HIV/AIDS in Morocco

First to respond to a question from a reader. Yes, the grant for my water project is SPA.

The last World Health Organization report (that I’ve heard about) estimated that there are something like 20,000 cases of HIV/AIDS in Morocco. In a country of 30 million, that’s only 0.06%. It’s, fortunately, a very low percentage. However, I believe that it is a great public health risk to the country as a whole. There are a number of factors that make the country vulnerable to the disease becoming wide spread.

First is ignorance about the disease. Speaking generally, people don’t know what it is. If people have heard of it they know no specifics and what they know might very well be wrong. They don’t know how it is transmitted. People say that the disease is transmitted by sharing toothbrushes, going to the hammam (public bath), and by being breathed on. I’ve never heard someone say that sex is a mode of transmission for the disease.

Second is that cultural boundaries that discourage honest discussion of the topic. This is a very religious society where appearing pure is very important to fitting into one’s community. So this makes it difficult to bring up such important issues as condom use.

Third (seemingly contradicting the previous issue) is the prevalence of prostitution in the country. This is particularly the case for my province, Khenifra, which is known for its prostitution. I’ve heard that the province has three of the four biggest prostitutions towns in the country. One of these centers is very close to me and I know that men from my village visit prostitutes there. They’ve told me. Compounding this problem is the fact that many of the sex workers in these prostitution centers come from out of town. I believe these places could easily become spreading points for the disease.

In sum, it’s a topic that people are ashamed to talk about and no one knows anything about. And prostitution means that large numbers of men are sleeping with a small number of women. I know that sexually transmitted diseases such as syphilis are common even in a small community like mine, so it’s easy to imagine how this could happen with HIV/AIDS.

A volunteer in my market town works with a women’s association. The women of the association were interested in learning more about “SIDA” (the French acronym for the disease). The volunteer asked for my help, so I talked to the doctor in the local health clinic and she agreed to do education with the women. This seemed like a good way to spread important information through the community because the doctor would know how to talk about the issue in a culturally sensitive way. I was not at the workshop, but the report I heard on the doctor’s talk was that it did not even broach the topic of sexual intercourse as a mode of transmission for HIV/AIDS. Apparently, she told the women that they could get the disease from sharing mascara or toothbrushes.

It’s disappointing to find out that you cannot count on a doctor to transmit accurate information about HIV/AIDS. I remember reading about Ministry of Health officials in South Africa spreading misinformation about the disease, but being this close to the ignorance (and being associated with the training) is much more astounding. If doctors can’t/won’t/don’t take the lead in the fight against HIV/AIDS, who will? And what is the reason this doctor ignored the meat of the issue? Is she uninformed (which suggests a Ministry-wide training problem)? Is she embarrassed (culture-wide problem)? Maybe it’s just this one doctor who has the problem; I hope so.

So what to do? Well another volunteer is currently in the middle of a ‘Training of Trainers’ workshop. The idea is to empower local leaders to educate their communities on the dangers of HIV/AIDS. I think it’s a great way to tackle the problem; I’m curious to see how the trainers do.

A different volunteer and I will (hopefully) ourselves be doing HIV/AIDS education in local schools. We have gotten permission from the local government and are now waiting on permission from the Ministry of Education. Some of the people who attended the ‘Training of Trainers’ workshop may be working alongside us, which would be great. The idea is to educate kids so that they can at least protect themselves. I would really like to do education with people in the sex industry at some point, but that would be very difficult to do.

Update
I want to say that although my posts are consistently negative and critical, that doesn’t mean that I dislike the country, the culture, or the people. The things that I write about in my posts are exceptions. The norm is positive interactions with people. I’m sure that no matter what country I was in, I would be finding problems and critiquing them.

An addendum to my previous post about deforestation. I forgot to mention that, during the winter, people cut down the branches of live oak trees to bring back to their barns to feed their sheep and other animals. This is another big killer of trees. The other day my host dad went out to cut down branches and he was late coming back. I asked my host mom why he was late and she said that he waits to come back until the sun comes down because otherwise an official from the Ministry of Forest and Water will fine him. So there is some government effort to police the resources, but it’s ineffective and insufficient.

I’ve been talking to more people about the problems of deforestation and erosion. People say it’s a huge problem. Someone today said, “The trees have gone, the soil has gone, the community will soon be gone.” So I think there is a consensus on the issue. However, getting collective action on the issue is incredibly difficult.

Other than that, things are going well. Winter may be coming to an end, which would be nice. I’ve just started a water source project. I go around and map places where people collect drinking water, take a photo, get information, and take a sample of the water with me. The Ministry of Health will send the sample to a nearby facility to be tested. When the result comes back I’ll go and talk to the people and try to convince them to treat their water (bleach is free). In addition to hopefully having a benefit on public health, I like the project because it forces me to meet people I otherwise wouldn’t. Most of the people who have decentralized water sources live outside of towns, so I haven’t me them yet.