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HIV prevalence and related risk behaviours in female seasonal farm workers in Souss Massa Draa, Morocco: results from a cross-sectional survey using cluster-based sampling
  1. Ivana Bozicevic1,
  2. Fatiha Guezzar2,
  3. Aleksandar Stulhofer3,
  4. Aziza Bennani2,
  5. Senad Handanagic1,
  6. Jelena Barbaric1,
  7. Houssine El Rhilani4,
  8. Kamal Alami4,
  9. Hamida Khattabi5,
  10. Gabriele Riedner5,
  11. Abderrahmane Maaroufi2
  1. 1World Health Organization Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Zagreb, Croatia
  2. 2Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
  3. 3Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
  4. 4UNAIDS Country Office for Morocco, Rabat, Morocco
  5. 5World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
  1. Correspondence to Dr Ivana Bozicevic, WHO Collaborating Centre for HIV Strategic Information, School of Medicine, University of Zagreb, Zagreb 10000, Croatia; Ivana.Bozicevic{at}


Objectives To determine prevalence of HIV and HIV-related behaviours in female seasonal farm workers (FSFWs) in two provinces of Souss Massa Draa (SMD) region in Morocco. SMD has a higher burden of HIV compared with other parts of Morocco and is characterised by a substantial aggregation of FSFW.

Methods We carried out a cross-sectional HIV biobehavioural survey using cluster-based sampling of farms in the provinces Chtouka Aït Baha and Taroudant Ouled Teïma in 2014. HIV testing was done using the Determine HIV-1/2 rapid test and reactive specimens were tested using ELISA and western blot. Collected data were post hoc weighted for region-based stratification and adjusted for clustering effects using complex survey functions of SPSS (V.21).

Results Among those eligible to participate, the response rate was 92.8%. HIV prevalence was 0.9% (95% CI 0.4% to 2.4%) among 520 recruited participants. A high proportion of respondents (67.7%) had no education. Ever having sex was reported by 79.8% and among these, 12.7% ever exchanged sex for money or goods. Sixty-one per cent reported condom use at most recent commercial vaginal sex in the past 12 months. STI symptom recognition was found to be low because 62.4% and 46.8% of FSFW could not report any STI symptoms in men and women, respectively. Twenty-seven per cent of respondents had an HIV test in the past 12 months. In multivariable analysis, those with primary or higher education (adjusted OR (aOR)=2.38, 95% CI 1.33 to 4.27) and those who participated in an HIV educational session at their workplace (aOR=11.00, 95% CI 3.99 to 30.31) had higher odds of ever been tested for HIV.

Conclusions Although we found a relatively low HIV prevalence among FSFW in SMD, HIV interventions should be intensified, in particular, in a subgroup of women who are involved in sex work.

  • HIV

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  • Handling editor Jackie A Cassell

  • Contributors IB, FG, AS, AB, HK, KA and AM participated in the planning and conception of the research questions and the study design. IB, FG and AS conceptualised the study design and coordinated the study implementation. SH was responsible for analysing the data. IB, SH and JB drafted the article, and all authors participated in interpreting the data and critically revising the manuscript. All authors read and approved the revised manuscript.

  • Funding The study was carried out by the financial support of the Ministry for Foreign and European Affairs of the Republic of Croatia and the grant of the Global Fund for AIDS, tuberculosis and malaria for the National AIDS Programme of the Kingdom of Morocco. The funders did not participate in the implementation of the study and writing up of this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical Committee of the Faculty of Medicine in Casablanca.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available for further publications and for planning of HIV interventions, primarily for the Ministry of Health of Morocco.

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