Association de Lutte Contre le Sida XIX International AIDS

Association de Lutte Contre le Sida
XIX International AIDS Conference
22 – 27 juillet 2012
Washington DC - USA
1
Présentations orales
2
Dimanche 22 juillet 2012
Dimanche 22 juillet, 10:00 – 17:00, Workshop on HIV infection in the MENA
Region
Intervention de Pr Hakima Himmich:
HIV testing and treatment in the MENA region – the case of Morocco
Update on HIV testing and treatment in MENA region: the case of Morocco.
H. Himmich
Moroccan context. HIV prevalence in Morocco remains low in the general population
(0,14%) and the estimated number of PLHIV is 28 000. However there is a concentration of
the epidemic in MARPS (HIV prevalence is 5% among female sex workers, 5.7% among MSM
and 7 to 22.5% among IDUs). HIV testing is not mandatory and has to be performed by
physicians.
Description. Despite the repressive laws, the Association for Fighting AIDS (ALCS)
implemented, in close partnership with the Ministry of Health, the 1st ever NGO-run
anonymous and free VCT site of the MENA Region in 1992, strongly targeting MARPS and, in
2004, HIV rapid testing in mobile VCT. ART was introduced in 1999 at Casablanca, in 2003 it
was decentralized and available, free of charge, to all PLHIV with less than 300 CD4/mm3.
CD4 count and viral load are available. Thanks to ALCS lobbying efforts, a comprehensive
package care has been implemented, including ART, treatment of opportunistic infections,
educational therapy and psychosocial support.
Results. In 2011, VCT is mainly provided through NGOs in 52 VCT sites and 8 mobile units,
with a good acceptability. However, the number of tests (57567, of which 85% by ALCS)
remains insufficient. As a consequence, 50% of the diagnosis occurs at a late stage and only
10% of PLHIV know their HIV status. Accordingly, knowledge of HIV status is considered as
the major obstacle to access to treatment. By the end of 2011, 4.047 PLHIV were receiving
ART, in 9 specialized centers with a coverage rate estimated at 40%. Actually, all people
eligible to treatment receive it without any discrimination and regardless of their behaviors.
Educational program and psychosocial support are also available to all in need
Next steps. To scale up HIV testing and access to treatment, ALCS is advocating to clear nonphysicians to perform testing and general practitioners to deliver ART. ALCS is also trying to
advocate for the ban of MARPS' repressive laws.
3
Lundi 23 juillet 2012
Lundi 23 juillet, 12:30 – 13:45, Session “HIV funding in the MENA Region” in
the MENA Networking Zone
Intervention de Madame Fouzia Bennani
Mobilisation de fonds, société civile.
Lundi 23 juillet, 14:30 – 16:00, session “Drug Policy, Criminal Justice, and
Human Rights”
Human right as a key component of harm reduction strategy targeting people using drugs
in Morocco
H. Himmich1, O. Maguet2, M. Essalhi3, C. Caldéron2, R. Alaoui Hasnouni4, A. Kandil5
1
Association de Lutte Contre le Sida (ALCS), Casablanca, Morocco, 2CCMO Conseil, Paris,
France, 3RDR Maroc, Tanger, Morocco, 4Association de Lutte Contre le Sida (ALCS),
Tétouan, Morocco, 5Association de Lutte Contre le Sida (ALCS), Nador, Morocco
Background : Morocco is facing a rising HIV epidemic among people using drugs (PUD). HIV
prevalence among PUD ranks from 7% to 38% according to recent studies as HIV prevalence
in general population is estimated to be 0.1%. This major change in epidemic pattern led
Moroccan stakeholders to pay more attention to PUD. A first national harm reduction (HR)
strategic plan (2008-2011) has allowed some needles and syringes programs as well as
methadone for 80 people out of other HR services. But PUD are facing legal and social
barriers acting as potential barriers for access to HIV prevention, care and treatment.
Country is in need to assess those barriers in order to design a more comprehensive
approach to mitigate and reverse HIV among PUD.
Method : National HIV/AIDS community based organization ALCS has managed a cross
sectional study in 3 North cities. 300 PUD recruited through outreach programs were asked
to answer a questionnaire including 9 questions designed to assess human right violation
from police officers, health professional and closed environment. Human right violation was
defined as a break in national endorsed civil rights or break in national health good practices.
Results : 99.8% of PUD have been victims of at least one of those 9 violations with following
sub scores: 87% from police officers (eg. non legal custody) and 49% from health
professional (eg. non access to emergency hospital units). 60% has faced situation closed to
human exploitation with drug smugglers or other PUD (including sexual intercourse against
drug). Family environment is also a major cause of human right violations.
4
Conclusion : Human right should be considered as a central component of HR interventions
in Morocco. At a time the country is designing HR scaling up it could improve PUD access to
health services and alleviate family burden.
