- 10:30
Forty years after the virus was identified by Luc Montagnier’s team, AIDS is no longer a death sentence. On the occasion of World AIDS Day, Ici Beyrouth offers an insight into the situation in Lebanon, where more than 2,600 people are living with HIV and some 250 new cases are recorded each year. The epidemic remains discreet, confined to the margins of a health system in crisis. Free treatment, anonymous testing and prevention campaigns exist. What is still lacking are diagnoses, the fight against stigma and real mental health care.
The history of AIDS officially begins in the early 1980s, when research teams, including that of Luc Montagnier at the Institut Pasteur, identified the human immunodeficiency virus. At the time, doctors had neither reliable tests nor effective treatment. Today, the situation has radically changed: triple and dual antiretroviral therapies control the infection, long-acting injections ease the daily burden of pills, and a person whose viral load is undetectable practically no longer transmits the virus. All over the world, HIV has gradually become a chronic disease, similar to diabetes or hypertension.
Yet behind this medical revolution lies another reality: that of regions where testing remains insufficient, access to care is unequal, and stigma slows progress as much as the virus. The EMRO region of the World Health Organization, to which Lebanon belongs, is thought to have only 40% of people living with the virus diagnosed, and barely a quarter of them on treatment. World AIDS Day, on 1 December, is a reminder that the battle is now being fought as much in people’s minds as in laboratories.
A country in crisis, a silent epidemic
Since 2019, Lebanon has been going through one of the worst crises in its recent history: economic collapse, political instability, the COVID-19 pandemic, then the Beirut port explosion in 2020, which destroyed hospitals and the central warehouse of the Ministry of Health. In this context of chronic drug shortages, weakened hospitals and poverty affecting more than half the population – and nearly 90% of Syrian refugees – the fight against HIV has long remained the poor relation of health policies.
Introduced into Lebanon in 1984 with the first diagnosed case, the epidemic has progressed slowly but steadily. At the end of 2022, the National AIDS Control Program recorded 3,018 cumulative cases since the 1980s, including more than 2,600 people currently living with the virus. Around 223 new cases were reported in 2022, continuing a trend estimated at some 250 diagnoses per year. The majority concern men who have sex with men, and nearly half of newly infected people are between 25 and 34 years old.
UNAIDS figures for 2023 nevertheless show a glimmer of hope: 79% of people living with HIV who know their status receive antiretroviral treatment, and 74% of them have an undetectable viral load. But the concentration of services in Beirut and its outskirts leaves large areas of the country – Tripoli, the South, the Bekaa – in a state of relative desertification in terms of provision. For many Lebanese and refugees, going to a testing or follow-up centre means several hours of travel, high transport costs, and often the risk of revealing a status they prefer to keep hidden.
Available treatment, but testing still too timid
From a therapeutic point of view, Lebanon is not lagging behind. Thanks to a partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministry of Public Health provides antiretroviral treatment free of charge to Lebanese citizens, Palestinian refugees, and Syrian refugees registered with UNHCR. No major stock rupture has been reported for more than five years. In Karantina, a dispensing centre independent from the central pharmacy distributes several first-line treatment regimens, in line with WHO recommendations.
Experts repeat it again and again: a person living with HIV, diagnosed early and treated properly, can lead a normal life. New drugs now make it possible to move from heavy triple therapies to better-tolerated dual therapies. Intramuscular injections every two months replace, for some patients, the daily intake of pills. HIV then becomes a medical file to be followed, no longer a sentence.
The weak link remains testing. In the EMRO region, only four in ten people living with the virus know they are infected. In Lebanon, the National AIDS Control Program, supported by WHO, UNICEF and other UN agencies, is multiplying voluntary, anonymous and free testing initiatives through centres across the country and specialised NGOs. In December, a regional media campaign specifically targets people at risk, with a clear objective: to encourage everyone to get tested, and each person living with HIV to persuade at least one person in their circle to take the step.
But information does not circulate sufficiently. Studies carried out among key populations – men who have sex with men, people who inject drugs, sex workers – show an inadequate level of knowledge about modes of transmission, means of prevention, and even care facilities. Many rely mainly on the Internet or social media, where rumours and fake news mingle with scientific data. In a country where sexual health remains largely taboo, “knowing” is not yet quite the same as “being able”.
Stigma, mental health and fragile rights
In Lebanon, HIV is not just a virus: it collides with a legal and social framework that weighs heavily on the shoulders of those concerned. Article 534 of the Penal Code, which criminalises relations “contrary to the order of nature”, continues to be used to arrest, intimidate or put pressure on men who have sex with men, transgender people and, more broadly, sexual minorities. Key populations have difficulty accessing justice, insurance companies often exclude HIV-related care, and certain illegal practices – refusal of care, mandatory testing before employment – persist in the shadows.
This stigma comes at a psychological cost. The discovery of one’s HIV status, and the fear of losing one’s job, home or family ties, feed a permanent anxiety. Local studies report disorders ranging from depression to self-harm. Mental health, although central to treatment adherence, remains the great absentee from care. Community organisations such as Vivre Positif and Think Positive try to fill this gap by offering listening, support groups, peer education and social support. But their resources are limited, dependent on unstable funding and the goodwill of a handful of trained professionals.
Faced with this reality, the National Program is stepping up initiatives: strengthening voluntary counselling and testing centres, developing three-year strategic plans with the support of UN agencies, information campaigns in schools and universities, and e-learning tools for teachers. Its stated objective is to raise the level of knowledge in the population while reducing stigma and improving the rights of people living with HIV.
On 1 December, the red ribbon reappeared on social networks, T-shirts and official podiums. It recalls the three letters of a virus which, in Lebanon, no longer makes headlines but continues to circulate in the gaps of a weakened system. AIDS itself can be treated. What remains hardest to heal are fear, judgement and silence. The real frontline now lies there: in a society’s ability to offer every person living with HIV not only free treatment, but also the right to live without hiding.X
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