ObjectiveTo collect baseline measurements of HIV and syphilis prevalence and sexual risk behaviours among men who have sex with men (MSM) in Agadir and Marrakech, Morocco, and provide strategic information to improve outreach programmes.Methods and DesignRespondent-driven sampling was used to recruit men who reported having anal sex with another man in the last 6 months, aged 18 years and older and living in either Agadir or Marrakech for the past 6 months, regardless of nationality. Data were analysed with the multiplicity estimator using respondent-driven sampling analysis tool V.6.0.Results323 MSM in Agadir and 346 in Marrakech were recruited into the survey. Most MSM in both cities reported being < 25 years, being unemployed, bisexual and in a couple with both a man and a woman. Most reported selling sex and having sex with women. HIV prevalence was 5.6% in Agadir and 2.8% in Marrakesh; syphilis was 7.0% in Agadir and 10.8% in Marrakesh. Among MSM who tested positive for HIV, 31.6% in Agadir and 56.4% in Marrakesh were co-infected with syphilis.ConclusionsHIV and syphilis findings coupled with high risk activities indicate the need for expanding programmes targeting MSM throughout Morocco. Selling sex and sex with women may be a strategy to cope with extreme stigma towards MSM. Criminalisation and discrimination of MSM in Morocco underscores the urgent need for long-term and sustainable risk reduction through legal reforms and promotion and protection of human rights.

Background HIV-related stigma and discrimination constitute a barrier to different intervention programs. Unlike external stigma, internal stigma is not well explored in in the Middle East and North African countries, while grasping this particular form of stigma is essential to limit its effects. The present study aims to measure internal stigma effects and to identify factors associated with this kind of stigma not yet documented among people living with HIV (PLHIV) in Morocco. Methods The PLHIV Stigma Index questionnaire (adapted and translated into French and Moroccan Arabic dialect “darija”) was used to collect information regarding the stigma and discrimination experienced by PLHIV across 8 cities in Morocco (September–October 2016). A randomly drawn cluster of 10 PLHIV, consisting of 5 men and 5 women, was drawn at each participating medical care center to achieve a nationally representative sample of PLHIV. Fifteen interviewers living with HIV and five supervisors were selected and trained to administer the questionnaire. An internal stigma score (range: 0–7), was calculated based on seven negative feelings/ beliefs. Negative binomial regression was used to identify characteristics associated with the internal stigma score. Results Among 626 PLHIV, internal stigma was reported by 88.2%. The median [IQR] internal stigma score was 4 [2–5]. Regarding internal stigma, 51% avoided going to the local clinic when needed and 44% chose not to attend social gatherings. Belonging to at least one key population (aIRR [95%CI] = 1.15 [1.03; 1.28]), experiencing discriminatory reactions from family following HIV status disclosure (1.28 [1.11; 1.49]), avoiding HIV services for fear of stigmatization by staff (1.16 [1.05; 1.28]) and being denied health services because of HIV status (1.16 [1.03;1.32]), are among the factors significantly associated with an increase of the internal stigma score. Conclusions Internal stigma is high among Moroccan PLHIV and significantly impacting their life decisions and their healthcare access. Multi-level interventions are needed to address internal stigma experienced by PLHIV in Morocco.

The objective of the present study was to determine the factors independently associated with disclosure of seropositivity to one's steady sexual partner in people living with HIV (PLHIV) who are recipients of services provided by Association de Lutte Contre le Sida, a Moroccan community-based organization (CBO) working on AIDS response. Between May and October 2011, 300 PLHIV were interviewed about their sociodemographic and economic characteristics, their sexual life and disclosure of their serostatus to their friends, family and to their steady sexual partner. A weighted logistic regression was used to study factors associated with serostatus disclosure to one's steady sexual partner. We restricted the analysis to people who declared they had a steady sexual partner (n = 124). Median age was 36 years old, 56 % were men and 62 % declared that they had disclosed their serostatus to their steady sexual partner. The following factors were independently associated with disclosure: living with one's steady sexual partner [OR 95 % CI: 9.85 (2.86-33.98)], having a higher living-standard index [2.06 (1.14-3.72)], regularly discussing HIV with friends [6.54 (1.07-39.77)] and CBO members [4.44 (1.27-15.53)], and having a higher social exclusion score [1.24 (1.07-1.44)]. Unemployment (as opposed to being a housewife) was negatively associated with disclosure [0.12 (0.02-0.87)]. Despite the potential positive effects for the prevention of HIV transmission and for adherence to HIV treatment, many PLHIV had not disclosed their serostatus to their steady sexual partner. Some factors shown here to be significantly associated with such disclosure will help in the development of future support interventions.

