Introduction

Despite global progress in HIV prevention and treatment, individuals in the Southwest Asia and North Africa (SWANA) (also known as the Middle East and North Africa (MENA)) region¹ continue to face structural and social barriers that limit their access to timely diagnosis and sustainable care. Legal restrictions, stigma, and discrimination surrounding HIV and key populations have created a climate of fear that dissuades many from seeking in-person testing or treatment. As a result, early detection rates remain low, and continuity of antiretroviral therapy (ART) is often disrupted. In this restrictive context, digital health technologies present an emerging and transformative opportunity to bridge the gap between local communities and essential HIV services.

Digital platforms—such as telemedicine, encrypted counseling applications, and home self-testing tools—have proven effective in expanding confidential access to healthcare in other regions, including North America and Europe.² These tools allow individuals to test privately, receive professional guidance remotely, and access treatment or psychosocial support without exposure to stigma or social risk. Applying similar models in the SWANA/MENA region would provide alternative, secure channels for early HIV detection and long-term management, particularly in environments where mobility, privacy, and legal protection are limited.

Integrating digital health within existing community and civil society frameworks offers an added advantage: it empowers local organizations to deliver HIV services that are safe, rights-based, and user-centered. By leveraging encrypted communications, remote diagnostics, and virtual follow-up systems, digital solutions can help build sustainable care pathways that preserve confidentiality and enhance public health outcomes. This paper explores how digital innovations can be adapted for the SWANA/MENA region to enable rapid, stigma-free access to HIV testing, treatment, and support services, laying the groundwork for technology-driven, comprehensive health equity.

Background

Throughout the SWANA/MENA region, national responses to HIV still primarily rely on facility-based testing and treatment models. Most countries—including Morocco, Tunisia, Lebanon, Egypt, and Sudan—operate through national AIDS programs coordinated with the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).³ Testing and treatment services are delivered through public health centers, specialized clinics, and community outreach, often supported by non-governmental organizations like the Association de Lutte Contre le Sida (ALCS) in Morocco or the Society for Inclusion and Development in Communities and Care for All (SIDC) in Lebanon.

While these programs have made progress in awareness, diagnosis, and ART provision, early detection remains constrained by social stigma, confidentiality concerns, and geographical barriers. In conservative or politically sensitive settings, individuals—especially from key populations such as men who have sex with men (MSM), female sex workers (FSWs), or migrants—often avoid testing for fear of exposure or discrimination. These dynamics have contributed to delayed diagnosis rates and persistent transmission gaps, undermining regional progress toward the UNAIDS 95-95-95 targets.

In contrast, regions like Europe and North America have demonstrated the transformative potential of digital health tools in overcoming these barriers. Telehealth consultations, encrypted chat-based counseling, and online platforms guiding users through self-testing procedures have proven effective in promoting confidential, stigma-free testing. In the United Kingdom, for example, national e-health programs enable individuals to order self-test kits online, access virtual one-on-one consultations, and receive medical guidance for follow-up, ensuring a continuum of care from diagnosis to treatment.⁴ These models have expanded coverage and normalized testing behaviors, particularly among marginalized groups.

The absence of such digital interventions in the SWANA/MENA region represents a missed opportunity. With high smartphone penetration rates and growing digital literacy, SWANA/MENA countries are uniquely positioned to integrate technological responses to HIV into their health strategies. Digital platforms can complement existing community systems, offering discreet, accessible, and scalable alternatives for early detection and treatment adherence. Adopting such models will not only advance progress toward global HIV targets but also foster greater health resilience and inclusivity regionally.

Globally, the rapid development of digital health tools has revolutionized HIV prevention, testing, and treatment services, helping countries move significantly closer to achieving the UNAIDS 95-95-95 targets.⁵ These goals aim for 95% of people living with HIV (PLHIV) to know their status, 95% of those diagnosed to receive sustained antiretroviral therapy (ART), and 95% of those receiving ART to achieve viral suppression.⁶ In recent years, digital platforms, mobile health (mHealth) applications, and online self-testing systems have emerged as effective mechanisms to overcome the barriers of stigma, distance, and confidentiality that previously limited early diagnosis and treatment continuity.

