Washington D.C., USA, 22-27 July 2012www.aids2012.org
Human rights as a key component of harm reduction strategy
targeting people using drugs in Morocco
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Drug use and Harm Reduction in Morocco Dramatic increase of PUD esp. in North Morocco* Rapid assesment on
HIV risk among PUD in Morocco, Ministry of Public Health
HIV prevalence (7% to 22%) and HCV prevalence (80%) associated to injection route* Prevalence study, MoPH (not published)
MoPH and NGOs have been implementing needles and syringes program (since 2008) and methadone maintenance treatment (since 2010)
On behalf of positive outputs from evaluation of the first national Harm Reduction strategic plan (2008-2011), decision to scale up access to harm reduction services
Washington D.C., USA, 22-27 July 2012www.aids2012.org
The challenge of Human Rights Legal obstacles (including drug use criminalization) are a main
barrier for • Access to care and treatment • Access to prevention and Harm Reduction*Strathdee and all. The
Lancet, 2010 Assumption endorsed at high level:
• Vienna Declaration• Global commission on drug policy*Report of the Global Commission on
Drug Policy, June 2011 Human Rights of people using drugs are neglected despite those
evidences
Need to asses legal and social barriers in Morocco and to design a more comprehensive approach to mitigate and reverse HIV/ HCV infections among PUD ALCS, with the support of OSF, cross sectional study project
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Design Sites: 3 cities of the north of the country (Tangiers, Tetouan, Nador) 10 inquirers recruited among outreach teams and trained Structured questionnaire
• Administred to 300 PUD recruited through outreach programs, in 2011
• 21 questions investigating 4 dimensions: • Sociodemographic profile• Drug use• Inmate story• Human right violations from law enforcement, health professional
and closed environment Data completed with:
• 3 focus groups (one per site) • Individual incident reports collected among PUD (408 reports)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
General profileMen Women Total
Gender 91% 9% 100%
Age 37.3 [18-60] 35.2 [20-52] 37.1 [18-60]
Homeless 31% 11% 29%
Major income source
–Formal activity 4% 4% 4%
–Non formal activity 71% 7% 65%
–Beggars 9% 7% 9%
–Illegal activity 9% 68% 15%
–Family support 7% 14% 16%
Sex work (regular + occasional
8% 96% 16%
Education level=<primary school
62% 85% 62%
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Drug use Heroin: 97% / Two thirds are injecting Injection (any drug)
• in timelife: 81%• last month: 64%
Multiple use: 94%• Cannabis: 84%• Benzodiazepines: 45%• Cocaine: 38%
Alcohol consumption higher among women (39%) than men (13%)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Prison
82% have been incarcerated Average number of prison stays: 4 (1- 30) Life setting (cf. income source) seems play a major role:
26%
41%
33% Only drug offences
Only other offences
Drug offences AND otheroffences
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Human rights violations / Overview
• 9 specific situations were investigated to assess the level of human rights violations– 3 associated to law
enforcement officers behaviors & practices
– 3 associated to health professionals behaviors & practices
– 3 associated to behaviors & practices of people from close environment
• Only 0.6% had never face any of those 9 situations
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Human right violations / Law enforcement officers
83%
65%61%
violence from policeofficers
illegal custody non human rightbased custody
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Human right violations / Health professionals
45%
26%
12%
Barriers to access tohealth system and
professionals
non human rightbased medical
practices
break in confidentiality
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Human right violations / Close environment
9%
60%
14%
Sent by familly inforced detox centre
victim from illegalnetworks
Sex against drugs
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Self perception of people using drugs
« There is no place for us in community except prison or death »
Key words used by PUD:Injuries, physical and psychological violence, rudiness, denial of care and treatment, stigmatization, rape, forced closing, racketeering, denial of basic rights, extortion, etc.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusion This study has clearly assessed violations of human right
among PUD due to the fact they intake illegal drugs
It is worth to raise that this break in basic human rights’ respect are wider that the ones generated by drug offences:• HR violation due to activities generating incomes• Denial of health services• Stigmatization from famillies
Those legal and social barriers counteract with real and enhanced access to harm reduction services in Morocco.National Harm Reduction strategy should include a core
action plan regarding human right issue .
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