Morocco makes headway against HIV but stigma remains

A member (L) of Morocco's Association for the Fight Against AIDs (known by its French acronym ALCS) talks with patients suffering from AIDS in the infectious diseases department at the Ibn Rochd Hospital in Casablanca on September 12, 2019. (File/AFP)
Updated 28 September 2019

Morocco makes headway against HIV but stigma remains

  • In Casablanca, a group therapy workshop offers HIV patients a rare opportunity to speak openly about their disease
  • Thanks to improved screening, access to treatment and monitoring, new HIV infections in Morocco declined by 42 percent between 2010 and 2016

CASABLANCA: In Morocco, the struggle against HIV has been so successful in recent years that campaigners worry about losing funding for combatting the virus, but for people living with the disease it remains a heavy stigma.

In Casablanca, a group therapy workshop offers HIV patients a rare opportunity to speak openly about their disease.

“Here I feel normal, I’m treated like a human being,” said Zineb, a 29-year-old mother. Organized by the Association for the Fight Against AIDS (ALCS), on a recent Thursday the workshop brought 12 HIV patients together with a psychologist and a therapist.

The ALCS also organizes follow-up therapeutic care in hospital, and prevention and screening campaigns, with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

These programs were developed shortly after the first HIV case was detected in Morocco in 1986. This early start is partly why UNAIDS, the Joint United Nations Programme on HIV/AIDS, calls Morocco a “model country” for its HIV response.

Thanks to improved screening, access to treatment and monitoring, new HIV infections in Morocco declined by 42 percent between 2010 and 2016, compared to an average reduction of four percent across the rest of the Middle East and North Africa.

Morocco had 350 deaths from AIDS in 2018, from a population of about 35 million. But some groups remain vulnerable, with intravenous drug users, men who have sex with other men, and sex workers accounting for two thirds of Morocco’s 21,000 identified cases.

And the stigma attached to those infected remains high, even within the family. “My mother treated me like a murderer. For a long time I felt alone in the world,” said Youssef, a 28-year-old who has twice attempted suicide.

Like other HIV patients interviewed by AFP, he asked to be identified by a pseudonym. And all of them — save for a 40-year-old considered very lucky by the group — have either hidden their illness or been rejected by loved ones.

In this conservative Muslim society, where sex outside marriage and homosexuality are illegal, HIV patients seldom talk publicly about the virus.

“The subject is taboo, because the infection is linked to sex, itself a taboo subject in Morocco,” said Yakoub, a 25-year-old ALCS worker.

“The social rejection is such that some (HIV patients) lose everything: family, friends, work, home,” he said. Zineb, like many HIV patients, hides her medication to conceal her illness.

For 10 years, the former teen mother has told her family that she is being treated for diabetes. “My 17-year-old son knows nothing, I can’t bring myself to tell him, I’m too afraid,” she said with a sad smile.

“Once you’re sick, you’re no longer a person,” said Sakina, a mother who says she never speaks of her illness except with doctors, the ALCS staff and other HIV patients.

Like 70 percent of HIV positive women in Morocco, Sakina was infected by her husband. She cannot bring herself to tell her 15-year-old son that he is also infected.

She has always lied to him but she can “no longer sleep at night,” she told the group through tears. “My advice: above all, don’t tell him anything,” said a young man.

“For your sake, let him find out from someone else,” another group participant suggested. Then the psychologist interjected to say that private sessions are available to “reflect on these difficult questions.”

The shame of HIV is so entrenched, it even permeates the medical establishment. “For 30 years we’ve been talking about it, the virus is well known but the discrimination is still there,” said Dr. Kamal Marhoum El Filali, head of the infectious diseases department at Ibn Rochd Hospital in Casablanca, which hosts an ALCS branch.

“The stigmatization isn’t just from society but also from medical staff within the hospital environment.” Amina, another group therapy participant, experienced this first hand.

“When I went to the hospital to give birth, no one wanted to take care of me, no one wanted to touch me, I ended up in intensive care,” she recalled indignantly.

Others in the session though were grateful for the care they had received. “We are lucky to be under the care of the infectious diseases department: we are well cared for compared to others, considering the lack of funding and disrepair in Moroccan hospitals,” said another participant.

The emergency room at Ibn Rochd is sometimes overwhelmed with doctors each seeing up to 40 patients a day.

But the infectious diseases department is always spotlessly clean, providing personalized support as ALCS staff liaise with the medical teams.

But how much money Morocco will receive to continue its fight against HIV will be determined at a three-yearly conference for the Global Fund in October.

With funding declining globally and controversy surrounding the management of UNAIDS, ALCS president Mehdi Karkouri fears financial cuts.

“We are a victim of our own success: because our results are good, we risk losing funding,” he said.


What shapes the Middle East’s migration patterns

Updated 29 min 28 sec ago

What shapes the Middle East’s migration patterns

  • An estimated 29 million people have migrated from Arab countries since 1990, according to UN data
  • Political crises and civil conflicts have blurred the lines between voluntary and forced migration

ABU DHABI: Less than two months since an unhappy year for the Arab region’s migrants and refugees came to an end, the omens of things to come are far from good.

According to the latest “Situation Report on Migration in the Arab Region,” prepared by the International Organization for Migration (IOM) in collaboration with various UN agencies, displacement and migration are two prominent trends at the beginning of 2020. Particularly — and unsurprisingly — in countries withongoing wars.

An overwhelming majority of Arab countries endorsed the Global Compact for Migration (GCM) at the UN General Assembly in December 2018, voting to adopt its principles in national legislatures.

Subsequently, the number of migrants and refugees crossing the Mediterranean Sea was found to have plunged in 2018 to almost a tenth of what it was in 2015.

However, the reality of the region’s migrant and refugee situa- tion belies the hopes raised by the adoption of the GCM.

In Libya, for example, there was a steep deterioration last year in the living conditions of migrants and refugees stranded in the unstable North African country.

FASTFACTS

29m - An estimated 29 million people have migrated from Arab countries since 1990.

1/2 - Almost half of the people who migrated stayed within the Arab region.

9.1m - Refugees who have sought protection in the Arab region include 3.7 million under the mandate of the UN Refugee Agency and 5.4 million registered with UNRWA.

14.5% - The number of migrant workers in 18 Arab countries stood at 23.8 million in 2017, representing 14.5 percent of all migrant workers globally.

?The country’s protracted civil conflict has not only caused massive displacement within its borders, but also means it has become a dangerous place for economic migrants from sub-Saharan Africa wishing to travel to Europe. World leaders have just pledged in Berlin not to interfere in Libya’s civil conflict and to uphold a UN arms embargo, but only time will tell if that promise will be honored.

In Syria, meanwhile, the human- itarian situation in Idlib — the last stronghold of opposition forces and a safe haven for millions of internally displaced persons (IDP) — remains shaky as Russian- backed regime forces press on, despite mounting civilian casualties.

In Yemen, a peace opportunity was missed in early 2019, and there has been no let-up since in the fighting between government forces and the Houthi militia, who control the capital Sanaa and the northern highlands. The country currently hosts between 2 million and 3.5 million IDPs and another 1.28 million returnees, in addition to 279,000 migrants and refugees — almost exclusively from Somalia and Ethiopia — for whom the country is a short-term way station, not a final destination.

Lebanon is in the grip of a wide- ranging crisis, too. People at the bottom of the economic ladder, including 1.5 million Syrian refugees and almost 500,000

Palestinian refugees, supple- ment their meager incomes with handouts from aid agencies. Even before the protests erupted in Lebanon in October last year, a UN vulnerability assessment report for refugees in the country, carried out in early 2019, made grim reading.

It said about 73 percent of Syrian refugees in Lebanon were living below the poverty line — up from 69 percent the year before, and considerably higher than the estimated 28 percent of Lebanese in the same situation.

Of course, migration and displacement have long shaped the Arab region, with countries simultaneously acting as points of origin, transit and destination.

However, in recent years, the distinction between voluntary and forced migration has become blurred as political crises and civil conflicts — viewed as the chief causes of human displace- ment — have proliferated. “The challenge today is to put in place policies that will ensure successful and true integration while benefiting both the countries of residence and origin,” Laura Petrache, a senior adviser at Migrant Integration Lab, told Arab News.

According to UN reports, the number of migrants and refugees originating from the Arab region reached 29 million in 2017. Almost half of them remained in the region. Overall, the number of migrants and refugees as a propor- tion of the total population of the Arab region has risen steadily over the past three decades.

In 2018, around 80 percent of the region’s refugees originated in the Levant, mostly on account of the Syrian conflict.

Caption

 

Jordan, Lebanon, Libya, Syria and Sudan are among the top 10 Arab destinations for migrants and IDPs owing to conflicts in the neighborhood. Apart from Lebanon, all of those countries have witnessed an increase in the number of refugees and migrants within their borders since 2015.

After Turkey, Jordan was the second-most-popular destination country for refugees and migrants from the region, with Lebanon, 

Saudi Arabia and the UAE also reporting significant numbers. Iraq was the only country that saw its national refugee and migrant population decrease.

What the latest reports confirm is that migration in the Arab world not only has multiple drivers — socio-economic pressures, political instability and environmental degradation — but also complex patterns and trends.

Take the Gulf and the Levant regions. They attract different kinds of migrants because their levels of stability, security and development are not comparable. While Libya, Syria, Lebanon and Yemen are plagued by conflict, violence, corruption and divisions in both society and polity, GCC member countries are leading the way in groundbreaking ideas and investments, building cities of the future and attracting talent from across the world.

The migrant population in the GCC countries swelled from 8.2 million in 1990 to 28.1 million in 2017 — a substantial rise compared with figures for other parts of the Arab region.

Around 27 percent of global remittance outflows in 2017 reportedly came from the Arab region, estimated at $120.6 billion, and almost all of that (98.9 percent or $119.3 billion) came from GCC countries. According to the IOM’s report, the top remittance-sending countries were the UAE (at $44.3 billion) and Saudi Arabia (at $36.1 billion).

Under the circumstances, it is difficult to see meaningful, positive change for migrants happening any time soon in the Arab region, with the possible exception of the GCC.

“Migration policy making should move away from assimila- tionist frameworks,” Petrache, of the Migrant Integration Lab, told Arab News. “Instead, the policy emphasis should be on working with countries of origin to achieve sustainable integration — and re-integration in the case of return immigration.

“The policies should take into consideration the potential for win-win solutions using and developing the capability of the migrants to make a positive contri- bution to local host communities,” Petrache said.