Evidence from Europe, North America, and parts of Asia illustrates how digital HIV services enhance reach and impact. For example, the national e-health testing system in the UK enables users to order HIV self-test (HIVST) kits online, receive virtual guidance, and access follow-up consultations, strengthening every stage of the healthcare cascade—from diagnosis to treatment adherence. Similarly, studies from the United States and Thailand show that digitally supported self-testing, combined with encrypted counseling and text-based reminders, significantly increases testing frequency and retention in care.⁷ These interventions have proven particularly effective among key populations who often face discrimination in traditional clinical settings, such as MSM, migrants, and sex workers.

For the SWANA/MENA region, these global lessons are especially relevant. Despite commendable progress in expanding facility-based HIV services, the region still struggles with low testing coverage and delayed diagnosis due to social stigma, legal restrictions, and inequities in access to care.

The integration of digital channels—such as telemedicine, confidential e-counseling, and self-test distribution platforms—can directly contribute to advancing the region’s alignment with the 95-95-95 targets. By enabling discreet, user-controlled access to testing and subsequent care, digital innovations can engage individuals who are currently outside the formal health system.

Furthermore, the SWANA/MENA region possesses a robust digital infrastructure, widespread smartphone penetration, and a growing youth demographic familiar with online health-seeking behaviors—all favorable conditions for implementing such models. Adopting technology-enabled HIV strategies will not only enhance early detection but also strengthen data-driven surveillance, improve treatment adherence, and ensure confidential, stigma-free engagement with health services. Consequently, aligning national programs with these digital approaches can play a critical role in achieving the WHO 95-95-95 vision and building a more inclusive and resilient public health system across the region.

Methodology and Research Design

This study adopts a qualitative policy and case study approach, combining desk research with an analysis of digital health applications in comparable contexts. The primary objective is to explore the potential of digital solutions to support early detection, treatment, and follow-up for people living with HIV in the SWANA/MENA region.

Data Collection: Information was gathered from multiple sources, including: (1) peer-reviewed literature on digital health interventions for HIV and decentralized telemedicine applications; (2) policy documents and guidelines from the WHO, UNAIDS, and national AIDS programs in SWANA/MENA countries; (3) technical white papers on digital infrastructure, including the IPFS system, permissioned blockchain, and federated messaging protocols (Matrix and Signal); and (4) case studies from high-income countries (e.g., UK, Bulgaria) that have implemented self-testing services, telemedicine, and encrypted counseling. The focus was on collecting evidence linking digital solutions to improved access, confidentiality, and community engagement in HIV care.

Data Analysis: The collected data underwent thematic analysis, identifying recurring patterns in digital health design, security measures, and governance strategies. A comparative analysis was applied to assess the transferability of global lessons to the SWANA/MENA context, considering local constraints such as political instability, social stigma, and fragmented health infrastructure. The analysis also integrated ethical and privacy considerations, highlighting participatory governance and community ownership as key enablers for the adoption of these solutions.

Case Study Selection: Morocco and Lebanon were selected as primary case studies due to the availability of comprehensive HIV program data and active national AIDS programs aligned with WHO guidelines. Secondary attention was given to Sudan and Syria to examine the potential applications of digital solutions in fragile or conflict-affected settings, demonstrating how telemedicine and decentralized platforms can extend access to vulnerable populations.

Research Design Rationale: This approach focuses on policy relevance and practical feasibility, aiming to inform both civil society organizations (CSOs) and health bodies. By combining technical analysis with contextual insights, the methodology supports the development of a secure, decentralized, and culturally-attuned digital health framework that addresses the operational and ethical challenges of implementing HIV care solutions in the SWANA/MENA region. The design also provides a basis for recommendations and a scalable roadmap for regional adoption.

