Policy and Guidelines
The Kingdom of Saudi Arabia has a low-prevalence of HIV with ongoing transmission in some risk groups. There is an increased concentration in larger major urban cities with higher rates of infection in men than in women. Global reports quote the rise of new infections in the MENA region. Despite the sensitivities around HIV-related risk behaviors in KSA, the government is committed to provide an active programmatic response.
The policies and guidelines view the HIV issue not just as a health issue, but as a larger developmental and a public health issue, thus necessarily integrating HIV services with other developmental programs. Programmatic strategies and activities are to be informed by evidence based medicine from research, surveillance, program monitoring, evaluation and feedbacks from the program implementation.
The package of services offered are awareness generation, promotion of safe sexual practices, prevention of parent to child transmission, voluntary counseling and testing facilities through mobile and static units, promotion of voluntary blood donation and access to safe blood, providing care and support services for people living with HIV/AIDS, Anti-Retroviral Treatment (ART) for people living with HIV/AIDS. National AIDS Program (NAP) envisages a greater role of civil society in provision of outreach services to risk groups and PLHA.
Greater stress is laid on provision of ART and increasing the coverage by facilitating the availability and accessibility of ART. The strategic use of ART as a prevention tool is envisaged for the prevention of new cases from occurring.
The National Policy on Blood Banks ensures adequate supply of safe blood and blood components.
The National policy on STI treatment and management states provision of Syndromic approach of STI case management at Primary Health Centres and Etiological case management at hospitals.
Apart from this, there are extensive guidelines on the treatment and management of STI, operational guidelines for ART centres to standardize ART services across the country and VCT guidelines for mobile & static clinics.
National HIV/AIDS strategy
The National Strategy Plan on HIV/AIDS (2013-2017) aims to provide an overall policy and programmatic guidance to all stakeholders involved in HIV prevention, care, support and treatment.
The National Strategic Plan (NSP) has two overall goals to prevent the further spread of HIV and mitigate the impact of AIDS on society:
These two goals are further operationalized in six strategic objectives which address the key priority areas based on the comprehensive analysis of the state of the HIV epidemic and the national response to date. The six strategic objectives are:
- To halt the further spread of HIV among the Saudi Arabian population and maintain HIV prevalence rates below 1.0% amongst all risk groups and below 0.1% among the general population by 2017.
- To improve the quality of life, health and well being of people living with HIV by providing universal access to comprehensive HIV treatment, care and support services of high quality.
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- To strengthen the availability, sharing and utilization of strategic information on HIV/AIDS that will guide the development and implementation of evidence-informed policies, programs and services;
- To scale up and improve the quality of HIV-prevention programs and services for most-at-risk populations (MARPs) with the aim to reach universal access;
- To scale up and improve the quality of key HIV-prevention programs and services for the general population, with a special focus on vulnerable groups;
- To strengthen the quality, and scale up coverage and utilization of comprehensive treatment, care and (self) support for PLHIV, in accordance with international standards;
- To promote supportive social, legal and policy environments that enable a multi-sectorial national response to HIV/AIDS, with special attention for PLHIV, and key populations at risk and vulnerable to HIV;
- To strengthen and build technical, organizational and institutional capacity for the coordination, implementation monitoring and evaluation of an effective, decentralized, multi-sectorial response to HIV/AIDS.
National AIDS Committee
The National AIDS Scientific Committee provides technical guidance to the National AIDS Program as regards to program and policies. It is chaired by the Deputy Minister of Health for Public Health, MOH and has representative members from health and non-health sectors e.g. Ministries of Social Affairs, Education, Labor, Interior, Defense, civil society, private sector, Chambers of Commerce, Faith-based organizations and others. (For further information: Refer to the list of current National AIDS Scientific Committee members).
(For further information-Refer to the list of current National AIDS Scientific Committee members)
IEC (Information Education Communication)
HIV and AIDS education programme focuses on raising awareness through mass media, IEC messages and campaigns, informing general population (with special focus amongst adolescents and young people) on the modes of transmission of HIV, dispelling the prevalent myths and misconceptions, promoting abstinence and safe sexual practices.
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Stigma and discrimination against HIV /AIDS is widely prevalent in the general community, amongst health care providers, professionals, in the work place and even in schools. The behaviors which lead to the vulnerability of the individual contracting the disease are socially unacceptable and illegal. HIV stigma is largely related to ignorance and fear of transmission and moral condemnation. This leads to denial of the rights of PLHIV to access of basic services (health, employment, education and others), social rejection by families and communities, fear of disclosure of their HIV status and thus being widely discriminated against.
