HIV Responses in Arab States on the Southern Persian Gulf Border: The First Review.

CONTEXT: There is no review of HIV responses in Arab states on the southern Persian Gulf border. This narrative review aimed to describe and synthesize HIV responses in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE). EVIDENCE ACQUISITION: A review of scientific databases and grey literature was conducted based on an international guide. Overall, 16 original studies and reports were found. RESULTS: The review indicates that HIV has been found present in each Arab state based on sporadic case finding. The prevalence of HIV is the result of heterosexual relationship and/or drug injection. Mandatory testing of the nationals and expatriate workers is the main route of HIV detection. In general, HIV knowledge and education are poor. Only Bahrain has some non-governmental organizations that provide HIV education. Lack of identifying key populations and high risk behaviors has been reported in all of the states. HIV responses are mainly for Arab and Arabic-speaking nationals. Effective strategic plans for HIV have not been developed in all of the states. The provision of antiretroviral therapy for the nationals is the main HIV response. Only Qatar has paid for the treatment of Qatari and non-Qatari HIV-infected patients. As a HIV response, drug treatment is based on short-term inpatient rehabilitation. Only Qatar has voluntary HIV counseling and testing. Lack of needle and syringe programs has been reported for people who inject drugs with HIV problem in all of the states. CONCLUSIONS: To conclude, HIV problem needs a comprehensive policy response in each state. Providing effective strategic plans for HIV and sero-surveillance data systems is required. Empowering human resources and infrastructural development are suggested.

HIV Programs in Iran (Persia), Iraq and Saudi Arabia: A Brief Review of Current Evidence in West and Southwest Asia.

BACKGROUND: In Western and Southwest Asia, literature is not documented on human immunodeficiency virus (HIV) programs in Iran, Iraq and Saudi Arabia. The present study is the first brief review that describes HIV programs in these three neighboring countries. METHODS: Data regarding the evidence of HIV programs were gathered through a systematic literature searching. English publications were retrieved through searching online scientific databases. Grey literature was also searched online. The review was based on the studies related to the last decade. FINDINGS: Systematic searching resulted in retrieving 21,948 studies but only 21 studies were relevant to the study aim. The review findings indicated that Iran has provided a nationwide sero-surveillance data system and has identified its key populations. Detecting HIV prevalence has been limited to case-finding in Iraq and Saudi Arabia. However, strategic plans for HIV have been provided in the three countries. HIV education, knowledge and support have been provided but still needs consideration in the three countries especially in Iraq. The low coverage of antiretroviral therapy (ART) has remained a critical gap in the provision of comprehensive HIV programs in these three countries. This issue has been followed by the lack of opiate substitution therapies for drug dependents and injecting drug users in Iraq and Saudi Arabia. Condom promotion and voluntary HIV counselling and testing have been provided for at-risk groups in the three countries but need more nationwide coverages. However, needle and syringe programs (NSPs) have been only provided in Iran. CONCLUSION: The review concluded that the provision of effective HIV programs should address training human resources and infrastructural development. This issue should be facilitated by international collaborations and governmental supports.

Sexual Dysfunction, Depression and Quality of Life in Patients With HIV Infection.

OBJECTIVE: In Iran, psychological aspect of HIV infection is poorly understood. The purposes of this study were to evaluate sexual dysfunction, depression rate and health-related quality of life and evaluate the association between sexual dysfunction, depression and quality of life in a group of HIV(+) subjects in Shiraz, Iran. METHODS: In this cross-sectional study, 278 male HIV-positive patients who had referred to voluntary counseling and testing and methadone maintenance therapy centers were recruited based on convenience sampling from May to October 2010. The purpose of the study was explained and interested individuals provided informed consent and completed validated questionnaires [Medical Outcomes Study Short Form-36 (SF-36(, Brief Male Sexual Function Inventory (BMSFI), Beck Depression Inventory-short form(BDI)] to assess overall health related quality of life (HRQOL), sexual function, and depression. RESULTS: Average age of the participants was 34.9 ± 10.7 years and 37.5% were severely depressed. Ordinal logistic regression indicated that sexual drive (-0.15; CI: -0.28 to -0.027), ejaculation (-1.91, CI: -2.71 to -1.12), and problem assessment (-0.098, CI: -0.17 to -0.02) had significant effect on depression type. Depression was significantly correlated with poorer quality of life in all domains. Pearson's correlation coefficients between the BMSFI and the domains of SF-36 indicated that sexual drive (r= 0.215), ejaculation (r= 0.297) and problem assessment (r= 0.213) were significantly correlated with emotional wellbeing. CONCLUSION: Sexual function and depression showed association with quality of life. Effective treatment of depression and sexual function may improve the quality of life of HIV-infected person. DECLARATION OF INTEREST: None.

Depression, Testosterone concentration, sexual dysfunction and methadone use among men with hypogonadism and HIV Infection.

Low testosterone levels are associated with depression and impaired sexual performance. We examined the association between hypogonadism, sexual function and depression among men with HIV infection in Shiraz, Iran. A total of 237 male HIV-positive patients referred to voluntary counseling centers were recruited based on convenience sampling from May to October 2010. All patients provided informed consent and completed the Beck Depression Inventory (BDI-II) and Brief Male Sexual Function Inventory (BMSFI). Blood samples were collected after an overnight fast to measure free testosterone (FT) concentration. Hypogonadism was found in 68 % of the participants, and about 68.8 % had moderate and severe depression. Serum FT levels were significantly lower in patients with depression and a direct association was found between the risk of hypogonadism and increased BDI-II score. Among methadone nonusers and nondepressed patients, an inverse association was found between hypogonadal and eugonadal men in the sexual drive, erectile and ejaculatory function domains of the BMSFI. However, there was no significant association between methadone user status and depression. Depression and hypogonadism had a reciprocal effect. Depression and methadone use were associated with hypogonadism and had a significant effect on sexual function.