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What’s next for Morocco?

M. Karkouri

Association de Lutte Contre le Sida

Morocco

FRRE01 – Managing Change in the Middle East and Northern Africa

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Background

• Morocco : low HIV prevalence with evidence of concentrated epidemic among Key Populations

• Diversity in the landscape of HIV (stakeholders, funders, dynamics of the epidemic)

• Often quoted as a “model” in the MENA Region

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Epidemiology

• Prevalence : 0.15% General Population • Evidence of a concentrated epidemics :

• FSWs : 5.8%• MSM : 5.6% • PWID : 11,4-25%

• 31,000 estimated cases of HIV infection, 30% only identified

• Female : 49%

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A ‘successful’ HIV response

• Early response (started in 1988)• Highly active Civil Society and Community• High level political commitment• Comprehensive range of services • Significant scale-up of response (HTC, Care)• Significant capacity improvement for HIV

research (“Know your epidemic”)

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But barriers to accessing and using services…

• Overall weak Health Sector

• High prevalence of stigma and discrimination

• Social judgment, prejudice and stereotypes against PLHIV and Key Populations

• Women living with HIV may be doubly or triply stigmatized

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Hostile legal and socio-cultural context

• Religious and conservative society model

• Laws criminalizing sex work, homosexuality and drug use

• Context shared by the countries of the MENA Region

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Key Populations are the core drivers of the HIV epidemic

• FSWs and clients, MSM and PWIDs :

– 66% of the total HIV incidence

– 6% of the total adult population

• FSWs + clients + stable sexual partners of the clients 50% of new HIV infections/year

• MSM + PWIDs 20% of HIV incidence/year

Mumtaz GR, et al. Sex Transm Infect 2013;89:iii49–iii56. doi:10.1136/sextrans-2012-050844

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Criminalization of same-sex relationships in the MENA Region

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Criminalization of sex work in the MENA Region

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People Who Inject Drug

• Harm reduction services being implemented (NSP, OST) but scale-up needed

• Access to care is limited (Hep C)

• Extreme vulnerability and overlapping risks

• Counter-productive punitive laws and policies

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People Who Inject Drug• HIV prevalence = 11,4%• HCV prevalence = 73%

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Low uptake of HIV Testing and Counseling

Year MSM FSW

2009 5.2% 9.7%

2010 9% 8.7%

2011 7.6% 9.5%

2012 6.5% 10.9%

2013 9.6% 10.6%

% of Key populations undertaking HTC after contact with prevention servicesALCS data

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Is Morocco missing opportunities?

• New constitution adopted in 2011

• Voices calling for removing punitive laws (drug use, adult consenting same sex)

• Expertise and capacity acquired, reliable data generated

• Very advanced Civil Society

• International donors support

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Potential threats

• Sustainability of actions

• Quality of services provided

• Financial hardship (domestic expenditure : 55%)

• Non faith-based NGOs limitative policy (under debate)

• Human rights infringement

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What’s next?

• Health sector and community strengthening

• Law revision and removal of structural barriers to services

• Gender equality and human rights prioritization

• Capacity of innovation