1. Al Borj: listening to the needs of MSM Mohcin HARRI Moroccan Association against AIDS (ALCS)

2. Al Borj: ALCS Marrakesh response to adverse environment for MSM In Morocco, article 482 of the penal code punishes “ “Any person who commits unnatural acts with an individual of the same sex ”. Prevalence among MSM in Marrakesh: 2,8% for HIV and 10,8% for syphilis Low access to needed information High levels of stigma and discrimination Since1995, most services are HIV screening and prevention IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

3. Al Borj: adapted services for MSM Primary objective: Improve access and quality for MSM to services of prevention, care and support. Introduction of the notion of “follow-up care” / “suivi de cas” (codified file) Broadening of care services for MSM: syphilis test, dermatology, proctology, psychosocial consultations, orientation to MSM- friendly private doctors, social aid with a solidarity fund to face health challenges, therapeutic mediation, cultural and friendly activities, legal advise Discussions on good practices and MSM care with the Sexual Health Center “Le 190” in Paris (member of SIS-Réseau). IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

4. How does Al Borj work? The center is open 2 days per week. Multidisciplinary team: 1 host, 1 doctor, 1 psychologist, 2 advisers, 2 therapeutic mediators, 1 lawyer Service provision includes: Assessment of knowledge on the risk of transmission (with the link to HIV/STI and substance abuse, mental health…) Anonymous and confidential testing Individualized care and follow-up plan IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

5. Average age28 Homosexuals46% Bisexuals50% Engage in risky behavior55% present strong substance addiction46% Return rate for HIV testing71% Living with HIV10% Psychological consultations10 % Descriptive Info of Al Borj Clients

6. Reason of visit IAS 2014- Melbourne « Al Borj: listening to the needs of MSM » Screening tests: 55% Psychological support: 16% STI consultation: 12% Overall checkup: 7% Other: 10%

7. Mental health status IAS 2014- Melbourne « Al Borj: listening to the needs of MSM » Anxiety / Depression : 37% Social Isolation: 29% Sexual Abuse / Violence : 28% Family or Social Problem: 3% Interpersonal problem: 3%

8. Limitations Lack of specialized staff (No volunteers) Insufficient funds for care of certain high-cost pathologies (hepatitis screening, HBV vaccine…) Impossible to carry out small surgeries IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

9. Lessons learned The follow-up system allows an individualized and adapted prevention plan Customized approach = taking ownership of their health HIV screening is an entrance door that facilitates prevention Prevalence among clients is higher than the national averages among MSM  The Center grasps the most-at-risk MSM IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

10. The lessons learned (cont.) The broadening of services at the Center alerted on other MSM problems that were previously ignored: violence (sexual abuse, incest), mental health Mental health should not be dissociated from prevention work Individual prevention is more efficient -Change or adaptation according to risk behavior -Integration of new prevention strategies IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

11. Conclusions Al Borj is identified since more than 4 years by priority populations as a service that listens to their needs Al Borj has an efficient method of approaching and retaining MSM through health care The need to reinforce the fight against stigma and discrimination against MSM among regular health providers in the healthcare system IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

12. Next steps Reinforcement of current services Assessing the impact of Al Borj on the MSM community Duplicate the service in other cities of Morocco – mobilizing funds Consortium bringing together other sexual health centers in the MENA region (i.e., Marsa in Lebanon and ATL in Tunisia) IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »

16. Thank you for your attention mohcin.harri@gmail.com IAS 2014- Melbourne « Al Borj: listening to the needs of MSM »