Bahrain is a small high-income country. There is insufficient updated information on drug use pattern. It is estimated that there are 20,000 to 30,000 drug users in Bahrain (UNDP & Bahrain MoI, 2006). There is a primary drug rehabilitation center at a psychiatric hospital in Manama that provides drug treatment services as well as ART. The center produces information about drug users' profiles, risk behaviors and HIV prevalence through mandatory testing. A report has mentioned that two thirds of the 3,200 registered drug users are injecting (Bahrain MoH, 2010). Heroin, followed by Amphetamines and Cocaine are the major drugs of injection (Bahrain MoH, 2012).

Bahrain has a low HIV prevalence in its general population. Around 80% of identified HIV cases have been non-citizens and were deported. It is evident that heterosexual transmission has been increasing in recent years (Bahrain MoH, 2012). However, injecting drug use is the dominant mode of transmission. Up until the end of 2011, 58.1% of Bahraini HIV infections were attributed to injecting drug use (Bahrain MoH, 2012). Nevertheless, according to the results of the mandatory testing of all PWIDs in the rehabilitation center, the HIV prevalence among PWIDs has remained below 5% (Bahrain MoH, 2012). There were only two reports from the years 1989 and 1991, showing that 8% and 21.1% of PWIDs were HIV positive, respectively (Al-Haddad, et al., 1994; UNAIDS, et al., 2004); the findings that were never replicated. A knowledge, attitudes and practices study (KAP) among PWIDs in 2006 showed that HIV knowledge is moderate and use of new syringes, as well as condom use is common, nonetheless, sharing and unsafe sex are not rare (Al-Jowder, et al., 2007; Bahrain MoH, 2010).

The National Strategy for AIDS Prevention (2008-2010) is the first and most recent national strategy. It will be updated for 2012-2016 (Bahrain MoH, 2012). Overall, the country's response to HIV followed a conservative approach and NGOs have not been active in HIV prevention. However, Bahrain's prison program has been a best practice since 2009 in the region. It includes peer education and support groups (Bahrain MoH, 2012). The first national strategy had recognized PWIDs as a high risk group, but a harm reduction strategy has not been adopted. OST is not available, although Methadone has been available and utilized for detoxification for several years. NSP is not available in Bahrain. Buying needles and syringes from pharmacies requires a prescription, and drug users are arrested for possession of syringes (Bahrain MoH, 2012). VCT is not available in the country and the proportion of PWIDs tested for HIV is not known. ART is provided in one center (the rehabilitation center for drug users).

At this time, HIV prevention is not a national commitment and priority; there has been a higher shift of priorities towards political issues in 2011. The National AIDS Program has suffered from structural and human resource limitations. Cultural and social barriers prevent the development of outreach program and condom distribution (Bahrain MoH, 2012). In addition, there is a need to study the size of PWIDs and update the current knowledge on risk behaviors of PWIDs. Development of a second National program for AIDS prevention will bring a golden opportunity for discussion and inclusion of harm reduction interventions in the country.

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