Case Study: Digital Channels and the HIV Response in the SWANA/MENA Region – Morocco, Lebanon, Sudan, and Syria

In the SWANA/MENA region, where silence and stigma often dominate the discourse on HIV, some nations are beginning to move forward, building digital bridges between people and healthcare services that once seemed out of reach. From Morocco to Lebanon, and indirectly to Sudan and Syria, this case study explores how digital tools can create secure and sustainable access channels for HIV testing, care, and treatment.

Morocco: Where Hope Begins

In Morocco, the implementation of HIV self-testing (HIVST) has become a key entry point for increasing testing coverage among populations most affected by stigma or fear. A 2024 study by the WHO Regional Office for the Eastern Mediterranean (EMRO), “Acceptability and feasibility of HIV self-testing distribution modes among key populations in Morocco,” found high acceptance rates among key populations—90.2% among female sex workers, 86.2% among men who have sex with men, and 80.4% among partners of PLHIV.⁸

Crucially, between 44% and 73.4% of these individuals had never tested for HIV before, demonstrating that HIVST is successfully reaching those most isolated from traditional services.

Another study published in BMC Public Health confirmed the high usability of oral fluid-based HIV self-tests, with 92.2% of MSM participants describing them as “very easy to use.” However, usability was slightly lower among female sex workers, especially those with limited literacy levels.⁹

Although Morocco’s HIVST initiative has not yet become a fully comprehensive digital system (diagnosis, then remote counseling, follow-up, and treatment), it represents a critical foundation. This experience has utilized digital communication channels for ordering kits and information, distribution in pharmacies and communities, and remote counseling via telephone and e-support networks.

This hybrid model—combining e-guidance, peer support, and community follow-up—shows that even limited digital integration can significantly reduce barriers to testing and disclosure in conservative environments.

Lebanon: Resilience Through Collaboration

Lebanon offers a second, complementary example of how HIV services can be sustained through digital adaptation and civil society partnerships amidst crises. The National AIDS Program (NAP), in collaboration with community-based organizations (CBOs), has maintained access to prevention, testing, and treatment services by combining in-person and remote support.

According to the “Progress towards the 95-95-95 targets to end HIV by 2030 in Lebanon” report (2023), approximately 86% of PLHIV in Lebanon were aware of their status, 93% of whom were receiving treatment, and 95% of those on treatment had achieved viral suppression.¹⁰ Despite economic collapse, electricity shortages, and political instability, CBOs collaborated with the NAP to maintain continuity of care—often by coordinating appointments, providing counseling, and following up with patients via mobile or online platforms.

While Lebanon does not yet have a formal, encrypted telehealth system for HIV, the adaptive use of digital channels—messaging apps, confidential phone calls, and online education—has helped maintain service delivery when physical access is cut off. This experience demonstrates that hybrid digital-community models can be both resilient and inclusive, even amid infrastructure and resource instability.

Sudan and Syria: The Urgent Humanitarian Need

In Sudan, where conflict has decimated healthcare systems, the need for alternative, decentralized service delivery is urgent. The ongoing war has destroyed hospitals, disrupted medication supply chains, and displaced millions. According to UNAIDS, access to the national ART storage center became unavailable during the conflict, cutting off life-saving medication for thousands. Before the war, approximately 11,000 people were receiving HIV treatment, many of whom have lost access due to health facilities being destroyed or abandoned.¹¹

The WHO EMRO profile on Sudan highlights the crisis: HIV services remain severely disrupted, and community outreach has become nearly impossible in conflict-affected areas.¹² In such circumstances, digital tools are not an option, but a survival mechanism. Even simple connectivity (like SMS, basic phone consultations, or encrypted messaging) enables health workers to coordinate medication deliveries, share prevention information, or remotely track patient adherence.