Mercredi 25 juillet 2012
Mercredi 25 juillet, 18:30 – 20:00, Robert Carr Memorial Lecture: Getting to
Zero Bullshit: Calling HIV-related Stigma what it is: Racism, Classism,
Misogyny, Homophobia, Elitism
Intervention de Dr Othman Mellouk:
Men who have sex with men
Jeudi 26 juillet 2012
Jeudi 26 juillet, 12:30 – 14:00, Global Fund Networking Zone, session
francophone
Intervention de Nadia Rafif:
Réponses appuyées par des exemples sur :
-
les approches en Afrique du Nord pour financer la santé ;
-
les pistes à explorer en Afrique du Nord et au Moyen Orient pour amener les pays à
contribuer au financement de santé et à la reconstitution des ressources du Fonds
mondial.
Jeudi 26 juillet, 16:30 – 18:00, Symposia session « ''The future of HIV
prevention, health and human rights in gay, other MSM and transgender
communities: towards more effective approaches with ICTs in a Web 2.0
world.''”
Intervention de Pr Mehdi Karkouri :
Using ICT solutions to reach MSM in Morocco
5
-
Jeudi 26 juillet, 16:30 – 18:00, session “Out in the World: Global MSM HIV
“Epidemics”
Men who have sex with Men and the HIV Epidemic in Morocco: Results from a
respondent-driven sampling study
O. Mellouk1,2, K. Alami3, H. El Rhilani3, N. Rafif1, A. Abadie1, L. Ouarsas4, A. Bennani5, B. El
Omari6, I. Oumzil7, L. Johnston8
1
ALCS, Marrakech, Morocco, 2ITPC North Africa, Marrakech, Morocco, 3UNAIDS Morocco,
Rabat, Morocco, 4ALCS, Agadir, Morocco, 5PNLS, Rabat, Morocco, 6Fonds Mondial, Rabat,
Morocco, 7INH, Rabat, Morocco, 8UNAIDS, Amsterdam, Netherlands
Background: HIV prevalence in the general population in Morocco is below 1%. There is
currently no reliable data documenting HIV among men who have sex with men (MSM) in
Morocco. This population is hard to reach due to social stigma, discrimination and the illegal
status of male-to-male sex in Morocco. From November 2010 to March 2011, two integrated
behavioural and biological surveillance (IBBS) surveys were conducted (Marrakech, Agadir),
among MSM in Marrakech and Agadir to obtain measure HIV and syphlis prevalence and
associated risk behaviors.
Methods: Using Respondent-Driven Sampling (RDS), 669 MSM (346 in Marrakech and 323 in
Agadir) were enrolled in the study. Respondents were males aged 18 and above who
reported to have had anal sex with another male in the past six months. Consenting MSM
completed a behavioral questionnaire and were tested for HIV and syphilis (venous blood).
Weighted analysis was performed with Respondent Driven Sampling Analysis Tool (RDSAT)
Version 6.0
Results: The median age of sexual debut for MSM was at 16 years. HIV prevalence among
MSM in Agadir was 5.6% and 2.8% in Marrakech; prevalence of syphilis was 7.0% in Agadir
and 10.8% in Marrakech. Among MSM who tested positive for HIV, 31.6% in Agadir and
56.4% in Marrakech were co-infected with syphilis. MSM reported multiple types of sexual
partners, including occasional and commercial. Only 27.6% of MSM in Agadir and 17.4% of
MSM in Marrakech reported always using a condom with any male partner during anal sex in
the past six months.
Conclusions: MSM are at a high risk for HIV and other sexually transmitted diseases. Current
prevalence of HIV in MSM is higher than the general population. These findings provide
appropriate evidence to support the focus on addressing HIV among MSM in the National
Strategic Plan 2012-2016 on HIV of Morocco.
6
Présentations affichées
(Posters)
7
Mardi 24 juillet 2012
Mardi 24 juillet 2012, 10:00 – 18:30, Category: Behavioral and social
research on risk reduction interventions
HIV prevalence and risk behaviors among MSM in Morocco - Can prevention programs do
better to insure universal access to prevention for MSM?
N. Rafif 1,2, 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, 2CSAT MENA, Marrakech,
Morocco, 3ALCS, Agadir, Morocco, 4ALCS, Casablanca, Morocco, 5ITPC North Africa,
Marrakech, Morocco, 6UNAIDS Morocco, Rabat, Morocco, 7PNLS, Rabat, Morocco, 8INH,
Rabat, Morocco, 9Fonds Mondial, Rabat, Morocco, 10UNAIDS, Amsterdam, Netherlands
Background: The ALCS is the sole organization in Agadir and Marrakech, Morocco, providing
social/health intervention/prevention programs to MSM. MSM, a highly stigmatized, hardto-reach and understudied population in Morocco, are expected to practice sexual behaviors
which put them at high risk for HIV and other infections. In 2010-2011,
behavioural/biological surveillance surveys were conducted among MSM in Marrakech and
Agadir
Methods: Respondent-Driven Sampling was used to sample 346 MSM in Marrakech and 323
MSM in Agadir. Males aged ≥18 who reported having had anal sex with another male in the
past six months completed a behavioral questionnaire and were tested for HIV and syphilis.
Estimates and comparisons of estimates between cities were calculated with adjustments to
differential network sizes and homophily.
Results: Overall, 50% of MSM in both cities were unemployed, >50% self-identified as
bisexual, 65% received money for sex during the last 6 months and had a median age of 22.
Compared to Marrakesh, Agadir MSM reported higher percentages of condom use with last
client (31.3 vs. 59%, p=0.026), lubricant use during anal intercourse (39.5 vs. 79.2%, p<
0.001), receiving condoms during the last year (63.1 vs. 84%, p=0.001) and knowing where to
get tested for HIV (27.9 vs. 51.7%, p=0.001). Compared to Marrakech, HIV prevalence among
MSM in Agadir was higher (2.8 vs. 5.6%), syphilis was lower (10.8 vs. 7%); however, these
differences were not significant.
Conclusions: Compared to Marrakech, higher percentages of MSM in Agadir use condoms,
lubricants, and know where to get tested for HIV. Nevertheless, MSM in both cities practice
8
numerous behaviors that put them at high risk for HIV and other infections. Given the
current HIV prevelance found among MSM in this survey, coupled with low condom usage,
an increase in HIV and other infections transmission is inevitable without the scale up of
exisiting MSM services.
Mercredi 25 juillet 2012
Mercredi 25 juillet 2012, 10:00 – 18:30, Category: Seropositivity: social
identity, disclosure and vulnerability
Do women disclose their HIV-status more than men? Results from a community-based
research among PLHIV in Association de Lutte Contre le SIDA, Morocco
A. Abadie1, M.K. Hilali2, M. Loukid2, E. Henry3, J. Otis4, M. Karkouri5, N. Rafif1, H. Himmich5,
L. Ouarsas6, M. Préau7
1
Association de Lutte Contre le SIDA, Marrakech, Morocco, 2University Cadi Ayyad,
Laboratoire d'Ecologie Humaine, Marrakech, Morocco, 3Coalition Plus SIDA, Paris,
France, 4Université de Québec à Montréal, CREcES, Montréal, Canada, 5Association de
Lutte Contre le SIDA, Casablanca, Morocco,6Association de Lutte Contre le SIDA, Agadir,
Morocco, 7Université de Nantes, LABECD, Nantes, France
Background: In Morocco, a low prevalence Muslim country, HIV infection remains a
sociocultural taboo. PLHIV suffer from high rates of stigma, leading to difficulty to disclose
their HIV-status. This seems particularly the case for women. However, no scientific data on
this issue are available to date.
Methods: A mixed (researchers/NGO) and international research consortium developed a
research program to study serostatus disclosure to inform policies and propose suitable
interventions. A standardized questionnaire was developed. Data were collected on
serostatus disclosure, HIV/AIDS representations and treatments and on psychological
construct, between May and October 2011 among a sample of PLWHIV in contact with
community organizations involved in the project.
Documenting gender patterns of HIV disclosure, using the chi square test was one of our
specific objective.
Results: In Morocco, 300 PLHIV enrolled in the study. 57% were female, 39% male and 4%
transgender. 76% have disclosed their status, essentially with their regular sexual partner
(W: 55%; M: 65%; p < 0.48). Women were more likely to disclose with female family
members: mother (51%), sister (45%) versus father (15%), brother (16%) and to ask for
assistance to disclose (W: 12%; M: 8%; p < 0.18). Both men and women (89%) considered
disclosure risky but more women asked their relatives to keep their HIV-status secrete (W:
9
82%; M: 60%; p < 0.001) and felt the "need to hide” it (W: 91%; M: 84%; p < 0.09). Moreover,
47% of women who disclosed considered it was a mistake (vs M: 22% ; p < 0.004).
Conclusions: Women are less likely to disclose their HIV-status and feel more vulnerable
after disclosure. The sociocultural and religious context may explain this situation. Disclosure
is an important issue regarding prevention, care and stigma. The results of this study need to
be used to develop a comprehensive and gender-oriented approach of disclosure programs.
10
Participations aux sessions, satellites,
ateliers ou autres
11
Mercredi 25 juillet 2012
Mercredi 25 juillet, 14 :30 – 16 :00, Regional Session on Middle East and
North Africa: Getting HIV and AIDS Down to Zero in the Arab States
-
Participation de Nadia Rafif : Point person de la session
-
Participation de Dr Othman Mellouk : Co-speaker
Thème: Best practices and innovation
Jeudi 26 juillet 2012
Jeudi 26 juillet, 14:30 – 16:00, session « The Global Fund: The next 5 years”
Participation de Nadia Rafif : Speaker de la session
12