Transcript Powerpoint

FRRE01 – Managing Change in the Middle East and Northern Africa
What’s next for Morocco?
M. Karkouri
Association de Lutte Contre le Sida
Morocco
www.aids2014.org
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
www.aids2014.org
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
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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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Stigma and discrimination in
Health Care settings in Morocco
Overall S&D
40%
Neglect, delayed care
14%
Denial of care
20%
Disclosing HIV status
27%
without consent
Testing without informing
30%
More prevalent in non-HIV Care Centers
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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%
Already incarcerated
82% (1 - 30
times, mean : 4
times)
Police violence and police harassment
87%
Discrimination by Health Care
Professionals
50%
Family and environmental rejection
32%
Victims of narco-trafficking networks
61%
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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 services
ALCS 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
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