AIDS epidemic in the country

Source: HIV and AIDS estimates (2014)[1] from UNAIDS Data

General description: While Egypt’s general population has a low HIV prevalence rate of less than 0.02%, there are demographic groups with markedly higher prevalence rates. The prevalence of HIV among these groups represents a major development concern for Egypt. People living with HIV in Egypt were estimated to be 6,500 in 2013 which remains low; however 2013 witnessed a surge in number of confirmed cases, which were almost double the cases confirmed in previous year. Also, Hepatitis C is a common co-infection among people living with HIV in Egypt.

AIDS epidemic among key populations: The 2010 Bio-Behaviour Surveillance System (Bio-BSS) indicated that there is a concentrated epidemic among specific groups including MSM and male PWID. The Bio-BSS 2010 also identified that there has been increased risk among street children. While street children currently had a low HIV prevalence rate of 0.5%, they exhibited high-risk activities that made them vulnerable to the spread of HIV. These behaviours include injecting drug use and relatively high rates of unsafe sexual activity. For example, 46.5% of male street children reported being sexually active. Of the female street children who responded, 16% admitted to being sexually active. These high-risk behaviours combined with relatively low levels of awareness about HIV suggest that street children are vulnerable to the spread of the HIV.

HIV transmission: In 2010, 66.8% of HIV transmissions occurred through sexual activity, of which 46.2% took place through heterosexual activity and 20.6% through homosexual activity. Transmission via injecting drug use represents 28.3% of detected cases. Detected cases in children represented 4.9% of transmissions, possibly due to mother to child transmission.

National AIDS response

The National AIDS Program led a series of capacity development activities targeting most at risk populations, aiming at increasing their awareness on HIV/AIDS and providing them with proper knowledge and tools for prevention. This activity had a wide geographical distribution across Egypt, and was hosted by VCTs.

Men who have sex with Men (MSMs): UNAIDS Egypt supports one project for MSM in Alexandria which remains functional and another in Cairo that ended in 2012. The projects provide street-level outreach and a comprehensive package of harm reduction services to MSM. Furthermore, FHI360 is technically supporting civil society organization (CSOs) implemented projects in Cairo and Alexandria addressing MSM initiated in 2013, through donor’s support coming from Drosos and Ford Foundation.

People who inject drugs (PWIDs): FHI360 has been supporting projects addressing PWID in Cairo and Alexandria continued in 2013, through a network of NGOs (NAHR) supported by Drosos foundation and Ford Foundation. Project NAHR seeks to establish a platform for harm reduction NGOs to share experiences, jointly address bottlenecks and mobilize resources. The network mobilized technical support from the National AIDS programme, UNAIDS, UNHCR and UNODC.

Female sex workers (FSWs): The UN Joint Team on AIDS (UNJT) supported an outreach program for FSWs in Cairo through its local NGO implementing partner Al Shehab. The project provides outreach, prevention and alternate career services to outreached female sex workers. By Mid-2012, the program’s 22 outreach workers had made contact with over 4,000 sex workers and more than 9,200 condoms had been distributed since 2010. The programme has received UNFPA, UNICEF and UNAIDS’ support to continue into 2014, while efforts are made to integrate its interventions in more sustainable programmes beyond that date.

Vulnerable Populations: In 2012 and 2013, UNHCR continued its support for local medical NGO partner Refugee Egypt, a local NGO that provides age and gender sensitive primary health care services and AIDS awareness raising activities to refugees and other persons of concern to UNHCR in Alexandria and Cairo. During this period, 45,000 refugees and other persons of concern to UNHCR received assistance from Refugee Egypt, including Syrian refugees and youth asylum seekers. UNHCR also supported 520 health awareness sessions attended by 10,400 beneficiaries with Refugee Egypt. Furthermore, Egyptian National AIDS Program provides ARVs as necessary to refugees free of charge, as part of the national treatment coverage.

Children and young people: UNICEF’s “Interactive Games” project provides educational programs for children aged 10-18 and youth ages 18-24 run out of DICs in 3 governorates of greater Cairo. Since the project began in 2010, more than 2,500 children have been reached. Through a partnership with YAPD, around 14,000 youth, 68% male and 32% female, aged 10-24 were reached through peer-to-peer education.

ARV & ART: In 2012 and 2013, UNICEF continued its efforts to improve the logistics and supply chain management for the acquisition of ARVs and other medical supplies. Additionally, UNICEF procured ARVs and related supplies through the National AIDS Programme (NAP) and Global Fund AIDS TB and Malaria Programme (GFATM) to support Post-exposure Prophylaxis (PEP) services coordinated by the NAP. With procurement support from UNICEF, the MOH distributed ARVs through a network of 11 public hospitals in 2012 and 2013[2].

Care begins with CD4 cell count testing and those eligible with a CD4 call count of 500 or lower are offered ART. A treatment cascade has been developed and a cohort analysis was performed for newly diagnosed patients for nine months. A summary care cascade as a bar chart is shown below. The biggest drop (60%) in the cascade was in people who were diagnosed (1) but did not receive a CD4 cell count test (2). That is, they were diagnosed but did not enter care. The second large drop of 40% was observed in people who began treatment (3) but were not observed to be continuing it after one year (4).

Challenges and actions

1)      There is both a gap in case detection and a gap in detecting cases before they require diagnostic testing;

2)      Both voluntary counselling and testing and provider initiated counselling and testing must be prioritized in service delivery sites that will lead to the highest yield or number of newly diagnosed people living with HIV;

3)      Both initiations and retention in care for the first year require urgent attention;

4)      All people newly found to be living with HIV need hepatitis C testing and registration in the new national hepatitis C treatment programme;

5)      A record keeping system to track health care outcomes for people living with HIV must be developed so that a care cascade can be updated to assess the effects of changes in the programme and to monitor progress towards global 90 90 90 targets[3];

6)      Key populations such as MSM, FSWs, and PWID and vulnerable population such as street children, migrants and refugees remain difficult to reach with information and services[4].

[1] http://www.unaids.org/en/regionscountries/countries/egypt/

[2] National AIDS Programme of Egypt, Global AIDS Response Progress Report: Egypt 2014, http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/EGY_narrative_report_2014.pdf

[3] National AIDS Programme of Egypt, National HIV Programme Situation and Gap Analysis (Egypt) 2015, April 2015, http://www.unaids.org/sites/default/files/country/documents/EGY_narrative_report_2015.pdf

[4] National AIDS Programme of Egypt, Global AIDS Response Progress Report: Egypt 2014, http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/EGY_narrative_report_2014.pdf