HIV in Syria: An urgent call for action amid a collapsed health system and widespread stigma

Dear Editor,

More than a decade of conflict in Syria has resulted in the widespread collapse of health infrastructure, displacement of millions, and the disruption of essential medical services. Yet amid this protracted humanitarian crisis, the issue of HIV remains critically under-recognised and insufficiently addressed. While national reports cite fewer than 1000 HIV cases across the country, this figure likely reflects severe underdiagnosis rather than epidemiological reality. ¹ In contrast, the actual number of cases is several times higher than officially reported, due to limited access to testing, a lack of public awareness, and widespread stigma. ² Routine HIV testing is rare, and many individuals avoid medical care altogether out of concern for discrimination and social exclusion. Investigative reporting has documented systemic mistreatment of people living with HIV (PLHIV), including violations of confidentiality, refusal of care by untrained providers, and the social ostracization of affected individuals. ³ These dynamics have created an environment in which HIV is not only poorly understood but actively suppressed within both the healthcare system and the public sphere, leading many PLHIV to hide their diagnosis—even during surgical procedures—out of fear of discrimination by healthcare providers. These accounts mirror wider reports of systemic stigma that drive people away from the healthcare system and heighten the risk of uncontrolled transmission. Interruptions in ART availability, absence of viral load monitoring, and lack of integrated HIV services further contribute to poor health outcomes and increased risk of transmission. ² Syria’s context of ongoing displacement, economic hardship, and societal breakdown creates a high-risk setting for the spread of HIV. According to UN estimates, more than 6.8 million people are internally displaced, many residing in overcrowded, underserved areas where access to healthcare is minimal. ⁴ These risk factors are exacerbated for marginalized populations, including men who have sex with men (MSM), sex workers, and survivors of sexual violence, who face additional barriers to care and legal protection. ² Despite the considerable emotional and psychological burden faced by PLHIV—stemming from social isolation, discrimination, and trauma—there are no national provisions for sustained mental health or psychosocial support from either former or current health authorities. ⁵ This gap further entrenches suffering and impedes long-term health and social reintegration. The current silence surrounding HIV in Syria presents a serious threat to public health and human rights. A coordinated response is urgently required to expand access to testing and treatment, ensure ART availability, train healthcare workers, and address stigma through public education and policy reform. International actors, including WHO and UNAIDS, must prioritize technical and financial support for a revitalized HIV response in Syria. Failure to act risks entrenching a preventable epidemic and undermining regional and global health security.