HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis
Figure 4
Trend of HIV prevalence among people who inject drugs, and when available men who have sex with men, in repeated rounds of bio-behavioral surveillance surveys.
These graphs display the trend of HIV prevalence in repeated rounds of bio-behavioral surveillance surveys using state of the art sampling techniques for hard-to-reach populations including respondent driven sampling and time-location sampling. Country level and aggregate data of multiple cities/provinces are displayed. For consistency between countries and between different rounds within a given country, unadjusted sample estimates are displayed. Three main patterns of HIV epidemics among PWID are depicted. A pattern of emerging concentrated epidemics is observed in Pakistan (A) and Egypt (B); a pattern of established concentrated epidemic is observed in Iran (B); and a pattern of low-level HIV epidemic is observed in Tunisia (D). In Afghanistan (E), there is an emerging epidemic among PWID in apparently only part of the country; the effect of which was diluted in the second round with the inclusion of new cities with still very limited prevalence. The potential overlap of the HIV epidemics among PWID and MSM is depicted in Pakistan and Egypt. In Pakistan, an emerging HIV epidemic among transgender sex workers is observed, but lags the epidemic among PWID (A). In Egypt, the concentrated epidemic among MSM seems to have preceded the epidemic among PWID (B). In Tunisia, the potential link between the MSM and PWID epidemics is not clear because the studies were conducted after the epidemics had already risen.