Morocco

Alliance linking organisation: Association Marocaine de Solidarité et Développement (AMSED)

Morocco ranks 125th of the 177 countries in the UN human development index, with 20% of the population living in poverty. Unemployment is estimated at around 19%. Adult literacy rates are very low at 50.7%, with women having by far the lowest levels. Intense migration towards urban centres has led to the emergence of shanty towns in the peripheries of larger towns, attracting sanitation, education and employment challenges to local governments.

Current estimates suggest that the number of people living with HIV has now reached 18,000. The adult prevalence rate is 0.1%, although assessments of the epidemic are inconsistent. The main modes of transmission are heterosexual sexual intercourse (82%) followed by homosexual transmission (8%). More than half of the HIV cases reported are in the regions of Greater Casablanca, Souss Massa Draa and Marrakech Tensift El Haouz.

HIV prevalence rates are increasing, especially among younger people and women, groups that are particularly vulnerable, as poverty in Morocco increases.

Increasing levels of sexually transmitted infections (STIs) also indicate high levels of unprotected sex and relatively high rates of sexual partner exchange among certain population groups (such as sex workers, seasonal workers and youth). Sharing of needles by injecting drug users is an emerging mode of HIV transmission. HIV prevalence rates in prison populations in Morocco are also considerably higher than the national average at 0.6%.

Morocco is increasingly used by migrant populations from other countries of Africa as a staging post on their attempts to reach Europe. These populations are often in extremely vulnerable situations. Weak knowledge of HIV transmission and sexual health, stigma, poverty, casual employment, illiteracy and internal as well as external migration are all driving the HIV epidemic. Discriminatory attitudes towards the most vulnerable groups to the epidemic mean that work reaching out to them has so far been limited.

While the Ministry of Health has started to set up services for treatment and diagnosis of STIs across the whole country, these services are not widely accessed for a number of reasons, including physical distance, lack of trust in public services, lack of money to pay for prescribed treatment, and the stigma associated with such clinics.

In the past five years, the national response to HIV has been strengthened considerably, including the recognition of the value of civil society involvement to ensure successful HIV prevention and care interventions. In 2002, the National Aids Programme (NAP) developed a National Strategic Plan for AIDS and ensured the involvement of many actors. Testing and treatment is offered free of charge by the government.

What we do

The Alliance has supported a focused prevention programme in Morocco since 1996 to reduce STI/HIV transmission by strengthening the capacities of community-based organisations and share information, training and institutional support.

Since 1997, the Alliance’s linking organisation AMSED has provided financial and technical support to 35 community-based organisations to carry out over 60 community STI/HIV prevention projects in locations across Morocco. Currently AMSED’s HIV/STI programme directly funds nine non-governmental and community-based organisations (NGOs and CBOs) through joint Comic Relief and Gates Foundation funding, as well as 12 partners supported through a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. All of these programmes share thematic and development approaches. The Global Fund and Solidaridad Internacioal Andalucia are amongst AMSED’s other main partners.

AMSED’s main strategy is to work on strengthening and supporting NGO/CBO partners to implement HIV/STI prevention and behaviour change activities for marginalised populations including men who have sex with men, sex workers, prisoners, mobile and migrant populations, single mothers, illiterate women, young people and STI service users.

AMSED’s approach is twofold. Firstly, to develop a comprehensive package of services and to make them more key population-friendly and accessible through advocacy initiatives. Secondly, to develop and promote an integrated approach of HIV/STI prevention activities into mainstream development and educational programmes, to reduce stigma and discrimination. Peer educator-led focused group discussions and community activists are the main drivers of the participatory approach AMSED has adopted in its work.

Morocco is also one of the countries taking part in the Alliance’s North Africa and Near East regional prevention programme with men who have sex with men (funded by USAID). This is through a collaboration with AMSED and the Association de Lutte Contre le SIDA.

What we have achieved

AMSED’s programme has improved referral systems between partner NGOs and local health services, with a focus on key populations, which has in turn led to an increase in referrals and demands for testing.

AMSED has made significant efforts to develop new partnerships, by leading participatory community assessments to identify and select new organisations. Involving key populations has been central to the development of prevention projects to meet the needs identified in the assessments.

AMSED has been driving prevention work with vulnerable populations, focusing on training and working with peer educators from key populations. It has particularly focused on working with sex workers, developing focused information, education and communication materials, and carrying out needs assessments and skills training. It has also strengthened the organisational capacity of partners in monitoring and evaluation, documentation, peer education, reporting and external communication, and onward technical support.

AMSED has been working to support the development of linkages to local inter-sectoral committees (Comités Régionaux Intersectorials). There has been a noted increased visibility and presence of AMSED’s HIV department as a national and regional leader in HIV prevention, demonstrated by its participation in the development of the new National Strategic Plan for Morocco 2006-2010.

AMSED has also been supporting the development of the national Moroccan AIDS network and its integration into the regional network. It has also been sensitising local mechanisms such as the CRI about the needs of sex workers and increasing their involvement in these mechanisms.

On a broader development platform, AMSED has been a keen advocate for the promotion of the integration of HIV into development issues through sharing of experiences, lessons learnt and future plans.

Future plans

The Alliance’s future work in Morocco will continue to support the organisational development of its linking organisation AMSED, and support them in their expansion and consolidation as the leading civil society response to HIV at a national and regional level. Strengthening key populations’ participation in local and national responses, as well as developing policy work around focused prevention with key populations, will be key elements of this scale up.

Work will continue institutionalising and strengthening referral systems and linkages to improve coordination with service delivery centres and ensuring accessibility to key populations. Reducing stigma and discrimination will be a key part of this.

Priority will also be given to learning and sharing lessons with other Alliance partners, ensuring the overall process, methodology, tools, lessons and impact are appropriately documented and communicated.