|Outreach-Based Prevention in Morocco Among Men Involved in Prostitution (UNAIDS - Best Practice Digest, 2000, 3 p.)|
Extracted from the article 'Outreach-based prevention in Morocco among men involved in prostitution', by Amine Boushaba, Director of Prevention Services and Trainer, ALCS, and Professor Hakima Himmich, Chef de Service, University Hospital Centre Ibn Roth, Casablanca, Lecturer, Department of Medicine, Chairman of the Board, ALCS in the magazine AIDS Infothek, 2000.
In 1993, the Moroccan AIDS Service Organisation launched a process of outreaching men who are involved in prostitution. Prostitution is principally an urban phenomenon but it would be erroneous to view it as solely associated with tourism. There is a form of prostitution among Moroccans themselves which is also important, existing on the margins of that for tourists, and known to exist even in smaller cities.
Homosexuality is seen as deviant in Arabic Muslim societies, and in Morocco it constitutes a crime punishable by three to six months in prison.
In order to have reliable data concerning the behaviour, perception and lifestyle of this population, ALCS (Association de Lutte contre le sida Maroc) initiated an action research project in 1995. The goal was to gather qualitative data and to develop prevention strategies adapted to the needs of the target population.
The principal problems found among the subjects interviewed were:
· A lack of knowledge about AIDS transmission and prevention.
· A large number of partners.
· A lack of skill in negotiating prevention and lower risk sexual practice with clients.
· Precarious living conditions due to economic dependence.
· A high rate of violence taking place where men meet potential clients.
The average age of the first paid sexual contact was 15. Some 38% of the sample practised prostitution only occasionally whereas for 62%, it provided their principle source of income. Some 37% had contact exclusively with Moroccans.
Interventions are essentially based on outreach approaches focused on:
· Peer education. Men from or close to the prostitution scene are recruited to communicate the prevention message to the group.
· An attempt to reach the most marginalised segments of the population through an ongoing presence in the places where men meet and by making use of personal contact.
· Refraining from all moral judgement concerning the men's conduct. Listening to and respecting differences.
The specific interventions are:
· Offering services at the places where men meet.
· Offering services at the offices of the ALCS.
· Organising discussion groups on specific topics.
· Organising social events.
· Providing access to HIV testing.
· Providing access to STD services.
Prevention workers discuss all aspects of HIV/AIDS and other STDs with members of the target group, raising awareness and providing information. Large quantities of condoms, lubricant and information brochures about AIDS are distributed. The workers also accompany men to centres of the ALCS which offer free and anonymous testing.
There is a major obstacle to the prevention work. The police consider the possession of condoms to be proof that illegal prostitution is taking place. Therefore the most committed men prefer not to have large quantities of condoms on them.
ALCS seeks to provide an open ear as well as a place for discussion and psychosocial support. Workers are aware that prevention work of this kind cannot be truly successful unless it attempts to address as much as possible the vulnerability and precarious situations of the men being served. In spite of the difficulties encountered, interventions such as this could surely be replicated in other countries with a similar socio-cultural context. The success of this approach depends on the interventions being implemented so as to maximise participation and community-based input of the population concerned.