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Rds aids 2012
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  • 1. Men who have sex with men and the HIV epidemic in Morocco:results from a respondent-driven sampling studyO.Mellouk, K. Alami, H. El Rhilani, N. Rafif, A. Abadie, L.Ouarsas, A. Bennani, B. El Omari, H. Oumzil, L, Johnston
  • 2. Context – HIV and MSM in Morocco• Few data exist about HIV in MENA region• Prevalence among the general population is <1% but regional concentrations of the epidemic: Agadir/Marrakech (38% of reported cases)• Epidemiological data about MSM is worrying: sentinel surveillance of HIV (4,4%/2009); ALCS VCT centers (M:2,4%; A: 3,7%/2011)• MoT study -> need to conduct bio-behavioral studies among key affected populations• Homosexuality is criminalized; high-level of stigma
  • 3. Integrated Bio-behavioral surveillance among men who have sex with men using RDS Agadir and Marrakech, Morocco, 2010-2011 Partners: ALCS, NAP, UNAIDS, NIH, GF• Eligibility: – Males who reported having anal sex with another man in the last six months – Aged 18 years and older – Lived in either Agadir or Marrakech for the past six months• Biological specimens – HIV – Syphilis
  • 4. Objectives• To measure – key socio-demographic characteristics – alcohol and drug use – knowledge of and attitudes towards HIV/AIDS – attitudes of stigma and discrimination towards people living w/HIV – STI occurrence and treatment-seeking behaviors – knowledge of and access to prevention services• To strengthen national research capacities• To develop recommendations to guide programs and expand services
  • 5. RDS study in Morocco
  • 6. Sampling AGADIR MARRAKECHN= 323, 10 seeds (blue squares) and N= 346, 8 seeds (grey squares) and 23 12 waves waves
  • 7. Socio-demographic variables
  • 8. Alcohol and Drug Use Variables
  • 9. General Sexual Risk Behavior
  • 10. Active and Passive Anal Sex
  • 11. Commercial Sex
  • 12. Condom use with occasional and regular sex partners
  • 13. Sexual risk with female sex partners
  • 14. HIV Testing
  • 15. HIV and Syphilis PrevalenceAmong MSM who tested positive for HIV, 31.6% in Agadirand more than 55% in Marrakech were also co-infectedwith syphilis
  • 16. Findings• Concentrated HIV epidemic among MSM in Agadir and potential spread of Syphilis• MSM are young, mostly unemployed and single• High risk alcohol and drug use practices• Few MSM are injecting drugs• Most MSM have sex with females• High levels of risky sexual behaviors• Condom use is more frequent for passive/receptive sex compared to active/penetrative sex
  • 17. Findings (2) (data not shown)• Most MSM never discuss HIV/AIDS or STIs with any partners• Low knowledge of STIs• Inconsistent knowledge about HIV• MSM tolerant of people infected with HIV• MSM who get tested get their test results• Low lubricant usage
  • 18. Recommendations• Scale up programs to provide targeted HIV outreach/services to MSM to control the further spread of HIV• Revise MSM programs in accordance with the results of the study and WHO guidelines• Ensure access to condoms and lubricants• Systematic screening for STIs (which are unrecognized by MSM) should be integrated into programs providing services to MSM
  • 19. Recommendations• Develop specific services to work with MSM living with HIV• Increase outreach efforts/policy changes, including decriminalizing and reducing stigma related to male-to-male sex• Modify policy that only medical doctors can provide pre- and post-test HIV counseling
  • 20. Acknowledgements (alphabetical order) Alise Abadie, Association de Lutte Contre le SIDA, Marrakech, Maroc Kamal Alami, UNAIDS, Rabat, Maroc Rachid Amri, Global Fund, Rabat, Maroc Aziza Bennani, National AIDS program, Rabat, Maroc Rachid Boudani, Association de Lutte Contre le SIDA, Agadir, Maroc Imad Cherkaoui, National Institute of Hygiene, Rabat, Maroc Elharti Elmir,, National Institute of Hygiene,Rabat, Maroc Boutaina El Omari, Global Fund, Rabat, Maroc Houssine El Rhilani, UNAIDS, Rabat, Maroc Fatimazahra Hajouji, Association de Lutte Contre le SIDA, Agadir, Maroc Mohcin Harri, Association de Lutte Contre le SIDA, Marrakech, Maroc Hakima Himmich, Association de Lutte Contre le SIDA, Casablanca, Maroc Lisa Johnston, consultant Mehdi Karkouri, Association de Lutte Contre le SIDA, Casablanca, Maroc Othman Mellouk, Association de Lutte Contre le Sida, Marrakech, Maroc Lahoucine Ouarsas, Association de Lutte Contre le Sida, Agadir, Maroc Hicham Oumzil, National Institute of Hygiene, Rabat, Maroc Nadia Rafif, Association de Lutte Contre le Sida, Marrakech, Maroc Soumia Triki, National AIDS program, Rabat, Maroc Younes Yatine, Association de Lutte Contre le SIDA, Marrakech, Maroc