title: New evidence on the HIV epidemic in Libya: why countries must implement prevention programs among people who inject drugs.
abstract: BACKGROUND
  Libya had one of the world's largest nosocomial HIV outbreaks in the late 1990 s 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.
authors: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Lusine
authors: L
authors: Mirzoyan
authors: Sima
authors: S
authors: Berendes
authors: Caroline
authors: C
authors: Jeffery
authors: Joanna
authors: J
authors: Thomson
authors: Hussain
authors: H
authors: Ben Othman
authors: Leon
authors: L
authors: Danon
authors: Abdullah A
authors: AA
authors: Turki
authors: Rabea
authors: R
authors: Saffialden
authors: Joseph J
authors: JJ
authors: Valadez
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data; D058872:Epidemics; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D016174:Hepacivirus / Q000302:isolation & purification*; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008002:Libya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires