XVI International AIDS Conference Toronto 2006 HIV Prevention Challenges Facing MSM in the Middle East and North Africa: an NGO Perspective Othoman MELLOUK Association de Lutte Contre le Sida MOROCCO

Regional Context Majority of muslim countries Sexuality is taboo Homosexuality is illegal (3 to 6 months prison sentence in Morocco) Homophobia, stigma and discrimination No legal recognition of sex-work No « gay community » as such like in western countries Majority of reported AIDS cases due to heterosexual transmission Lack of specific epidemiological data on HIV and MSM

The unfavourable socio-cultural context didn’t refrain ALCS from setting up a specific HIV prevention program for male sex-workers and other MSM since the early 90s Male sex work beeing = the visible tip of the Iceberg  MSM activists in the ALCS started the program in 1993 Study of “characteristics of male sex work” carried out in 1993 supported by UNAIDS

Results of the study Lack of awareness High multiplicity of sexual partners (1 to 30 per week) High frequency of anal sex (97%) Low use of condoms (57% never used a condom or did exceptionnally) Powerless in negociating safer sex practices with clients Precarious economic situation High level of violence in the cruising areas Non acceptance of homosexuality and low self estime.

Objectives Impowerment of the community Ensure access to adapted information, condoms and lubrificants Ensure access to VCT, STI and HIV care Psychological and social support Improvement of self estime Impowerment of the community

Strategy Involvement of the MSM community in the design of the program Outreach work based on peer education, regular presence in the cruising areas, Non judgement attitude Program implanted in 4 cities (Casablanca, Marrakesh, Tangier and Agadir)

Methodology Outreach work by peer educators Free access to condoms, lubrificants, information booklets Thematic discussions sessions and auto support groups Free STI clinics and anonymous VCT Workshops, and peer education trainings Conviviality parties, excursions…

Difficulties Police harrassment Violations of HR (testing by the police) Violence on the field Attacks from some media Lack of structures relating defending the SW Financial ressources: program stopped in Tangiers and Agadir

How the ALCS faced these difficulties Advocacy, training of journalists, judges, lawyers, police students Communication in the media Denounciation of HR violations and testing by the police Involvement of HR NGOs Advocacy with Ministries of Health, Justice and Home Office

Scaling up of MSM prevention program thanks to: Recent development of the Moroccan policy on HIV/AIDS The Global Fund Grant Extension of the program to 4 new sites (8 in total)

Recent developments in the HIV/AIDS policy in Morocco High political commitment 2002: MSW and MSM listed by MOH as target vulnerable groups More recently, commitment of the Ministry of Justice, Home Office and the police Sidaction Maroc, december 2005

Global Fund grant at Round 1 Unviersal acces to HAART in 2003 Creation of new VCT centers Recruitment of a coordinator and new outreach workers Availability of condoms and lubrificants Extension of the MSM program to 4 new sites: Tanger, Agadir, Essaouira, Tetouan

New Regional dynamic Regional MSM workshop in 2004 and 2005 at Casablanca Supported by Alliance MSM from Lebanon, Morocco, Algeria, Tunisia Similar program emerging in Lebanon, Algeria, Tunisia 2 new sites in Morocco supported by the Alliance Regional networking meeting in October 2006 in Morocco with the Alliance

From april 2005 to march 2006 16 767 contacts on the field 4336 SW attented educational sessions and workshops at the ALCS 851 HIV tests realised 100 000 condoms distributed as well as lubrificants

Keys of success Gay designed, gay owned and gay ruled program Unconditional respect of ethics, non judgment, and Human Rights Extreme discretion at start Large recongnition at international level Strong and continuous advocacy at all levels Financial support of the GFATM

Conclusion In spite of the unfavourable socicultural and religious context, such programs are possible in the MENA region with the condition of a participatory and communautary approach with full involvement of the MSM and total respect of Human Rights principles. SAY NO TO CRIMINALIZING HIV TRANSMISSION

Contacts: o.mellouk@menara.ma www.alcsmaroc.org