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Fight against HIV/AIDS makes headway in Morocco6 minutes read

Thanks to improved screening, access to treatment and monitoring, new HIV infections in Morocco declined by 42%

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Moroccan medical staff talk at the infectious diseases department at the Ibn Rochd Hospital in Casablanca on September 12, 2019
In Morocco, the struggle against HIV has been so successful in recent years that campaigners worry about losing funding for combatting the virus. (Photo by FADEL SENNA / AFP)

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

In Casablanca, a group therapy workshop offers HIV patients an 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.

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

These programmes 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.

A Moroccan AIDS patient talks with a member (unseen) of the Association for the Fight Against AIDs
A Moroccan AIDS patient talks with a member (unseen) of the Association for the Fight Against AIDs (known by its French acronym ALCS) in the infectious diseases department at the Ibn Rochd Hospital in Casablanca on September 12, 2019. (Photo by FADEL SENNA / AFP)

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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, 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.

A relative of a Moroccan AIDS patient looks out the window in the infectious diseases department at the Ibn Rochd Hospital in Casablanca
A relative of a Moroccan AIDS patient looks out the window in the infectious diseases department at the Ibn Rochd Hospital in Casablanca on September 12, 2019. – 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. (Photo by FADEL SENNA / AFP)

Don’t tell them anything

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. 

Two members of Morocco's Association for the Fight Against AIDs (known by its French acronym ALCS) talk with patients in the infectious diseases department
Two members of Morocco’s Association for the Fight Against AIDs (known by its French acronym ALCS) talk with patients in the infectious diseases department at the Ibn Rochd Hospital in Casablanca on September 12, 2019. (Photo by FADEL SENNA / AFP)

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 stigmatisation 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.

A member (L) of Morocco's Association for the Fight Against AIDs (known by its French acronym ALCS) talks with patients suffering from AIDS
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. (Photo by FADEL SENNA / AFP)

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‘Victim of own success’

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 personalised 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.

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Algeria insists on hydroxychloroquine for Covid-19 treatment

WHO said on Monday it had temporarily suspended clinical trials of hydroxychloroquine as a potential treatment for coronavirus.

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Algeria has disclosed plans to continue the use of hydroxychloroquine in tackling the coronavirus, despite the discouragement by the World Health Organization that has suspended clinical trials of such treatments following a study which showed that the drug caused more harm than good.

“We’ve treated thousands of cases with this medicine, very successfully so far,” said Mohamed Bekkat, a member of the scientific committee on the North African country’s Covid-19 outbreak. 

“We haven’t noted any undesirable reactions,” he said.

Bekkat, who is also head of the Order of Algerian Doctors, said the country had not registered any deaths caused by hydroxychloroquine.

“For confirmed cases, we use hydroxychloroquine and azithromycin. Then there is a whole protocol for serious cases,” a health ministry official said on Monday.

Bekkat’s comments came days after medical journal The Lancet published a study of nearly 100,000 coronavirus patients, showing no benefit in those treated with the drug, which is normally used against arthritis.

The study found that administering the medicine or, separately, the related anti-malarial chloroquine, actually increased Covid-19 patients’ risk of dying.

The World Health Organization said on Monday it had temporarily suspended clinical trials of hydroxychloroquine as a potential treatment for coronavirus, following the Lancet study.

Bekkat argued that the Lancet study had led to “confusion” as it “seems to concern serious cases in which hydroxychloroquine is of no help”.

“There is evidence that the use of chloroquine by some Arab and African countries has proven to be effective when used early,” he explained.  

Public figures including US President Donald Trump have backed the drug as a virus treatment, prompting governments to bulk buy — despite several studies showing it to be ineffective and even increasing COVID-19 hospital deaths.

Algeria’s coronavirus outbreak is one of the worst in Africa, with a total of 8,503 cases and 609 deaths officially recorded since February 25.

