1. XVI International AIDS Conference
Toronto 2006
HIV Prevention Challenges Facing MSM in the Middle East and North Africa:
an NGO Perspective
Othoman MELLOUK
Association de Lutte Contre le Sida
MOROCCO

2. Regional Context Majority of muslim countries Sexuality is taboo
Homosexuality is illegal (3 to 6 months prison sentence in Morocco)
Homophobia, stigma and discrimination
No legal recognition of sex-work
No « gay community » as such like in western countries
Majority of reported AIDS cases due to heterosexual transmission
Lack of specific epidemiological data on HIV and MSM

3. The unfavourable socio-cultural context didn’t refrain ALCS from setting up a specific HIV prevention program for male sex-workers and other MSM since the early 90s
Male sex work beeing = the visible tip of the Iceberg 
MSM activists in the ALCS started the program in 1993
Study of “characteristics of male sex work” carried out in 1993 supported by UNAIDS

4. Results of the study Lack of awareness
High multiplicity of sexual partners (1 to 30 per week)
High frequency of anal sex (97%)
Low use of condoms (57% never used a condom or did exceptionnally)
Powerless in negociating safer sex practices with clients
Precarious economic situation
High level of violence in the cruising areas
Non acceptance of homosexuality and low self estime.

5. Objectives Impowerment of the community
Ensure access to adapted information, condoms and lubrificants
Ensure access to VCT, STI and HIV care
Psychological and social support
Improvement of self estime
Impowerment of the community

6. Strategy Involvement of the MSM community in the design of the program
Outreach work based on peer education, regular presence in the cruising areas,
Non judgement attitude
Program implanted in 4 cities (Casablanca, Marrakesh, Tangier and Agadir)

7. Methodology Outreach work by peer educators
Free access to condoms, lubrificants, information booklets
Thematic discussions sessions and auto support groups
Free STI clinics and anonymous VCT
Workshops, and peer education trainings
Conviviality parties, excursions…

8. Difficulties Police harrassment
Violations of HR (testing by the police)
Violence on the field
Attacks from some media
Lack of structures relating defending the SW
Financial ressources: program stopped in Tangiers and Agadir

9. How the ALCS faced these difficulties
Advocacy, training of journalists, judges, lawyers, police students
Communication in the media
Denounciation of HR violations and testing by the police
Involvement of HR NGOs
Advocacy with Ministries of Health, Justice and Home Office

10. Scaling up of MSM prevention program thanks to:
Recent development of the Moroccan policy on HIV/AIDS
The Global Fund Grant
Extension of the program to 4 new sites (8 in total)

11. Recent developments in the HIV/AIDS policy in Morocco
High political commitment
2002: MSW and MSM listed by MOH as target vulnerable groups
More recently, commitment of the Ministry of Justice, Home Office and the police
Sidaction Maroc, december 2005

12. Global Fund grant at Round 1
Unviersal acces to HAART in 2003
Creation of new VCT centers
Recruitment of a coordinator and new outreach workers
Availability of condoms and lubrificants
Extension of the MSM program to 4 new sites: Tanger, Agadir, Essaouira, Tetouan

13. New Regional dynamic
Regional MSM workshop in 2004 and 2005 at Casablanca
Supported by Alliance
MSM from Lebanon, Morocco, Algeria, Tunisia
Similar program emerging in Lebanon, Algeria, Tunisia
2 new sites in Morocco supported by the Alliance
Regional networking meeting in October 2006 in Morocco with the Alliance

14. From april 2005 to march 2006 16 767 contacts on the field
4336 SW attented educational sessions and workshops at the ALCS
851 HIV tests realised
condoms distributed as well as lubrificants

15. Keys of success Gay designed, gay owned and gay ruled program
Unconditional respect of ethics, non judgment, and Human Rights
Extreme discretion at start
Large recongnition at international level
Strong and continuous advocacy at all levels
Financial support of the GFATM

16. Conclusion
In spite of the unfavourable socicultural and religious context, such programs are possible in the MENA region with the condition of a participatory and communautary approach with full involvement of the MSM and total respect of Human Rights principles.
SAY NO TO
CRIMINALIZING
HIV
TRANSMISSION

17. Contacts: