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

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

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%

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”)

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

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

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: /sextrans

Criminalization of same-sex relationships in the MENA Region

Criminalization of sex work in the MENA Region

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

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

Low uptake of HIV Testing and Counseling YearMSMFSW %9.7% 20109%8.7% %9.5% %10.9% %10.6% % of Key populations undertaking HTC after contact with prevention services ALCS data

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

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

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