With the above view in mind a Communication campaign on 'Zero New Infections, Zero Deaths and Zero Stigma and Discrimination’ was launched throughout the country using Television and Radio media in 2012. The campaign was for a period of 6 months and built up to the World AIDS Day on 1st December 2012.
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Capacity Building and Training
The National AIDS Program provides technical support and builds capacity on various aspects of HIV/AIDS/STI of the NAP central team and the Regional AIDS Coordinators and members of civil society. A need-based comprehensive national capacity building and technical assistance plan is developed and an annual training calendar is developed. The appropriate personals selected for trainings and workshops are drawn from both internal resources and external partners.
Some of the training activities undertaken are in the etiological and syndromic case management of STI, voluntary counseling and testing, HIV and STI surveillance, Behavior Change counseling and others.
M&E, Surveillance and Research
The National Strategic Plan lays strong emphasis on Monitoring and Evaluation (M&E), national surveillance system and conducting operational research to feed into the system for strengthening the national prevention and control response. M&E is seen as a cross-cutting priority of all service delivery, programme implementation and capacity building activities. Data collection and reporting responsibility lies with the national central team.
The National AIDS Program reports on the progress made towards commitments made in the context of the 2001 UNGASS Declaration of Commitment and Millennium Development Goals.
(For further information on Global AIDS Reporting Progress 2012 UNGASS report 2010 click on www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports
Kingdom of Saudi Arabia has a low-prevalence of HIV. Programmatic data and facility-based testing and reporting and surveillance data suggest Saudi Arabia’s incidence is among the lowest in the world, averaging <4 cases per 100,000 population for the decade (2000-2010) studied, and 1.5 cases per 100,000 among Saudi nationals with a gradual increasing trend amongst the nationals.
Majority of new cases (70%) reported were diagnosed prior to onset of advanced infection or AIDS diagnosis. Pediatric cases accounted for 4% of the Saudi total. Gender differences were pronounced with a male to female ratio of 4.4:1 among Saudis. There were more cases in major urban centers as opposed to smaller cities.
The zero-prevalence study has confirmed that Saudi Arabia is a low prevalence country with an overall HIV rate of 1.5 per 100,000. The overall HIV prevalence among medical clinic attendees was low (0.24%), pregnant women (0%), blood donors & TB patients (0.1%) and STI (0.7%) and IDU (0.8%)
(For further information: HIV/AIDS Trends Saudi Arabia 2000-20009, paper presented at the XIX International AIDS Conference 2012)
Research: Operations research initiatives are being undertaken on social and behavioral aspects of HIV in order to inform the program, have a better understanding of the drivers of the epidemic, thereby enabling NAP to strategize the program strategies accordingly.
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Our abstract posted in the latest section of Infection and Immunity
Michael S. Yang, MD, PhD
Editor of World Biomedical Frontiers
Trends Poster (PDF)
’Facilitation of marriages between PLHIV’-is quoted as one of the examples of good practices. Eight years ago the NAP launched a project to facilitate marriage between HIV positive individuals. The project was implemented through the Saudi Charity Association for AIDS Patients; the project has resulted in marriage of nearly 100 individuals that gave way for healthy deliveries of many babies. The quality of life for these couples has been improved through economic support for home furnishing, support for finding employment, trainings, and a sense of “well-being” that comes from being part of a family. The project has also provided health education, treatment & counseling services, drop in center facilities, and peer group support, and helped to minimize stigma and discrimination.
The April 2011 Riyadh Charter endorsed by the Gulf Cooperation Council members reaffirmed their political commitment to respond effectively to HIV. Minister of Health, KSA urged each country in the region to budget separately for HIV prevention and care activities and to have a unified Regional HIV/AIDS Strategy for GCC countries on issues of utmost importance to the region.
Meeting of the Arab League called upon the government, non-government and UN agencies for “Uniting Arab Countries to Fight Against AIDS” recommended developing a common strategic plan for the Arab region in line with the regional and global strategy on HIV/AIDS. Further there was a launch of the regional ‘Saudi Forum on HIV/AIDS’ for the Arab countries in November 2011.
Legal environment: Drafting of a bylaw to protect the rights of PLHIV in relation to human and civil rights (i.e. employment and work, right to education, right to marriage) has been working through the legal system and is with the highest body the ‘shoura’ council.