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Schools reopen in Côte d’Ivoire amidst Covid-19 protective measures

“We also have an imperative duty to ensure that the children entrusted to us can complete their education,” Assoumou Kabran, an education ministry official said.

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Children wear face masks in a classroom at a primary school in the popular district of Attecoube in Abidjan on May 25, 2020 on the first day day after resumption of classes after COVID-19 coronavirus lockdown. (Photo by ISSOUF SANOGO / AFP)

Schools have reopened in Abidjan, Côte d’Ivoire after the country lifted an almost two-month curfew in its fight against the coronavirus epidemic . Nightclubs, cinemas and bars will remain closed.

Thousands of children in face masks flocked back to school on Monday, and authorities are confident that pupils can study together in safety after the introduction of extra hygiene measures.

“At first we were a little scared. When we saw that the protective measures were being respected, the fear went away,” said 14-year-old Samira Cisse.

With a total of 2,376 cases and dozens of new infections each day, Côte d’Ivoire has yet to contain the virus.

But In Abidjan’s Adjame neighbourhood, children in backpacks queued to wash their hands under a teacher’s watchful eye before entering their school, where they sat just one to a desk with bottles of sanitising gel within reach.

“We also have an imperative duty to ensure that the children entrusted to us can complete their education,” Assoumou Kabran, an education ministry official said.

Reopening classrooms also means thousands of pupils and their teachers must be ferried back to boarding schools outside Abidjan, epicentre of the epidemic.

French teacher Patrick Yobouet, 38, waited with hundreds of others in a sun-baked stadium to board buses out of the city.

“We’re a bit worried as we leave, because we don’t know if we have the coronavirus or not or if the children are contaminated or not,” he said.

Nearby countries are likely to follow closely if Côte d’Ivoire’s decision to reopen schools does not cause a spike in infection. With millions of children still at home, aid agency Save the Children says many could face serious setbacks due to limited options for distance learning in parts of Sub-Saharan Africa.

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South Africa to ease lockdown to tier 3 by June 1

President Ramaphosa also said a controversial ban on the sale of alcohol would be lifted for home consumption when the country moves into level three of a five-tier coronavirus lockdown next month.

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South African President Cyril Ramaphosa has announced plans by the government to further ease lockdown restrictions aimed at curbing the spread of COVID-19.

In a televised address on Sunday, Ramaphosa noted the harm the disease has caused in the country, but said the indefinite time it may take to develop a vaccine means the country cannot continue being in a lockdown.

He said a controversial ban on the sale of alcohol would be lifted for home consumption when the country moves into level three of a five-tier coronavirus lockdown next month.

South Africans were prohibited from buying alcohol and cigarettes when the country went into one of the world’s strictest lockdowns on March 27.

The booze ban was meant to prevent a spike in violence and reduce pressure on emergency wards as hospitals gear up to face a virus that has infected at least 22,583 people across the country and killed 429.

“Alcohol will be sold for home consumption only under strict conditions on specified days and for limited hours,” Ramaphosa announced in an address to the nation.

“The sale of tobacco products will remain prohibited in alert level 3 due to the health risks associated with smoking,” he added.

South Africa started gradually easing confinement measures on May 1, allowing citizens to exercise outdoors in the morning and some businesses to partially resume operations.

Ramaphosa said the alert level would now be lowered from level four to three from June 1, with a “differentiated approach” to deal with “coronavirus hotspots”.

“Moving to alert level three marks a significant shift in our approach to the pandemic. This will result in the opening up of the economy and the removal of a number of restrictions on the movement of people, while significantly expanding and intensifying our public health interventions,” the president said.

The easing of the lockdown from a level four to a level three will take effect from June 1.
South Africa is the worst affected country by the COVID-19 pandemic in Africa.

President Ramaphosa also called for a fair distribution of any vaccine upon development.
“We have argued that should a vaccine be developed anywhere in the world it should be made freely and equitably available to citizens of all countries,” he said.

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