Using ICT solutions to reach MSM in Morocco

M. Karkouri, M. Harri, O. Mellouk, H. HimmichAssociation de Lutte Contre le Sida, Morocco

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The Context

• Low HIV overall prevalence but concentrated epidemic among Key Populations (MSM)

• Homosexuality is illegal in Morocco by Law 489 (6m to 3y prison and/or 12 to 120 $ fine)

• Homophobia and high level of stigma, violence, police harassment

• Development and diffusion of ICT (mobile phones, internet) lesser recourse to cruising areas

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The MSM Program of ALCS

• ALCS : Community-based organization (1988) with extensive experience working with MSM in Morocco

• MSM Outreach Prevention Program (since 1993) (Gov't approved):– Prevention sessions on cruising areas and in-house– Condom/lube access– Information on HIV, AIDS and STIs– Self-esteem improvement – Psychosocial support and income-generating activities

• Coverage limited to major urban centers3

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The Data

• BBSS Study, MSM, 2010-2011, Agadir & Marrakesh– HIV prevalence among MSM:

• Agadir : 5.6% and Marrakech : 2.8%

– Internet at least once a week : 56% (daily : 19-31%)

– Gay sites at least once a week : 33% (daily : 18%)

– Peferred way to get information about HIV and STIs:

• TV 45.5%• CBOs 26.3%• Internet 15.8%• Press 4.5%• Brochures 3.9%• Radio 3.8%

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The Intervention

• Creation of a profile "Pleasure & Health" on the most popular gay sites (Gayromeo, NRJChat)

• A standard message is sent to users explaining the purpose of our presence and offering to further chat

• Interested persons are invited to switch to "msn" instant messaging

• Conversations are recorded and FAQ are noted in a database allowing very quick answers ("Copy and paste")

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The Services

• Education and information about HIV, AIDS and STIs• Tailored counseling sessions on sexual practices• Discussion about safer sex practices• Reference to HIV Testing and Couseling sites• Promotion of the HIV Hotline • Information on psychological support and other

services offered to PLHIV• Safe space to talk about homosexuality

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The Sexual and Reproductive Health SMS Platform

• "Bilaharaje" ("Be comfortable to ask") program• Partnership : ALCS – OneWorld UK – Butterfly Works

SMS Plateform (started 2011) hosted by ALCS

"On t’écoute" ("We are listening to you") live free talk show airing weekly for two hours with a sexologist answering questions from young people (telephone calls, e-mail, Facebook)

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The Results

Jan-June 2011

July-Dec 2011

Jan – June 2012

Sessions 86 89 102

New contacts 432 562 583

Follow up contacts 120 482 489

Decline 88 89 85

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The Results

Most popular topics

PreventionSexual Prac-ticesStigma & DReligionFamilyViolence and rape

Referrals and orientation

HotlineHTCALCS'websiteHealth ClinicSexual

practices

Prevention

Stigma & Discr.

Religion

Family& Society

Living withHIV

Hotline

HIV Testing& Couns.

ALCS'website

Marrakesh Men's Health Clinic

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The Results

Most popular topics

PreventionSexual Prac-ticesStigma & DReligionFamilyViolence and rape

Referrals and orientation

HotlineHTCALCS'websiteHealth ClinicSexual

practices

Prevention

Stigma & Discr.

Religion

Family& Society

Living withHIV

Hotline

HIV Testing& Couns.

ALCS'website

Marrakesh Men's Health Clinic

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The Lessons learned

• High acceptability (low rate of decline)• Low cost of operations• Safety (for service providers and clients)• Safe space to talk freely about sexual practices (no

face-to-face bias)• Opportunity to scale up service provision• Referral to services more effective

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The way forward

• Formal evaluation of the program needed (change of behaviors)

• Scale up of the service provision• More extensive research to harness the potential of

ICT solutions for targeting MSM