Syria presents a similar, if less documented, picture. Over a decade of conflict has led to widespread damage to healthcare infrastructure and internal displacement. Data on HIV prevalence and service access is scarce, but humanitarian assessments consistently show gaps in diagnostic capacity, social stigma, and loss to follow-up. In regions like Syria and Sudan, digital health interventions—if locally developed and community-driven—can reconnect people to life-saving services despite the instability.

Regional Reflection: Designing for Connection and Dignity

In the SWANA/MENA context, where social stigma, restrictive laws, and fragmented health systems continue to impede HIV testing and treatment, a new approach is needed—one that preserves dignity while expanding access. The proposed SWANA/MENA Digital HIV Care Framework envisions a secure, fully digital pathway for early detection, counseling, and treatment, inspired by successful models in the UK and Bulgaria, but adapted to local realities.

This framework begins with confidential self-testing: Individuals can discreetly order an HIV self-test kit through a trusted digital platform, supported by national AIDS programs and local civil society partners. Kits are delivered in unmarked packaging, ensuring privacy and accessibility, especially for groups fearing stigma or exposure. Once the test is received, users can access step-by-step digital instructions—via video, chatbot, or encrypted text consultation—on how to perform it safely.

After performing the test, individuals are invited to connect via one-on-one encrypted tele-counseling with certified counselors or community health specialists. These consultations are not just medical but also psychosocial, helping individuals process the results, understand the next steps, and receive an immediate link to care if needed. For those diagnosed with HIV, the platform ensures continuity of support, integrating telemedicine follow-ups, treatment adherence reminders, and access to mental healthcare, all within a digital environment that prioritizes safety, consent, and confidentiality.

A core element of this framework is its decentralized, encrypted database, designed to protect user data while enabling the collection of comprehensive insights for national AIDS programs and WHO partners. This model allows both governments and CSOs to collaborate without compromising individual privacy—a critical feature in contexts where disclosure can have severe social consequences.

Implementing this model would accelerate the SWANA/MENA region’s progress toward the WHO 95-95-95 targets: ensuring 95% of PLHIV know their status, 95% of those diagnosed receive sustained ART, and 95% of those on treatment achieve viral suppression. By digitizing the HIV care cascade—from testing and counseling to treatment and support—the SWANA/MENA region can move from reactive, facility-based systems to proactive, comprehensive, and human-centered care. This transformation will not only strengthen health systems but also affirm the principle that every individual, regardless of their location or stigma, deserves connection, dignity, and access to life-saving care.

Digital Infrastructure, Security, Governance, and Data Sovereignty in e-Health Systems for HIV in the SWANA/MENA Region

Building an effective and trustworthy digital HIV care system in the SWANA/MENA region requires more than technological innovation; it demands an infrastructure rooted in resilience, privacy, and community control. This framework rests on four interconnected pillars: decentralized digital architecture, robust security, participatory governance, and community data ownership.

1. Decentralized and Interoperable Infrastructure

A resilient e-health system for HIV must minimize reliance on single points of failure. Instead of centralized servers, data and communications can be distributed across peer-to-peer networks. Technologies like the InterPlanetary File System (IPFS) allow patient records to be stored and shared in encrypted form across a distributed network, ensuring no single entity can alter or delete data without a trace. IPFS has been successfully used in archiving humanitarian data and protecting health records, offering low-cost resilience even in areas with connectivity challenges.¹³

To ensure data integrity, these storage systems can be integrated with a permissioned blockchain, such as Hyperledger, which records verifiable metadata (like hashes and timestamps) for each file stored on IPFS.¹⁴ This hybrid model—Hyperledger + IPFS—supports a tamper-resistant audit trail, while allowing sensitive data to remain encrypted and off-chain.¹⁵ This configuration enables local clinics, NGOs, and ministries to validate data authenticity without exposing the underlying medical data.

