Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in three high-risk groups, which is important when deciding how to approach intervention and prevention.
Of the 32 million population in Morocco, a 2009 estimate expects 26,000 are living with HIV (range of 19,000-34,000). Between 2009 and 2010, there were an estimated 3,447 new HIV infections (range: 2,500-4,400). [1]
Within Morocco, there are three high-risk groups: female sex workers (FSWs), men who have sex with men (MSM), and injecting drug users (IDUs). [1] The vast majority of HIV prevalence occurs within these three groups (67% of new infections), largely in part to transmission caused from unprotected sexual contact (87% of HIV/AIDS cases), while the overall Moroccan population HIV prevalence remains low at 0.14%. [2] [3] Heterosexual relations sit at only 7% of HIV infections. [3] HIV/AIDS knowledge appears to be fairly high for the overall population. [1]
Over the entire HIV epidemic, there is a growing feminization of infection. While in Morocco in 2001 women made up only 40% of people living with HIV/AIDS (PLWHA), women in 2009 made up nearly 50% of all cases. This could be due to women being more vulnerable than men to HIV infection because of women's lack of negotiation power in relationships and limited access to education for women and girls. [4] In heterosexual relationships, 71% of women are infected by their husbands. [3]
There were two modes of transmission (MoT) analyses done in Morocco, a national and Souss-Massa-Drâa. Considering the high mobility around the area, as Souss-Massa-Drâa is a prevalent tourist hub, it is understandable for there to be a more intense HIV epidemic present in Souss-Massa-Drâa. Both MoT models determine that direct sexual contact, without protection like a condom, is the most common transmission mode and that women and men contribute equally to HIV incidence, but most women are infected from infected spouses. [5]
Data suggests that resources need to focus on the primary 3 high risk groups, as well as FSW clients, to terminate HIV prevalence across Morocco, as these three groups are mainly driving the epidemic. [2] [5]
While FSWs were expected to reach an endemic equilibrium at 9% based on the Souss-Massa-Drâa MoT, or 3% based on the National MoT, [5] the past several years FSWs with HIV has remained fairly stable at around 2%, currently sitting at 1.7% based on the 2019 UNAIDS report. [6]
In 2019, 61.1% of FSWs reported consistent condom usage, a percentage that continues to rise. [6] This number is among the highest for FSWs across the MENA region. [2] The most common reasoning for non-condom use by roughly 40% of FSWs is because of client objection. Overall, there is a fairly high knowledge of HIV/AIDS among the FSW community. [1]
FSW clients are a part of the largest contribution to new infections. National MoT reports that 73% of all women are infected by their spouses, Souss-Massa-Drâa reports 57%. [2]
MSM were expected to reach an endemic equilibrium at 14% based on the Souss-Massa-Drâa MoT, or 10% based on the National MoT. [5] Currently HIV incidence is at 4.9% based on the 2019 UNAIDS report, and 57.7% report consistent condom usage in 2019. [6]
IDUs were expected to reach an endemic equilibrium at 14% based on the Souss-Massa-Drâa MoT, or 10% based on the National MoT. [5] Currently HIV incidence is at 4.9% based on the 2019 UNAIDS report. [6]
Lack of consistent condom usage is still the greatest concern for contracting HIV for IDUs. In 2019, 44.6% reported consistent condom usage, making IDUs the most likely to engage in risky sexual behavior. [6] Contaminated needles and syringes are still of concern, however. In 2013, HIV incidence was reduced relatively among IDUs by 24-73% simply by reducing sharing needles and syringes. [5]
There are a handful of barriers that PLWHA face. Stigma is one of the most problematic for PLWHA because of the strong association between cases of HIV/AIDS with homosexuality, sex outside of marriage, and drug use, all of which are sinful behaviors within the MENA region. [3] [4] PLWHA will be declined from everyday family life, community life, and the workspace because of fear of casual contact the general public has for PLWHA. HIV infection is viewed as a punishment for moral, social, and religiously unacceptable behavior. Women also tend to face more stigma than men: there is limited acceptance that the man within a couple is to blame, therefore women are shamed regardless of the situation. [4]
The biggest issue with stigma is that it may serve as a barrier for achieving HIV prevention and care services.
Disclosure of one's HIV status has potential benefits such as greater self-esteem, social and emotional support, greater access to HIV services, and positive effect on antiretroviral therapy (ART). [3] [7] Disclosure also has potential pitfalls in certain situations: family rejection, moral and/or physical violence, as well as a decline in sexual desire and performance. [3]
Disclosure is seen as a risky process by 91% of PLWHA. Within Morocco, 62% of PLWHA voluntarily disclosed their serostatus to steady sexual partners while 38% had not. 34.25% of PLWHA viewed their disclosure as a mistake, while the vast majority of those who had disclosed their serostatus (65.75%) did not think disclosure was a mistake. [3] [7]
Discrimination and stigma may affect the disclosure experience: 17% of PLWHA experienced rejection after disclosure and 8.7% experienced discrimination at work. Women were found to be more likely to report regret after disclosure. Discrimination within the workplace was strongly associated with greater regret. Regret and feeling of loneliness go hand-in-hand for many PLWHA who report disclosure being a mistake. PLWHA with a lower living standard also experience more regret than those with higher living standards, in part due to an increased likelihood of experiencing material instability or risk of homelessness from rejection. [3] [7]
Discussing HIV-related concerns with friends and family increases the chances of telling steady sexual partners serostatus. Unfortunately, the more PLWHA felt socially excluded, the higher the likelihood they had disclosure their serostatus to their steady sexual partner. [3]
While there are links found between disclosure and socioeconomic status, there is no direct association between disclosure and age / gender. Even now, disclosing one's HIV status is a draining concern and potentially costly process in many contexts, with non-disclosure acting as a form of protection in some instances. [3] [7] While inherently logical, there is no clear linkage between lack of disclosure and new HIV infections.
The Moroccan government has made noticeable steps to improve the HIV epidemic within the country. Since 1999, the government has provided ART to all eligible citizens. [4]
There is a need to address stigma and improve access to health care, which could be achieved through linkage between the education systems, community based organizations (CBOs), and social movements. HIV care also needs to be expanded to integrate sexual health and family planning. [4]
HIV-positive people, seropositive people or people who live with HIV are people infected with the human immunodeficiency virus (HIV), a retrovirus which if untreated may progress to acquired immunodeficiency syndrome (AIDS).
HIV is recognized as a health concern in Pakistan with the number of cases growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the HIV epidemic to take hold in Pakistan, mainly among injecting drug users (IDU), male, female and transvestite sex workers as well as the repatriated migrant workers. HIV infection can lead to AIDS that may become a major health issue.
Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.
With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.
UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.
The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.
The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.
Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.
Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.
The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.
HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).
Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.
With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year. But, in 2012 and 2013 it increased to about 600 new cases and in 2014 it reached 880 new cases per year. According to UNAIDS 2016 statistics, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.
With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.
Vietnam faces a concentrated HIV epidemic among high-risk groups, including sex workers, and intravenous drug users. There are cases of HIV/AIDS in all provinces of Vietnam, though low testing rates make it difficult to estimate how prevalent the disease is. The known rates among high-risk groups are high enough that there is a risk of HIV/AIDS rates increasing among the general population as well. People who are HIV+ face intense discrimination in Vietnam, which does not offer legal protections to those living with the condition. Stigma, along with limited funding and human research, make the epidemic difficult to control.
Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981, and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.