New Evidence on the HIV Epidemic in Libya: Why Countries Must Implement Prevention Programs Among People Who Inject Drugs

Mirzoyan, Lusine MD, MPH*; Berendes, Sima MD, MPH*; Jeffery, Caroline MA, PhD*; Thomson, Joanna MSc; Othman, Hussain Ben MD; Danon, Leon PhD; Turki, Abdullah A. MD*; Saffialden, Rabea DipPH*; Valadez, Joseph J. PhD, DSc, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 April 2013 - Volume 62 - Issue 5 - p 577–583
doi: 10.1097/QAI.0b013e318284714a
Epidemiology and Prevention

Background: Libya had one of the world's largest nosocomial HIV outbreaks in the late 1990s leading to the detention of 6 foreign medical workers. They were released in 2007 after the Libyan Government and the European Union agreed to humanitarian cooperation that included the development of Libya's first National HIV Strategy and the research reported in this article. Despite the absence of sound evidence on the status and dynamics of Libya's HIV epidemic, some officials posited that injecting drug use was the main mode of transmission. We therefore sought to assess HIV prevalence and related risk factors among people who inject drugs (PWID) in Tripoli.

Methods: We conducted a cross-sectional survey among 328 PWID in Tripoli using respondent-driven sampling. We collected behavioral data and blood samples for HIV, hepatitis C virus, and hepatitis B virus testing.

Results: We estimate an HIV prevalence of 87%, hepatitis C virus prevalence of 94%, and hepatitis B virus prevalence of 5%. We detected injecting drug use–related and sexual risk factors in the context of poor access to comprehensive services for HIV prevention and mitigation. For example, most respondents (85%) reported having shared needles.

Conclusions: In this first biobehavioral survey among PWID in Libya, we detected one of the highest (or even the highest) levels of HIV infection worldwide in the absence of a comprehensive harm-reduction program. There is an urgent need to implement an effective National HIV Strategy informed by the results of this research, especially because recent military events and related sociopolitical disruption and migration might lead to a further expansion of the epidemic.

*Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

Mathematics Institute, University of Warwick, Coventry, United Kingdom; and

National Centre for Diseases Control, National AIDS Program, Tripoli, Libya.

Correspondence to: Sima Berendes, MD, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom (e-mail:

Supported by the European Commission under the terms of the project “Supporting the development and implementation of a National HIV–AIDS Strategy in Libya.” The sponsor of the study had no role in the study design, data collection, analysis, and interpretation, or writing of the article.

H.B.O. works for the Libyan National Centre for Diseases Control (NCDC), Ministry of Health, which is also responsible for the planning and implementation of the National HIV Strategy informed by the results of this article. The other have no conflicts of interest to disclose.

Authors' contributions: J.J.V. wrote the proposal and obtained funding; J.J.V., L.M. and S.B. designed the study protocol; L.M. led study preparations; J.J.V, L.M., and H.B.O. managed all reporting to Libyan governmental institutions; J.J.V, A.A.T, H.B.O., S.B., and C.J. contributed to the study preparations; L.M., A.A.T., and R.S. predominantly managed data collection;H.B.O., J.J.V., S.B., and C.J. provided technical assistance to the data collection; J.T., L.D., S.B., and C.J. analyzed data; J.J.V., L.M., and R.S. supported the data analysis and all the authors contributed to the interpretation of results;S.B. wrote the first draft of the article; all the authors contributed to the writing of the article, and read and approved the final article.

This publication has been produced with the assistance of the European Commission. The contents of this publication are the sole responsibility of the authors and can in no way be taken to reflect the views of the European Union.

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Received September 06, 2012

Accepted December 20, 2012

© 2013 Lippincott Williams & Wilkins, Inc.