Despite a historically low prevalence of HIV infections, countries in the Middle East and North Africa are facing a rising number of HIV/AIDS cases at a time when the rates of new infections drop across the globe as part of a concerted effort to end the AIDS epidemic by 2030.
Such a dynamic is on clear display in Lebanon.
“What we see in Lebanon is what you saw in Europe in the 1980s when it comes to HIV — this boom,” said Bertho Makso, director of LGBT rights group Proud Lebanon.
Experts say the increase seen across the region is largely due to a lack of awareness of HIV, an absence of effective sexual education, and an ongoing stigma associated with communities most likely to be affected by the virus.
The numbers of people living with HIV in the Middle East are still comparatively low (in 2015 there were 230,000 HIV-positive people in the region) but the increase over the last five years is a cause for concern, said Joumana Hermes, an HIV expert for the MENA region at the World Health Organization.
“This region is witnessing one of the two fastest-growing epidemics in the world,” she told VICE News.
Between 2005 and 2013, AIDS-related deaths rose there by 66 percent, while globally they decreased by 35 percent. As the number of new infections fell by 50,000 between 2010 and 2015 in Eastern and southern Africa, they rose by 1,000 in the MENA region. AIDS-related deaths in the Middle East rose from 9,500 in 2010 to 12,000 in 2015.
The only other region in the world where rates of new infections are increasing is Eastern Europe and Central Asia.
Among specific groups of people, Hermes says, the data is even more striking. For example, about 87 percent of intravenous drug users in the Libyan capital of Tripoli live with HIV.
“It is increasing mainly among what we call key populations at increased risk — people who inject drugs, men who have sex with men (MSM), sex workers, prisoners, and transgender people,” Hermes said. “Among those groups the problem is overwhelming…. Obviously with the conservative atmosphere, it is not easy to make services reach these people. So it continues to grow.”
In Lebanon, about 13 percent of gay men are HIV positive compared to between 7 percent and 10 percent in the rest of the Middle East.
And these numbers may very well be underestimating the overall number of infections significantly.
“Gay people are the ones who are aware of this issue and they are the ones who are going to be tested,” he said. “If the whole Lebanese society was tested, the numbers would be much, much higher.”
NGOs have the best chance of reaching people who are in need of treatment, Hermes says. Most of the time, the national AIDS programs, which exist in every country in the region, support NGOs, “but in a discreet manner, so as not to offend people.”
Proud Lebanon, which offers HIV testing free of charge, officially partners with the National AIDS Program, co-run by the Lebanese Ministry of Health and the World Health Organization.
“I was afraid of the question – how did you get it?”
Being gay remains technically illegal in Lebanon and across much of the Middle East and North Africa, creating further obstacles for a population at increased risk. People who are HIV-positive “face double discrimination” in the region, according to Makso.
“A lot won’t approach for services, they won’t even approach for testing… and they keep on transmitting the virus,” Makso said.
Bob, a 26-year-old living in Beirut who asked to use the pseudonym to avoid being found out, was diagnosed with HIV six years ago.
“I was afraid,” he said. “I live in a very a traditional area, it’s very strict, very religious, and I lived with that, so I was afraid. People think HIV is related to sex, it’s related to drugs, it’s related to gays. I was afraid of the question — ‘How did you get it?’”
He managed to hide his status and the medicine he was taking from his family for five years even though he was living at home. He said he does not know how he contracted the virus, which he discovered while giving blood; his previous sexual partners, he said, all tested negative.
“The not knowing killed me for a while, but then I was like khalas (enough), this is what I’ve got, I can’t change anything.”
There is virtually no sex education in the Middle East, save for some facts about reproduction, according to Hermes. “It is more of reproductive health education than sexual education,” she said. “Prevention methods, for those who are not married, are not really accepted.”
Bob said he told his boss at the café where he worked about his diagnosis and was promptly fired. Makso says this is a common occurrence, due to the general lack of awareness and the absence of any protective laws for people living with HIV in Lebanon or the wider region. Proud Lebanon is campaigning for such protections this World AIDS Day.
In February, a landmark ruling in Egypt made it illegal for employers to dismiss workers on the basis of their HIV status, which UNAIDS called a “historic decision for Egypt and the region.” Though activists hope it will set a new precedent, legal protections remain few and far between.
When Bob eventually told his mother, she initially took it very poorly. “She collapsed, she started crying, she started visiting religious people to help me out. I said, ‘Mom, my meds will help me, and your prayers might help me, that’s all.’”
He said education is vital in the effort to combat the spread of HIV and AIDS in the Middle East: “Be more supportive, be more accepting, be more educated about it.”