1. HIV prevalence and risk behaviours among MSM in
Abstract Number: TUPE358
Morocco: Can prevention programs do better to ensure
universal access to prevention?
Results from a community-based research among MSM in Morocco
N. Rafif1,2, L. Ouarsas3, A. Abadie1, M. Karkouri4, O. Mellouk1,5, K. Alami6, A. Bennani7, H. Oumzil8, B. El Omari9, L. Johnston10
1-ALCS, Association de Lutte contre le Sida, Marrakech, Morocco, 2-CSAT MENA, Marrakech, Morocco, 3-ALCS, Agadir, Morocco, 4-ALCS, Casablanca, Morocco, 5-ITPC North
Africa, Marrakech, Morocco, 6-UNAIDS Morocco, Rabat, Morocco, 7-National AIDS Program, Rabat, Morocco, 8-National Institute of Health, Rabat, Morocco, 9-Global Fund, Rabat,
Morocco, 10- UNAIDS, Amsterdam, The Netherlands
Background USE OF CONDOM DURING SEXUAL INTERCOURSES
Agadir Marrakesh
o Morocco : low prevalence country (< 0,1%) with concentrated
 used condom with last client 59% 31.3% p=0.026
epidemic among MARPS
 received condoms /last year 84% 63.1% p=0.001
- Prevalence in Agadir among Female Sex workers : 5,1% always uses condoms/past 6 months 27.6% 17.4%
- Prevalence among Injected Drug Users in Nador: 37% Never uses condoms with male anal 26.7% 62.7%
o HIV infection is a socio-cultural taboo sex partners/6 months
o MSM : highly stigmatized, hard-to-reach and understudied
population in Morocco, expected to practice sexual behaviors at LUBRIFICANT USE DURING ANAL INTERCOURSE
high risk for HIV and other STIs  Compared to Marrakesh, Agadir MSM reported higher percentages of
o "ALCS" [Association de Lutte Contre le Sida] : CBO, providing in lubricant use during anal intercourse (39.5 vs. 79.2%, p< 0.001)
Agadir and Marrakech, Morocco, social/health
intervention/prevention programs to MSM HIV TESTING
o In 2010-2011,the first behavioural/biological surveillance survey Agadir Marrakesh
conducted among MSM in Marrakech & Agadir knows where to get an HIV test 57.7% 27.9% p=0.001
Had an HIV test 47.6% 82.6%
Received HIV test results at testing 93.9% 99%
Received post-test counseling 95.1% 77.6%
Marrakesh
Agadir PREVALENCE IN MARRAKECH AND AGADIR
Agadir Marrakesh
HIV prevalence 5.6% 2.8%
Syphilis prevalence 7% 10.8%
Methods ! Differences non significant
• Respondent-Driven Sampling used to sample 346 MSM in Co-infection HIV-Syphilis :
Marrakech and 323 MSM in Agadir
 31.6% (CI. 9.1%, 69.7%) in Agadir
• Partners of the study : ALCS /UNAIDS Country Office/ Ministry of  56.4% (0.1%, 87.9%) in Marrakech
Health/National Institute of Health/ Global Fund Unit in Morocco/
Researcher
•Recruitment of Males aged ≥18 who reported having had anal sex
Conclusion
with another male in the past six months and having lived in either
Agadir or Marrakech for the past six months, regardless of
nationality.  Compared to Marrakech, higher percentages of MSM
• 669 MSM completed a behavioral questionnaire and were tested in Agadir use condoms, lubricants, and know where to
for HIV and syphilis get tested for HIV
• Data were analysed with the multiplicity estimator using RDS
Analysis Tool V.6.0. and estimates and comparisons of estimates  Nevertheless, MSM in both cities practice numerous
between cities were calculated with adjustments to differential behaviors that put them at high risk for HIV and other
network sizes and homophily infections
Results  Given the current HIV prevalence found among MSM
SOCIO-DEMOGRAPHIC CHARACTERISTICS in this survey, coupled with low condom use, an
The median age in Agadir was 21 years and in Marrakech 22 increase in HIV and other infections transmission is
 Most MSM reported their sexual orientation as Bisexual (67.3% unavoidable without the scale up and upgrade of the
Agadir; 69.8% Marrakech), followed by Homosexual/Gay/Transvestite existing MSM services
(25.1% Agadir, 21.0% Marrakech)
50% of MSM in both cities were unemployed
The majority of MSM in both cities reported attending secondary (or
professional) school
More than 90% reported being single as opposed to married or
divorced, and more than a quarter reported being in a stable
relationship with a man
 Few MSM reported being in a stable relationship with a woman (7.6%
Agadir; 12.3% Marrakech).