Trends in reported HIV diagnoses, exposure patterns, and AIDS-related mortality in the Eastern Mediterranean Region, 2014–2023

Abstract The Eastern Mediterranean Region (EMR) continues to face a substantial HIV burden, with increasing numbers of reported diagnoses, heterogeneous exposure patterns, and persistent AIDS-related mortality. Despite global progress, countries of EMR remain far from achieving the UNAIDS 95-95-95 targets. This analysis of regional HIV surveillance data presents trends in reported diagnoses, exposure patterns, and AIDS-related mortality across EMR countries from 2014 to 2023. We analyzed country-level aggregated HIV surveillance data submitted annually to the WHO Regional Office for the EMR from 2014 to 2023. Data included new HIV diagnoses, exposure modes, demographic characteristics, and AIDS-related deaths. Descriptive analyses were performed to assess temporal trends, country-level disparities, and reporting completeness. Newly reported HIV diagnoses in the EMR increased sevenfold, from 3,717 in 2014 to 26,314 in 2023, with men accounting for nearly three-quarters of diagnoses. Exposure data, available for 73.6% of cases in 2023, indicated heterosexual contact as the most frequently reported route, followed by injecting drug use, same-sex contact, and blood exposure, though substantial proportions remained unknown. Exposure patterns varied markedly across countries, reflecting both epidemiological context and surveillance limitations. Over the study period, 22,569 deaths were reported, with greatest numbers from Pakistan, Egypt, Saudi Arabia, and Somalia. Mortality disproportionately affected men over the study period, though sex-disaggregated data were incomplete in several settings. HIV in the EMR is characterized by rising diagnoses, heterogenous reported exposure, and significant mortality, with major reporting gaps in coverage and completeness. Strengthening surveillance systems, expanding diversified testing strategies, and scaling up culturally sensitive prevention and treatment services are critical to improve epidemic control. Regional collaboration and integration of harm reduction, sexual health, and stigma reduction strategies remain essential for improving outcomes and achieving HIV control targets.