The region has one of the world's lowest infection rates in the world - 0.3 percent of adults - and yet there is concern among HIV/AIDS agencies that governments are not doing enough to contain the disease.

According to the Joint U.N. Programme on HIV/AIDS (UNAIDS) figures for 2007, there were 380,000 people living with HIV in the region.

Sudan has by far the biggest epidemic in the region - with an estimated 320,000 people living with HIV in 2007.

The virus is spreading in several countries including Algeria, Iran, Libya, and Morocco.

In many countries the virus has not yet moved from high risk groups - intravenous drug users, men who have sex with men, and sex workers - into the general population. But experts at the World Health Organisation (WHO), UNAIDS and the World Bank say evidence from other regions shows this is probably just a question of time unless governments act soon.

There is some controversy over how to tackle the epidemic. Some experts blame Islamic beliefs both for perpetuating stigma and preventing access to information about the disease.

The World Bank says some pamphlets about the virus do not even mention condoms as a method of prevention. Social mores also mean governments are more likely to ignore the disease.

In 2003 the World Bank warned that "the region's governments are overconfident in the protective effects of social and cultural conservatism". This overconfidence, combined with lack of data about the virus' spread means many governments give HIV/AIDS a low priority.

But many experts also say Islam has actually prevented the spread of HIV because of its promotion of abstinence until marriage, and fidelity.

Also, "low alcohol intake and male circumcision may account for this low prevalence," says Carla Makhlouf Obermeyer, a scientist with the WHO's HIV/AIDS department.

In some countries there is little data. Egypt, Jordan and Syria, for example, have focused their attention on screening blood donors and pregnant women, but there are few figures available on how widespread the virus is among high risk groups, according to the World Bank.

Other countries, such as Algeria, Bahrain, Iran, Kuwait, Lebanon, Libya, Morocco, Oman, Yemen and Tunisia, carry out incomplete surveys of high risk groups.

Another factor that could spread the virus is migration - Egypt alone has 3 million migrant workers, most of them working in Gulf countries.

And basic prevention programmes - steps such as condom promotion - are largely absent in the region.

Although unprotected sex is the main means of transmission in most of the region, UNAIDS says that injecting drug use is the main form of transmission in Iran and Libya. Dirty needles have caused the majority of new infections among men in Libya since 2000.

In 2003 the World Bank estimated that relatively cheap prevention programmes - increasing condom use and expanding access to safe needles for injecting drug users - could save the region the equivalent of 20 percent of today's GDP over the next 25 years.

Without these, costs may rise to 35 percent of today's GDP as increasing mortality reduces the labour force and productivity, investment falls and health expenditure rises.

Treatment in the Middle East and North Africa lags far behind other regions. Only 7 percent of the 100,000 people needing anti-retroviral (ARV) therapy were receiving it at the end of 2007. This figure is very low compared with sub-Saharan Africa where 30 percent of a much larger number of patients receive ARV drugs.

The Iranian government is one of the few in the region to take the epidemic seriously.

It has publicised both the extent of the epidemic and the urgent need to control its spread.

It has also passed laws to protect the rights of people with HIV and reduce the social stigma attached to the illness. As recently as 2001, workers could be fired from their jobs for being HIV-positive, and doctors and hospitals could refuse to treat AIDS patients.

School children now learn about the virus as a standard part of their health curriculum, and couples applying for marriage licences receive information on how to protect themselves from the disease.

Iran's programme for injecting drug users inside and outside prisons is considered a global best practice model by UNAIDS - injecting drug use is the main form of transmission in Iran, according to the agency.

The government runs needle exchange programmes in high drug-use areas of Tehran, syringes are now available over the counter in many chemists and there are drug treatment centres across the country. These centres also provide food and shelter, employment, HIV/AIDS screening and treatment and family counselling.

But there is still a lot of work to do. A survey of male injecting drug users who attend drug treatment centres in the capital, Tehran, found that most of them were sexually active but only half had ever used a condom.