Menahra

Morocco

Although Cannabis followed by sedatives are the most common drugs used in Morocco, in relation to HIV transmission, Heroin and Cocaine are the main drugs that are used by injection (Morocco MoH, 2005; WHO Website). According to the 2004-5 National survey, the current prevalence of substance-related disorders was 2.8% of the population aged more than 15 years (Kadri, et al., 2010) . Various types of treatment services, including out-patient, in-patient and rehabilitation services run by governmental (WHO Website), public and university centers where non-governmental organizations are deeply implicated as management partners of the National Program (CCM Morocco).

In Morocco, HIV prevalence in the general population has remained low, but there are reports of concentrated epidemics among FSWs, MSMs and PWIDs in parts of Morocco (Morocco MoH, 2012). It has been estimated that injecting drug use contributes to less than 6% of HIV epidemics (Morocco MoH, 2012). Studies have been conducted on samples of PWIDs from 2005 to 2011. In recent years, almost all reported high rates of HIV among PWIDs have been from Nador (Morocco MoH, 2012; UNAIDS, 2011a). However, risk behaviors seem to be equally common in all studied areas with low and high HIV prevalence among PWIDs (Morocco MoH, 2012). A modeling study on HIV modes of transmission estimated the national rate of HIV prevalence among PWIDs to be 2%. The incidence rate is predicted to be at 1.07% per person-year, which may result in a future increase in the HIV prevalence to levels as high as 11.3% among PWIDs (Mumtaz, et al., 2010).

The country has recently launched the new 2012-2016 National AIDS Program. Harm reduction strategies have been adopted since 2007 and include NSP as well as condom distribution (Morocco MoH, 2012). Other national plans on drug use and the approved GFATM program also include harm reduction strategies (Morocco MoH, 2006; WHO, et al., 2011; WHO Website). The national plan on harm reduction for PWIDs is part of the national strategic plan on drug use which consists of four main axes: prevention, treatment, harm reduction and rehabilitation. The prevention axis is sustained intensively by WHO. The harm reduction plan, which is also a part of the national strategic plan on HIV, receives assistance from the GFATM, as well as from UNAIDS and UNODC. There are several NSP sites in the country managed by NGOs which are providing PWIDs with hundreds of thousands of needles and syringes per year (Mathers, et al., 2011; Morocco MoH, 2012). However, the coverage and the number of syringes distributed per IDU are very low (Morocco MoH, 2012). MMT was included in GFATM Round 6 proposal which was launched in 2010. Currently three centers, in Tangier, Casablanca and Sale, are providing MMT (Morocco MoH, 2012); This program was evaluated in 2012, and is currently being extended to other sites. The program is expected to spread to 5 other sites before the end of 2016. Centers for Counseling and Testing are widely distributed in the country. These centers provide services to tens of thousands of people every year (Morocco MoH, 2012; WHO, et al., 2011). Several ART centers are also providing services to thousands of PLHIV in need (Mathers, et al., 2011; Morocco MoH, 2012). Arrazi hospital in Rabat has been appointed by WHO as a knowledge hub for promoting harm reduction in the sub-region and has held multiple training workshops on the related subjects(MENAHRA, 2010a). Currently, the centre of Tangiers remains the principal training site for outreach practice and for research on PWIDs (CCM Morocco).

Although Morocco has made significant progress in developing policies and implementing programs for MARPs including PWIDs, coverage still needs to be expanded. The budget available for harm reduction services is highly dependent on external resources, which jeopardizes the sustainability of the services. NGOs need to improve their infrastructure and strengthen their capacities. The services should be widely available and accessible in the country. The areas with low prevalence of HIV among IDU population are susceptible to an outbreak in the future.