In several countries in East Asia, male-to-male sex has become the dominant mode of transmission among newly diagnosed infections . The list of included countries can be found in Text S3. Articles in Arabic were reviewed by the same two authors, whose first language is Arabic. Saleem had mentioned in his petition that gender reassignment surgeries were being conducted in several Islamic countries, including Iran and Egypt. While the global prevalence of HIV has stabilized  , there seems to be a trend of increasing HIV prevalence among men who have sex with men MSM , and recent reports indicate new, newly identified, and resurging HIV epidemics among MSM in different parts of the world  — . Our inclusion criteria were thus based on the mode of disease transmission rather than the ethnographic and social background of the term. It is reported that they are often subject to homophobia, harassment, discrimination, and criminalization  — .
Sources of data included PubMed Medline , international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. Particular attention has been made to distinguish, when possible, transgender people from the rest of the MSM population groups. Bibliographies of relevant articles were cross-checked for other potential citations. Our inclusion criteria were thus based on the mode of disease transmission rather than the ethnographic and social background of the term. More details on these search criteria can be found in Text S2. A questionnaire was developed, based on the objectives of the study. What Do These Findings Mean? The remaining relevant documents were identified through the extensive and multi-source data search of the Synthesis Project. However, the quality of this evidence varies greatly. At the initial screening phase, eligibility was based on having a data point on any of the following measures among MSM in any of the 23 MENA countries covered in our search: There is a shortage of scientific data on the subject of sexuality from Pakistan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Since very few studies in the available literature in MENA differentiate between MSM and transgender subgroups, and since, as will be described later, sexual and gender identities in this region are complex and often not distinctly defined, the emphasis was on being as inclusive as possible of all studies of male-to-male sexual behavior in the region, which often combined persons of different sexual orientations and gender identities, levels of same-sex attraction, and levels of sexual behavior with men and women. In this systematic review and data synthesis, the researchers use predefined search criteria to identify all the published and unpublished data on the epidemiology of HIV among MSM in MENA and combine synthesize these data to produce a coherent picture of the HIV epidemic in this potentially key group of people for HIV transmission in this region. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In this first review of HIV and MSM from a region perceived to have very limited data on this topic  —  , inclusion criteria were kept broad to cover all relevant data from the region. There was double entry of the data from questionnaires and the demographic form into the computer program, using the Fox Pro for windows and the SPSS for windows. But, as the disease rapidly spread, it became clear that AIDS also affects heterosexual men and women. Thus, by , MSM transmission was responsible for more than a quarter of notified cases of HIV in several countries. HIV is most often spread by having unprotected sex with an infected partner and, globally, most sexual transmission of HIV now occurs during heterosexual sex. Details of the search criteria for each of these databases are in Text S2. Little has been collected over time in individual populations and, because only the visible part of the MSM populations in many MENA countries has been sampled, these findings may not be representative of all MSM in this region. We also studied the association of demographic variables with these prevalence figures, in order to point out areas for future studies and interventions. The data were categorized according to quality of study design and methods at a later stage in the analysis phase as described below. It was administered to men between the age's years, who presented to the outpatient department of the Aga Khan University Hospital. August 2, Copyright:
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