2. Secure Communications and Zero-Trust Architecture

Privacy protection is not an afterthought; it must be designed into every layer. A Zero-Trust model assumes no device or node is inherently trustworthy, requiring continuous authentication and encryption for all interactions.

Communications across this ecosystem can be powered by the Matrix protocol, an open standard for end-to-end encrypted, federated messaging. In this model, each organization—for example, a regional HIV clinic or a civil society network—hosts its own “Matrix homeserver,” ensuring data sovereignty while maintaining interoperability with others. Matrix uses encryption frameworks like Olm and Megolm, derived from the Signal protocol, to ensure only intended recipients can access messages or files.¹⁶

By using these open-source, peer-reviewed protocols—Signal, Matrix, and their derivatives—the system maintains confidentiality even under surveillance or network compromise. This is particularly vital in the SWANA/MENA region, where stigmatization and criminalization can put PLHIV at social and legal risk.

3. Ethical Governance and Accountability

Technology alone is insufficient to guarantee ethical practice. A multi-stakeholder governance council should oversee the digital system, composed of health ministries, CSOs, data protection experts, and representatives from communities living with HIV. This council would set standards for data sharing, approve new functionalities, and review independent security audits.

“Privacy by Design” should be the default: the platform must collect only the minimum necessary anonymized data and require explicit consent for any sharing. Anonymized identifiers (rather than personal names) can be used to protect individuals while maintaining continuity of care.

Building transparent accountability mechanisms—such as periodic reports on system performance, audit results, and community feedback—establishes long-term trust among users, implementers, and donors.

4. Data Sovereignty and Community Ownership

To ensure data sovereignty, health data should be stored locally or regionally whenever possible, under the stewardship of local health authorities or community organizations. When cloud services are necessary, encryption keys should remain in the hands of local entities.

Emerging identity models, such as Self-Sovereign Identity (SSI) and Decentralized Identifiers (DIDs), allow users to manage their own credentials without relying on centralized authentication systems. In practice, this means a person living with HIV can control which parts of their digital health record are shared with any institution and can revoke access at any time.¹⁷

Crucially, affected communities must be involved not just as recipients of services, but as co-designers. Involving PLHIV and local advocacy groups in developing user interfaces, consent protocols, and outreach strategies ensures cultural relevance, practical usability, and ethical legitimacy.

This community-embedded design fosters autonomy and builds resilience against misuse—transforming digital systems from tools of surveillance into platforms for empowerment.

Roadmap and Recommendations for a Digital HIV Care Ecosystem in the SWANA/MENA Region

To accelerate progress toward the 95-95-95 targets in the SWANA/MENA region, a coordinated roadmap is essential, combining technology, community engagement, and policy alignment.

First, establish pilot digital health platforms in Morocco and Lebanon, leveraging lessons learned from the UK and Bulgaria. These platforms should enable online ordering of self-test kits, provide one-on-one encrypted counseling, and offer secure follow-up care, ensuring cultural attunement and user anonymity.

Second, scale the technical infrastructure regionally using decentralized storage (IPFS), permissioned blockchain (Hyperledger), and federated messaging protocols (Matrix + Signal). This combination ensures data integrity, privacy, and resilience, particularly in conflict-affected areas like Sudan and Syria where centralized infrastructure is weak.

Third, institutionalize participatory governance and ethical oversight by creating multi-stakeholder councils comprising health ministries, CSOs, and representatives of PLHIV. These councils should oversee data policies, review security audits, and guide implementation priorities to ensure community trust and ethical legitimacy.

Fourth, promote community ownership and self-sovereign identity systems, enabling users to control access to their health data while maintaining interoperability for clinical and research purposes. Digital literacy and training programs must accompany technology deployment to empower local communities to manage their data securely.

