1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Human rights as a key component of harm reduction strategy targeting people using drugs in Morocco

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Drug use and Harm Reduction in Morocco  Dramatic increase of PUD esp. in North Morocco * Rapid assesment on HIV risk among PUD in Morocco, Ministry of Public Health  HIV prevalence (7% to 22%) and HCV prevalence (80%) associated to injection route * Prevalence study, MoPH (not published)  MoPH and NGOs have been implementing needles and syringes program (since 2008) and methadone maintenance treatment (since 2010)  On behalf of positive outputs from evaluation of the first national Harm Reduction strategic plan (2008-2011), decision to scale up access to harm reduction services

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org The challenge of Human Rights  Legal obstacles (including drug use criminalization) are a main barrier for Access to care and treatment Access to prevention and Harm Reduction*Strathdee and all. The Lancet, 2010  Assumption endorsed at high level: Vienna Declaration Global commission on drug policy* Report of the Global Commission on Drug Policy, June 2011  Human Rights of people using drugs are neglected despite those evidences  Need to asses legal and social barriers in Morocco and to design a more comprehensive approach to mitigate and reverse HIV/ HCV infections among PUD  ALCS, with the support of OSF, cross sectional study project

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Design  Sites: 3 cities of the north of the country (Tangiers, Tetouan, Nador)  10 inquirers recruited among outreach teams and trained  Structured questionnaire Administred to 300 PUD recruited through outreach programs, in 2011 21 questions investigating 4 dimensions: Sociodemographic profile Drug use Inmate story Human right violations from law enforcement, health professional and closed environment  Data completed with: 3 focus groups (one per site) Individual incident reports collected among PUD (408 reports)

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org General profile MenWomenTotal Gender91%9%100% Age37.3 [18-60]35.2 [20-52]37.1 [18-60] Homeless31%11%29% Major income source –Formal activity 4% –Non formal activity 71%7%65% –Beggars 9%7%9% –Illegal activity 9%68%15% –Family support 7%14%16% Sex work (regular + occasional 8%96%16% Education level=<primary school 62%85%62%

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Drug use  Heroin: 97% / Two thirds are injecting  Injection (any drug) in timelife: 81% last month: 64%  Multiple use: 94% Cannabis:84% Benzodiazepines:45% Cocaine:38%  Alcohol consumption higher among women (39%) than men (13%)

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Prison  82% have been incarcerated  Average number of prison stays: 4 (1- 30)  Life setting (cf. income source) seems play a major role:

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Human rights violations / Overview 9 specific situations were investigated to assess the level of human rights violations –3 associated to law enforcement officers behaviors & practices –3 associated to health professionals behaviors & practices –3 associated to behaviors & practices of people from close environment Only 0.6% had never face any of those 9 situations

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Human right violations / Law enforcement officers

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Human right violations / Health professionals

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Human right violations / Close environment

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Self perception of people using drugs « There is no place for us in community except prison or death » Key words used by PUD: Injuries, physical and psychological violence, rudiness, denial of care and treatment, stigmatization, rape, forced closing, racketeering, denial of basic rights, extortion, etc.

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusion  This study has clearly assessed violations of human right among PUD due to the fact they intake illegal drugs  It is worth to raise that this break in basic human rights’ respect are wider that the ones generated by drug offences: HR violation due to activities generating incomes Denial of health services Stigmatization from famillies  Those legal and social barriers counteract with real and enhanced access to harm reduction services in Morocco.  National Harm Reduction strategy should include a core action plan regarding human right issue.