Barriers to HIV Treatment as Prevention (TasP) in men who have sex with men in the Eastern Mediterranean Region

The significant reduction in human immunodeficiency virus (HIV) viremia to ‘undetectable’ levels (HIV plasma viral load < 40 copies/ml) in response to effective antiretroviral therapy (ART) removes the risk of HIV transmission.1 This approach, known as ‘treatment as prevention’ (TasP), has proven to be successful especially in men who have sex with men (MSM) and in other key populations. In view of the demonstrable effectiveness of TasP, significant efforts have been made to increase public awareness and understanding of this approach in western, industrialized societies, such as the USA and the UK. However, this has not been the case in the Eastern Mediterranean Region (EMR according to World Health Organization (WHO) includes Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen), in which HIV remains a highly stigmatized condition, which is seldom discussed mainly because of its association with MSM—a stigmatized group in EMR society. In this editorial, we discuss the effectiveness of TasP in major observational studies and current levels of public understanding of, and belief in, TasP, with a focus on MSM in the EMR. We argue that by increasing the awareness and understanding of TasP in MSM in the EMR could enable the epidemic to move closer toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90-90-90 (The UNAIDS ‘90-90-90’ strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on ART and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030).