Lebanon

Lebanon is a small middle-income country that has been faced with war and internal and external conflicts in the last three decades. No clear information is available to reflect the drug scene in Lebanon. Cannabis, Cocaine, and Opioids are the main drugs used in the country, but Opioids followed by Cocaine constitute the principal drugs of use in those who attend treatment. There is evidence showing that a considerable number of prisoners are sentenced due to drug-related offences (Skoun Lebanese Addictions Center, et al., 2011). From 30% to 60% of drug users use drugs by injection (Skoun Lebanese Addictions Center, et al., 2011). It is estimated that there are 2,000 to 3,000 PWIDs in Lebanon (Lebanon MoPH, 2012). Heroin appears to be the most commonly used drug by injection (Skoun Lebanese Addictions Center, et al., 2011). Most PWIDs are young and single with low levels of education and a history of imprisonment (Mahfoud, Afifi, et al., 2010; Skoun Lebanese Addictions Center, et al., 2011). 

Lebanon has a low HIV prevalence in the general population (Lebanon MoPH, 2012). MSMs, FSWs, PWIDs and prisoners are considered as the main at risk groups for HIV/AIDS. Less than 6% of the HIV epidemic is attributed to injecting drug use (Lebanon MoPH, 2012). HIV sero-prevalence studies among PWIDs have not found any HIV positive cases (Lebanon MoPH, 2012; Mahfoud, Afifi, et al., 2010). However, sharing injection practice and unsafe sex have been reported to be common among PWIDs (Lebanon MoPH, 2010a; Mahfoud, Afifi, et al., 2010). Moreover, studies have shown a high HCV prevalence among PWIDs (Mahfoud, Kassak, et al., 2010a). Drug use, injecting drug use and needle-syringe sharing have been reported within prisons as well as in the community (Lebanon MoPH, 2012).

The first National AIDS Program was planned and implemented for 2004-2009. It has been updated for 2012. HIV prevention for PWIDs, including OST, is also planned (Lebanon MoPH, 2012). A decree on OST implementation was signed by the Minister of Public Health in 2010; however, Buprenorphine is the only medicine used for OST in the country. As of March 2012, about 120 clients were receiving Buprenorphine maintenance treatment (BMT) in two hospitals in Beirut (Lebanon MoPH, 2012). It should be noted that a considerable number of NGOs, general practitioners and psychiatrists are providing out-patient, in-patient and community treatment services for drug dependence in the country (Skoun Lebanese Addictions Center, et al., 2011). NSP and condom distribution for PWIDs were begun in the country many years ago. SIDC, the NGO providing social and health care services to drug users, the only NGO providing NSP in the country, reports that the number of syringes distributed for each IDU in one year has been very low (Badran, 2012; Lebanon MoPH, 2012; SIDC, 2011). VCT is available throughout the country and MARPs are using the service. However, the available information indicates that the proportion of PWIDs tested for HIV in the last 12 months is low (Mahfoud, Afifi, et al., 2010). ART is provided for Lebanese citizens and Palestinian refugees (Lebanon MoPH, 2012). ART coverage is increasing and PWIDs are also receiving treatment at one site (UNAIDS, 2011a). CSOs are active in providing harm reduction services. More than 75% of HIV interventions for PWIDs are estimated to be provided by CSOs (Lebanon MoPH, 2010b). The secretariat of a regional NGO (MENAHRA) is in Lebanon and another NGO (SIDC) is the WHO-recognized knowledge hub for harm reduction in the region.

The AIDS program faces a shortage in financial and human resources and inadequate surveillance systems. Stigmatization of MARPs and PLHIV, prejudiced personal views of religious leaders toward PLHIV and the criminalization of PWIDs and MSMs are among other limiting factors for expansion of the HIV prevention services. External assistance has been received from several UN organizations to strengthen the country's capacities for HIV response (Lebanon MoPH, 2012). However, a mapping of PWIDs and considerable expansion of the services are needed to reach a significant number of PWIDs and to provide a range of important harm reduction services. Moreover, current information on HIV prevalence, risk behaviors and received services are slight and require updating.

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