Egypt faces several challenges in maintaining a low HIV/AIDS prevalence, including a general reluctance to address risk practices and issues associated with marginalized groups (such as injection drug users [IDU]), stigmatization of HIV/AIDS and other sexually transmitted infections (STIs), and changes in sociocultural norms toward sexual behavior, alcohol, and injection drug use. In addition, the lack of effective STI/HIV/AIDS education and other prevention programs among at-risk groups compound the pervasive culturally-based fears and stigmatization of HIV/AIDS and STIs. Egypt also has the highest Hepatitis C (HCV) prevalence in the world estimated at 14.7% (PNAS). Transmission routes that contributed to this may exacerbate HIV/AIDS transmission. One study reported the HCV prevalence among IDUs at 63% (Saleh 1998), indicating that this group is particularly vulnerable to HCV-HIV co-infection (MENA Synthesis Report, UNAIDS 2009). Despite evidence which suggests that there is a growing concentrated HIV epidemic among IDUs, estimated at 6.8% (BBSS 2010) little research has been conducted with this population to assess their knowledge of and health care seeking practices around STI, HCV, and HIV, little research has been conducted to capture the prevalence of STI, HCV, and HIV prevalence and co-infection rates, and there are few interventions to address the current HIV epidemic. Consistent with the goals and mission of the National Institute of Drug Abuse, we propose to conduct qualitative and quantitative research complemented with a STI/HCV/HIV prevalence study to understand the role of injection drug use and HIV/co-infections among IDUs. We propose to build upon the results of qualitative research conducted by the team to quantify high risk behaviors in order to inform the development of a culturally appropriate health education and HIV/AIDS counseling and testing (HCT) interventions targeting IDU populations in Egypt, recognizing that they are an important bridging group to the general population, in order to reduce the public health impact of the HIV/AIDS epidemic. Evidence suggests that throughout the Middle East and North Africa (MENA) there are active high-risk networks where HIV is being transmitted and clustering in multiple risk groups has been documented (Mumtaz 2011). A similar trend was documented in Russia, when IDU represented the main mode of HIV transmission for at least a decade, and was soon replaced by other modes of transmission (Thomson 2009). Egypt is the largest Arab country in the world and has a strong influence on the MENA region. This study has the potential to impact the HIV/AIDS landscape in MENA by providing needed data on high risk behaviors among IDUs and prevalence estimates. More significantly the results of this study will lead us to a larger R34 application to adapt efficacious HCT and STI screening programs in order to develop and pilot culturally appropriate health education and HIV/AIDS counseling and testing (HCT) intervention targeting IDU populations in Egypt.
The proposed research addresses the goals of the National Institute of Drug Abuse. We will assess injection drug use, and sexual behaviors that place injection drug users (IDUs) at high risk for STI/HCV/HIV infection in Egypt and we will conduct prevalence study of STI/HCV/HIV co-infection among drug use populations. Results will inform the development of culturally-appropriate interventions targeting IDUs in Egypt.