Epidemiology of HIV infection in the Middle East and North Africa
Epidemiology of HIV infection in the Middle East and North Africa
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DOI：
10.1097/01.aids.0000386729.56683.33
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发表时间：
2010-07-01
期刊：
影响因子：
3.8
通讯作者：
Wilson, David
中科院分区：
文献类型：
--
作者：
Abu-Raddad, Laith J.;Hilmi, Nahla;Wilson, David
目标：中东和北非 (MENA) 地区仍然被认为是艾滋病毒流行病学数据非常有限的地区，引发了有关该地区艾滋病毒流行状况的许多争议。本次审查和综合的目的是通过描绘该地区艾滋病毒流行病学的数据驱动概述，解决中东和北非地区艾滋病毒战略性可解释数据的缺乏问题。方法：对中东和北非地区的艾滋病毒、性传播感染 (STI) 和危险行为研究（无论设计如何）进行了全面系统审查。数据来源包括 Medline 的同行评审出版物、Google Scholar 的非索引本地和区域期刊上发表的其他科学文献、国际组织报告和数据库、国家级报告和数据库（包括政府和非政府组织出版物）以及各种其他机构文件。 结果：识别和审查了 5000 多个与艾滋病毒和性传播感染相关的数据源。数据质量和研究设计的性质差异很大。没有证据表明中东和北非地区任何国家的普通人群中艾滋病毒流行持续存在，苏丹南部可能除外。中东和北非地区不同国家的总体模式表明，高危人群中正在出现流行病，包括注射吸毒者、男男性行为者（MSM）以及较小程度的女性性工作者，而各国之间对这些高危人群的相对作用存在差异。在一些中东和北非国家中，与出国旅行有关的国民中的外源性艾滋病毒暴露似乎是主要的艾滋病毒传播模式，但没有证据表明存在大量流行病或地方性传播。研究发现，桥接人群在艾滋病毒感染与普通人群之间的桥梁作用非常有限。结论：虽然它们不能提供针对艾滋病毒传播的完全保护，但近乎普遍的男性包皮环切术以及可能盛行的性保守文化规范迄今为止似乎在中东和北非相对于其他地区减缓和限制艾滋病毒传播方面发挥了保护作用。如果现有的社会和流行病学背景基本保持不变，除了外源性暴露外，艾滋病毒的流行传播可能仍然局限于高危人群及其性伴侣。该地区的艾滋病毒预防工作继续受到与艾滋病毒/艾滋病相关的耻辱和相关危险行为的阻碍，需要积极扩大，重点是根据风险和脆弱性控制艾滋病毒的传播。在中东和北非地区，控制艾滋病毒在高危人群中进一步传播的机会之窗，如果错过，可能会带来该地区在很大程度上尚未做好准备的健康和社会经济负担。 (C) 2010 年 Wolters Kluwer Health 垂直条 Lippincott Williams & Wilkins
Objective: The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by delineating a data-driven overview of HIV epidemiology in this region.Methods: A comprehensive systematic review of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific literature published in nonindexed local and regional journals, international organizations reports and databases, country-level reports and database including governmental and nongovernmental organizations publications, as well as various other institutional documents.Results: Over 5000 sources of data related to HIV and STIs were identified and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in bridging the HIV infection to the general population was found to be very limited.Conclusion: Although they do not provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the region, in large part, is unprepared for. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins