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What’s next for Morocco?

FRRE01 – Managing Change in the Middle East and Northern Africa. What’s next for Morocco? . M. Karkouri Association de Lutte Contre le Sida Morocco. Background. Morocco : low HIV prevalence with evidence of concentrated epidemic among Key Populations

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What’s next for Morocco?

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  1. FRRE01 – Managing Change in the Middle East and Northern Africa What’s next for Morocco? M. Karkouri Association de Lutte Contre le Sida Morocco

  2. 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

  3. Epidemiology • Prevalence : 0.15%General Population • Evidence of a concentratedepidemics : • FSWs : 5.8% • MSM : 5.6% • PWID : 11,4-25% • 31,000 estimated cases of HIV infection, 30% only identified • Female : 49%

  4. A ‘successful’ HIV response • Early response (started in 1988) • Highly active Civil Society and Community • High level political commitment • Comprehensive range of services • Significantscale-up of response (HTC, Care) • Significant capacity improvement for HIV research (“Know your epidemic”)

  5. 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

  6. Hostile legal and socio-cultural context • Religious and conservative society model • Lawscriminalizingsexwork, homosexuality and drug use • Contextshared by the countries of the MENA Region

  7. 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

  8. Criminalization of same-sexrelationships in the MENA Region

  9. Criminalization of sexwork in the MENA Region

  10. 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

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

  12. Low uptake of HIV Testing and Counseling % of Key populations undertaking HTC after contact withprevention services ALCS data

  13. Is Morocco missing opportunities? • New constitution adopted in 2011 • Voicescalling for removing punitive laws (drug use, adultconsentingsamesex) • Expertise and capacityacquired, reliable data generated • Veryadvanced Civil Society • International donors support

  14. Potential threats • Sustainability of actions • Quality of services provided • Financial hardship (domesticexpenditure : 55%) • Non faith-basedNGOs limitative policy (underdebate) • Humanrightsinfringement

  15. What’s next? • Healthsector and communitystrengthening • Law revision and removal of structural barriers to services • Genderequality and humanrightsprioritization • Capacity of innovation

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