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Review
. 2013 Nov;89 Suppl 3(Suppl 3):iii49-56.
doi: 10.1136/sextrans-2012-050844. Epub 2013 Feb 14.

The distribution of new HIV infections by mode of exposure in Morocco

Ghina R Mumtaz  1 , Silva P Kouyoumjian, Nahla Hilmi, Ahmed Zidouh, Houssine El Rhilani, Kamal Alami, Aziza Bennani, Eleanor Gouws, Peter Denis Ghys, Laith J Abu-Raddad
Affiliations
Free PMC article
Review

The distribution of new HIV infections by mode of exposure in Morocco

Ghina R Mumtaz et al. Sex Transm Infect. 2013 Nov.
Free PMC article

Abstract

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.

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Figures

Figure 1
Figure 1
Distribution of new HIV infections by mode of exposure including the uncertainty in the modes of transmission model predictions for Morocco. Access the article online to view this figure in colour.
See this image and copyright information in PMC

References

    1. Abu-Raddad L, Akala FA, Semini I, et al. Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic action. Middle East and North Africa HIV/AIDS epidemiology synthesis project. Washington, DC: The World Bank Press, 2010
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    1. Mumtaz G, Hilmi N, McFarland W, et al. Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? A systematic review and data synthesis. PLoS Med 2011;8:e1000444. - PMC - PubMed
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