The distribution of new HIV infections by mode of exposure in Morocco
- Ghina R Mumtaz1,
- Silva P Kouyoumjian1,
- Nahla Hilmi1,
- Ahmed Zidouh2,
- Houssine El Rhilani3,
- Kamal Alami3,
- Aziza Bennani4,
- Eleanor Gouws5,
- Peter Denis Ghys5,
- Laith J Abu-Raddad1,6,7
- 1Infectious Disease Epidemiology Group, Weill Cornell Medical College—Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
- 2Free-lance Epidemiologist, National consultant, Rabat, Morocco
- 3Joint United Nations Programme on HIV/AIDS, Morocco Country Office, Rabat, Morocco
- 4Morocco National AIDS Programme, Ministry of Health, Rabat, Morocco
- 5Evidence, Innovation and Policy Department, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
- 6Department of Public Health, Weill Cornell Medical College, Cornell University, New York, New York, USA
- 7Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Correspondence to Dr Laith J Abu-Raddad, Infectious Disease Epidemiology Group, Weill Cornell Medical College—Qatar, Qatar Foundation, Education City, P.O. Box 24144, Doha, Qatar;
- Received 24 October 2012
- Revised 16 December 2012
- Accepted 6 January 2013
- Published Online First 14 February 2013
Objectives Building on a wealth of new empirical data, the objective of this study was to estimate the distribution of new HIV infections in Morocco by mode of exposure using the modes of transmission (MoT) mathematical model.
Methods The MoT model was implemented within a collaboration with the Morocco Ministry of Health and the Joint United Nations Programme on HIV/AIDS. The model was parameterised through a comprehensive review and synthesis of HIV and risk behaviour data in Morocco, mainly through the Middle East and North Africa HIV/AIDS Synthesis Project. Uncertainty analyses were used to assess the reliability of and uncertainty around our calculated estimates.
Results Female sex workers (FSWs), clients of FSWs, men who have sex with men (MSM) and injecting drug users (IDUs) contributed 14%, 24%, 14% and 7% of new HIV infections, respectively. Two-thirds (67%) of new HIV infections occurred among FSWs, clients of FSWs, MSM and IDUs, or among the stable sexual partners of these populations. Casual heterosexual sex contributed 7% of HIV infections. More than half (52%) of HIV incidence is among females, but 71% of these infections are due to an infected spouse. The vast majority of HIV infections among men (89%) are due to high-risk behaviour. A very small HIV incidence is predicted to arise from medical injections or blood transfusions (0.1%).
Conclusions The HIV epidemic in Morocco is driven by HIV incidence in high-risk population groups, with commercial heterosexual sex being the largest contributor to incidence. There is a need to focus HIV response more on these populations, mainly through proactive and sustainable HIV surveillance, and the expansion and increased geographical coverage of services such as condom promotion among FSWs, voluntary counselling and testing, harm reduction and treatment.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode