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.


How Middle East cities can meet the sustainability challenge

Updated 25 min 52 sec ago

How Middle East cities can meet the sustainability challenge

  • With a growing population and diminishing water resources, region's cities face a major challenge
  • Despite tech breakthroughs and growing use of renewable energy, many of the world's cities are ailing

DUBAI: As the cities of today grow into those of the future, they will encounter daunting sustainability challenges.

Arguably, the most significant factor that all urban centers will have to take into account is climate change.

With temperatures projected to rise, new infrastructure and operational challenges will have to be tackled by city authorities.

“We need to manage our greenhouse gas emissions while managing our economy,” said Fahed Al-Hammadi, director of climate change at the UAE’s Ministry of Climate Change.

“We must understand future trends in the region and how we will be affected in different sectors. We must engage with the private sector because we can’t work as a government alone,” he added.

FASTFACT

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Percentage of its lifetime a car in the US is parked on average.

“We need to attract more ‘green’ investors, and ensure that the capacity of renewable energy we’re transitioning to can cope with the transformation.”

Speaking at a recent summit in Dubai on emerging technologies, Al-Hammadi visualized cities of the future contributing to a reduction in emissions — transportation currently contributes a third of total emissions — and thus helping governments achieve their emission-reduction targets.

Senseable City Lab at MIT collects data on car movement to improve urban transport. (Supplied)

Cities’ sustainability will prove a major challenge in the Middle East, a region with a growing population and diminishing water resources.

“Climate change is happening and there are future challenges, but it’s very important, with the structure we have in modern cities, to have an understanding of the impacts and the changes we’re going to experience,” Al-Hammadi said.

One tool that is becoming increasingly important for urban authorities planning for future challenges is data.

Carlo Ratti, director of Senseable City Lab at MIT, said that reliable data is essential for a better understanding of the cities we live in.

He is working on collecting data from the movement of cars to understand transport patterns in a city and how it can be improved.

With the average number of car sensors today ranging from 2,000 to 3,000, Ratti told the EmTech MENA conference that the “ambient sensing platform” can be scaled up to include taxis and used for monitoring a city’s “structural health” (bridges and other infrastructure). Pilot projects are currently being conducted in collaboration with Uber in Singapore, he said. 

“You can radically change the way we move in a city,” Ratti added. “In the US today, a car is parked on average 95 percent of the time. It uses valuable space in our cities as well. But a self-driving system can change that.”

Ratti  offered the example of the 1.37 million parking spots in Singapore, 70 percent of which can be cut with autonomous cars. 

His work encompasses traffic lights as well, whereby cars will be able to detect intersections, removing the need for such lights.

Meanwhile, in Amsterdam self-driving boats that can be used as floating platforms for temporary bridges are being deployed to configure the city in an increasingly dynamic way.

Self-driving boats are used as temporary bridges in Amsterdam, Netherlands. (Supplied)

“The beauty of technology isn’t about creating new needs. It’s about doing things in a different and better way,” Ratti said.

Experts have jumped to cities’ defense by trying to make them more resilient as they face the twin onslaughts of overpopulation (55 percent of the planet’s 7.4 billion people live in urban areas) and climate change (rising sea levels due to global warming threaten to wipe out many coastal cities).

The health sector will need an overhaul to cater for the evolving needs of the cities of the future. 

A pioneer in this area is BioBot, a US biotech company that measures the concentration of drugs that are excreted in urine and collected in sewerage systems.

“We measure opioids in sewage to estimate consumption in cities, counties and states,” says BioBot’s website. “We map this data, empowering communities to tackle the opioid epidemic in real time.”

By mapping a city’s wastewater network and studying the demographic information associated with that data, more effective public-health policies can be created, said Newsha Ghaeli, the company’s co-founder and president.

“A human health crisis affecting communities, such as measles, polio, obesity or diabetes, is only heard about when the crisis turns into a catastrophe,” Ghaeli said.

“But it doesn’t have to be this way. We imagine a city where every person can contribute to a database about our health and we’re building it, based on a concept called wastewater epidemiology.”

For instance, human urine is an important pathological sample, and so can be regarded as a rich source of information embedded in city sewers.

“You need a lot of different disciplines and industries working together to make sense of this data, like engineers, chemists, biologists, public health, urban planners, water and sewers, elected officials, data scientists and public works,” Ghaeli said. “So we’re the first company in the world to commercialize data from sewage.”

Hardware units are installed inside manholes, hanging a few feet above the sewer flow, with tubes that capture bacteria and study the chemical profile. BioBot’s team of scientists then looks at the human bacteria, viruses and chemicals. 

“There’s so much we can learn from wastewater,” Ghaeli said. “We chose to tackle, first, the opioid epidemic, which is the leading cause of accidental death of Americans under 50.”

However, recent studies have shown that less than 1 percent of those who suffer from  opioid use disorder are dying. 

“So it doesn’t matter how you slice or dice the data, we just don’t have the information,” Ghaeli said. “What’s clear is that we’re measuring the wrong thing, so we are now measuring 30 different drugs and looking at emerging trends in drugs.”

The first town to test the system was Cary in North Carolina, where overdoses decreased by 40 percent last year for the first time in half a decade, Ghaeli said.

Pavegen’s tech captures energy from pedestrian footsteps to power street lighting. (Supplied)

During a six-month pilot program, BioBot was also able to create a heat map to pinpoint areas where overdoses were concentrated.

Despite such technological breakthroughs, and the fact that an estimated 33 percent of the world’s energy is now derived from renewable sources, many of the world’s most densely populated cities are ailing.

“Cities have been built for machines — cars and planes — and some have forgotten about the people,” said Laurence Kemball-Cook, CEO of Pavegen.

The technology company has developed paving slabs to convert energy from citizens’ footsteps into “energy, data and rewards.”

He said: “I’m on a mission to try to make our cities greener. There is a big challenge in urban areas.”

To achieve his goal, Kemball-Cook turned to kinetic energy, capturing the energy from pedestrians’ footsteps to power streetlights.

So far, the kinetic-energy system has been used in Nigeria, London, Abu Dhabi Airport, Thailand and Birmingham, as well as on a running track in Hong Kong.

“We’re excited about the vision of the future city,” he said, adding that he hopes to take Pavegen’s technology to Expo 2020 in Dubai and Neom in Saudi Arabia.

“The potential of using human power in our cities is huge. The technology in a city has to work with the people,” Kemball-Cook said.

“A city isn’t just about finding a new energy solution, it has to be about wellness, smart (practices), fun, sustainable and connecting into the Internet of Things data layout,” he added.