Finally, foster regional knowledge-sharing and evidence-based policy. SWANA/MENA countries should document and disseminate findings from pilots, facilitating cross-country learning and guiding funders, health authorities, and NGOs toward scalable, context-sensitive interventions. This integrated approach aligns with digital health innovations and the WHO 95-95-95 strategy, reduces stigma, improves accessibility, and positions the SWANA/MENA region to achieve measurable gains in HIV detection, treatment initiation, and retention in care.

References

¹ The term “SWANA” (Southwest Asia and North Africa) is used as a geographical and political alternative to “Middle East and North Africa” (MENA), aiming to avoid Eurocentric and colonial-rooted labels and provide a more inclusive analytical framework for the region.

² “Results from INTEGRATE – the EU Joint Action on integrating prevention, testing and linkage to care strategies across HIV, viral hepatitis, TB and STIs in Europe.” BMC Infectious Diseases. Accessed October 28, 2025. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06362-7.

³ “About the programme – AIDS and sexually transmitted diseases.” WHO Regional Office for the Eastern Mediterranean. Accessed October 28, 2025. https://www.emro.who.int/asd/about/.

⁴ “All about HIV | Free HIV Home Testing Kit.” sh.uk. Accessed October 28, 2025. https://www.sh.uk/about-stis/hiv.

⁵ “Self-testing for HIV at home – successful project in Bulgaria.” WHO/Europe. September 18, 2020. https://www.who.int/europe/news-room/18-09-2020-self-testing-for-hiv-at-home-successful-project-in-bulgaria.

⁶ UNAIDS. Global AIDS Update 2023: The Path that Ends AIDS. (Geneva: UNAIDS, 2023). https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023.

⁷ See, for example: “Evidence on Digital HIV Self-Testing From Accuracy to Impact.” JMIR (2025). https://www.jmir.org/2025/1/e63110; also World Health Organization (2024) and Public Health England (2020).

⁸ “Acceptability and feasibility of HIV self-testing distribution modes among key populations in Morocco.” Eastern Mediterranean Health Journal 30, no. 10 (2024). https://www.emro.who.int/emhj-volume-30-2024/volume-30-issue-10/acceptability-and-feasibility-of-hiv-self-testing-distribution-modes-among-key-populations-in-morocco.html.

⁹ “Acceptability and usability of oral fluid-based HIV self-testing among female sex workers and men who have sex with men in Morocco.” BMC Public Health. November 26, 2022. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14632-5.

¹⁰ “Progress towards the 95-95-95 targets to end HIV by 2030 in Lebanon, 2023.” PubMed. https://pubmed.ncbi.nlm.nih.gov/40512690/.

¹¹ “Sudan’s unsung heroes: Protecting people living with and affected by HIV amidst conflict and famine.” UNAIDS. April 15, 2024. https://www.unaids.org/en/resources/presscentre/featurestories/2024/april/20240415_sudan.

¹² “Sudan HIV/AIDS country profile 2020.” WHO Regional Office for the Eastern Mediterranean. Accessed October 28, 2025. https://www.emro.who.int/asd/country-activities/sudan.html.

¹³ “SMART Guidelines.” World Health Organization. Accessed October 28, 2025. https://www.who.int/teams/digital-health-and-innovation/smart-guidelines.

¹⁴ Mani, V., et al. “Patient-Centric IPFS-Based Storage of Health Records.” MDPI Electronics 10, no. 23 (2021): 3003. https://www.mdpi.com/2079-9292/10/23/3003.

¹⁵ Hasnain, M. “The Hyperledger Fabric as a Blockchain framework for securing electronic health records (EHRs) in the healthcare sector.” Journal of Medical Internet Research 25, no. 1 (2023): e10713743. https://pmc.ncbi.nlm.nih.gov/articles/PMC10713743/.

¹⁶ “Is The Matrix app safe?” Linagora. Accessed October 28, 2025. https://linagora.com/en/topics/matrix-app-safe.

¹⁷ World Health Organization. Policy brief on digital health data in HIV services. (Geneva: WHO, 2023). https://www.who.int/publications/i/item/9789240064355.