informal credit-based arrangements -and were recruited using snowball and location-based methods in October-December 2010. We used successive logistic regression models to explore determinants of HIV infection among women reporting venue-based sex work (e.g. bars -includes women recruited onsite) and women reporting non-venue based sex work. Results HIV prevalence was significantly higher in venue SW compared to non-venue women (55.5% vs. 41.9%, p < 0.01). Numbers of clients reported were low, but more venue SW reported 2 or more clients in the last fortnight (38% vs. 7.6%, p < 0.01); consistent condom-use during commercial acts was similar (60% and 68%, p > 0.1). More venue SW reported ever travelling away from where they live to sell sex (27% vs. 12%, p < 0.01), initiated sex work earlier (age 25 vs. 28 years, p < 0.01), and sold sex for longer (6 vs. 5 years, p < 0.05). Factors associated with HIV infection were type of sex work (aOR: 2.2, 95% CI: 1.3-3.8 vs. non-venue), and SW not requesting condom-use (aOR: 3.0, 95% CI: 1.15-7.85), after controlling for basic demographic differences. Conclusion Venue SW were more likely to be HIV-positive than non-venue women, although in both groups HIV prevalence was substantial, and consistent condom use low. High risk of HIV among women not requesting condom use highlights the importance to renew prevention efforts in this population. The results emphasise the need to understand SW more broadly.Using ResPondent-dRiven samPling to estimate Hiv and syPHilis PRevalence among Female sex WoRkeRs in agadiR, Fes, Rabat and tangieR, moRocco

BackgroundTruck drivers constitute an important bridging group in the HIV epidemic in Morocco. This study examined the effect of a community-based educational intervention in Morocco on HIV testing and counseling, in representative samples of truck drivers before (2007) and after (2012) the intervention.MethodsFace-to-face structured interviews, adapted from UNAIDS documents, collected data on socio-demographic characteristics, HIV testing and counseling, and HIV risk behaviors in both the 2007 and 2012 surveys. Information about exposure to the intervention was also collected in the latter. Individuals exposed to the intervention were compared with those unexposed (i.e. unexposed in 2012, and all the 2007 pre-intervention sample).ResultsThe 2012 group included 459 men with a median [IQR] age of 38 [31–44] years, 53% of whom reported exposure to the educational intervention. The percentage of participants tested for HIV and receiving HIV counseling in the last 12 months, was significantly higher in the 2012 group (29.6% vs 4.3% in 2007). Data from the 2012 survey confirmed a significant positive trend between being HIV tested and receiving counseling and the number of times a participant was exposed to the intervention (once: (OR = 5.17(2.38-11.25)), twice or more (OR = 19.16(10.33 - 35.53)). These results were confirmed after adjustment for employment, knowledge that the HIV test results would remain confidential, inconsistent condom use with occasional partners or sex workers, and when including individuals from 2007 considered unexposed.ConclusionsCommunity-based educational interventions targeting truck drivers can be effective in increasing coverage of HIV testing and counseling, particularly if they are repeated and cover a considerable portion of this at-risk population. These results are encouraging for other countries which urgently need to implement prevention interventions for most-at-risk populations. Furthermore, they clearly show the power of community-based organization interventions in settings where resources for HIV prevention remain limited.