Background The Middle East and North Africa (MENA) continues to be perceived as a region with limited HIV epidemiological data. The objective of this work was to review and synthesise for the first time all available data related to HIV in Lebanon, in order to assess the status of the epidemic in this country and provide the basis for future interventions, prevention, and research needs.

Methods A comprehensive systematic review of HIV and risk behaviour studies in Lebanon was undertaken. Sources of data included (1) PubMed using a strategy with both free text and MeSH headings, (2) country-level reports and databases including governmental and non-governmental organisations publications, and (3) international organisations reports and databases.

Results Available data indicate that HIV prevalence among the high risk groups ranged between 0 and 3.6% among men who have sex with men (MSM), 0 and 3.9% among injecting drug users (IDUs), and 0%–0.3% among female sex workers (FSWs). HIV prevalence in the general population was very limited (∼0%). Analysis of HIV notified cases indicated a substantial recent increase in the contribution of male same-sex sex, whereby 52% of notified cases in 2008 were due to MSM transmission compared to 13% in the cumulative period until 2008. Substantial levels of risk behaviour were reported by the three high-risk groups. MSM reported an average of 9.5 sexual partners in the last year and up to 36% engaged in male sex work. Seventeen to 65% of IDUs shared needles/syringes, 33%–47% had sex with FSWs, 17%–33% engaged in sex work, and 24.7% reported male same-sex sex. FSWs reported an average of 11.7 sexual partners per week. Despite relatively high levels of risk behaviour, condom use in Lebanon was high and among the highest in the MENA region, so were the levels of knowledge of HIV/AIDS and of its modes of transmission. Molecular epidemiology evidence indicated a diverse HIV subtype distribution suggesting multiple exogenous introductions of the virus.

Conclusions The evidence gathered in this review indicates that HIV endemic transmission appears to be still limited in Lebanon with most diagnosed cases representing exogenous exposures. There are however few indications suggesting an emerging epidemic among MSM. HIV surveillance of high-risk groups needs to be actively expanded in Lebanon to track such potential emerging epidemics and prevent further HIV transmission among population groups at high risk of HIV infection.