Ensuring HIV Data Availability, Transparency and Integrity in the MENA Region Comment on "Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward"

Abstract

In this commentary, we elaborate on the main points that Karamouzian and colleagues have made about HIV data scarcity in Middle Eastern and North African (MENA) countries. Without accessible and reliable data, no epidemic can be managed effectively or efficiently. Clearly, increased investments are needed to bolster capabilities to capture and interpret HIV surveillance data. We believe that this enhanced capacity can be achieved, in part, by leveraging and repurposing existing data platforms, technologies and patient cohorts. An immediate modest investment that capitalizes on available infrastructure can generate data on the HIV burden and spread that can be persuasive for MENA policy-makers to intensify efforts to track and contain the growing HIV epidemic in this region. A focus on key populations will yield the most valuable data, including among men who have sex with men (MSM), transgender women and men, persons who inject drugs (PWIDs), female partners of high risk men and female sex workers.

Tackling HIV in MENA: Talk Is Not Enough–It Is Time for Bold Actions: A Response to Recent Commentaries

“… 1 Modjarrad and Vermund explain how the existing public health infrastructures and data systems could enhance the quality and quantity of HIV-related data in the region and highlight the need for intensifying the “follow-up, care and data collection efforts for known HIV cases.” They also discuss some real world examples about reaching key populations effectively despite their ‘criminalized’ status. 2 We completely agree with their excellent suggestions about taking full advantage of network of existing “surveillance, clinical and research data repositories, along with information-sharing agreements across the MENA region.” 2 However, considering the slowly evolving nature of the epidemic in the region, MENA countries need to invest further in learning from the global experience and optimizing the intervention outputs in order to evade the future burden of HIV on their population and healthcare system.…”

“…We appreciate the insightful and thought-provoking commentaries by Kaplan and El Khoury 1 and Modjarrad and Vermund 2 about our recent editorial entitled “Improving the quality and quantity of HIV data in the Middle East and North Africa: key challenges and ways forward.” 3 Kaplan and El Khoury highlight the challenges faced by lesbian, gay, bisexual, and transgender (LGBT) communities and offer insight in improving HIV surveillance efforts among this marginalized population in the conservative context of the Middle East and North Africa (MENA). 1 Modjarrad and Vermund explain how the existing public health infrastructures and data systems could enhance the quality and quantity of HIV-related data in the region and highlight the need for intensifying the “follow-up, care and data collection efforts for known HIV cases.” They also discuss some real world examples about reaching key populations effectively despite their ‘criminalized’ status.…”

“…We also agree about the importance and feasibility of reaching key populations and welcome the thoughtful suggestions for improving LGBT engagement in HIV surveillance efforts. 1 , 2 Furthermore, we would like to highlight the importance of modifying the language around key populations at risk of HIV across MENA as a useful strategy in linking them to prevention and care services. For example, the inclusion of female sex workers (FSWs) in Iran’s HIV surveillance programs, despite their ‘criminalized’ status in the country’s Judiciary system, was largely facilitated by changing the former lexicon around FSWs (ie, ‘street women’ or ‘street prostitutes’) to the culturally and religiously sensitive term of ‘vulnerable women’ (ie, women who need help).…”

“…On the other hand, one size will not fit all and any public health intervention needs to be culturally, ethnically, and religiously sensitive in order to be beneficial in providing key populations with services without crossing the ‘red-lines’ of the ruling governments in Muslim-majority MENA countries. Considering that “MENA countries comprise a complex mosaic of populations and policies,” 2 uptaking a country-specific causal layered analysis approach – a method that goes beyond the conventional framing of the problem and examines all of the deep and shallow influential factors based on their level of effect (ie, litany, causes, worldview, and metaphor levels) – could be a game changer in addressing the HIV epidemic in MENA in the near future. 9 - 12 …”

Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System

“…19 For example, the limited resources that hamper priority setting in LICs may also contribute to a lack of credible evidence. [19][20][21][22] Furthermore, there are reported cases where evidence has been disregarded by decision-makers whose priorities lie elsewhere. 1,[22][23][24] Evidence is thought to be key to improving the quality of priority setting and resource allocation decisions.…”