercourse with any casual partner or with a regular partner whose HIV status is not concordant with the participant's. …