HIV and STI service provision in Syria: A study of contradictions

Background: Although Syria remains a low prevalence country for HIV/STIs, rising rates of infection are documented. Many emerging societal factors that preceded HIV/STI outbreaks in other parts of the world are observed. Methods: We conducted interviews with providers in Aleppo Syria to learn about HIV/STI testing and treatment practices. Results: Distinct differences emerged with regard to HIV versus STI testing and treatment, and standard practice in public versus private clinics. HIV confirmatory testing and treatment, conducted by the Syrian National AIDS Program (NAP), adhered to standardized protocols: risk assessment, information provision, and treatment follow-up. High standards of privacy and confidentiality were maintained. STI testing and treatment occurred in private and public clinics. Diagnoses were typically made via clinical observation without laboratory confirmation. Providers described STI test labs as outdated, lacking skilled technicians, and having high rates of false negatives. Public clinics, which served primarily low-income males, followed standardized protocols, including educational counseling, but did not make patient privacy and confidentiality a priority. Protocols in private clinics, which served primarily middle- to upper-income patients of both genders, varied widely and focused on diagnosis and treatment only. High emphasis was given to patient privacy and confidentiality reflecting social stigma concerns, including refusal to adhere to mandated reporting requirements, recording false diagnoses in patient files, and providing misinformation to sexual partners of STI patients. Conclusions: Findings highlight a need for increased connection between HIV and STI services, adherence to standardized testing and treatment protocols, and greater medical privacy in public clinics.