Only 10 to 14 percent of the 400,000 people infected with HIV in the Middle East and North Africa get treatment due to the stigma and discrimination that has made people wary of being tested, a UNAIDS official said.

The epidemic remains a touchy subject in the region’s conservative societies, due to its correlation with unprotected premarital and extramarital sex, men having sex with men without condoms, or prostitution and intravenous drug use.

“Our main challenge is scaling up efforts to reach people who need our services, such as antiretroviral treatment,” Hind Khatib Osthman, the UNAIDS regional director, told Reuters in an interview at a UNAIDS conference.

Patients on medication could live normal life spans, she said, and treatment was often provided by governments in the region, but many feared coming forward out of shame.

The number of reported HIV cases in the region grew by 100,000 in the past two years according to U.N. statistics. However, concerns remain that more cases go undetected due to lack of systematic surveying.

“We’re doubting the accuracy of reports - it’s not doubting what governments report but doubting that we have the system to actually properly report cases,” Osthman said.

An unwillingness to discuss risk behaviors associated with HIV has hurt regional public awareness campaigns, she added.

“What we’ve seen in the region when they want to establish a national AIDS strategy, it’s easier for them to talk about a strategy as if the prevalence is generalized (in society) ... they don’t want to speak about key populations,” she said.

The Middle East and North Africa (MENA) region lacks any targeted campaign for groups living in the margins of society most at risk for HIV, such as sex workers or drug users.

Osthman warned that the low prevalence of the virus in the MENA region would not last without more openness about how the virus is spread.

“Low prevalence will not continue to be low if we don’t have the right intervention,” she said.

Reluctance to discuss risk behaviors has often made foreigners, seen as more promiscuous, or from high prevalence HIV areas, a target in efforts to tackle HIV/AIDS while the local population is ignored.

Many countries in the region test foreigners and deny those who test positive residency visas or quarantine and deport them.

“We have to admit this is home grown ... Deportation doesn’t help. Just having someone with HIV doesn’t mean they are automatically spreading the virus,” Osthman said.

“We (UNAIDS) are calling for a change of policy,” she said, adding that a new strategy in awareness efforts was needed.

Entertainment media, she said, has played a role in common misconceptions of the disease. Popular Arabic soap operas often portray HIV as something that comes from foreigners or can be contracted by mouth, and as untreatable and humiliating.

Changing media portrayals is a key concern for Osthman, who brought several Arab actors to Dubai’s UNAIDS conference.

“We’re educating them on HIV, we’re getting their voice, so that hopefully the wrong messages are not put in different programs and soap operas because they’re watched highly in the region ... we need them on our side,” she said.

Public realization of the comparatively low prevalence of HIV/AIDS in the MENA region is also risky, Osthman said, as many, especially officials in high public positions, prefer to turn a blind eye.

“I think the region did not want to face HIV ...” she said. “We have to create a movement. The battle is still to be won, we’re quite a ways from it.”

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By Erika Solomon

DUBAI (Reuters)