Drug use and Harm Reduction in Morocco

1. Human rights as a key component of harm reduction strategy targeting people using drugs in Morocco

2. Drug use and Harm Reduction in Morocco • Dramatic increase of PUD esp. in North Morocco*Rapid assesment on HIV risk among PUD in Morocco, Ministry of Public Health • HIV prevalence (7% to 22%) and HCV prevalence (80%) associated to injection route* Prevalence study, MoPH (not published) • MoPH and NGOs have been implementing needles and syringes program (since 2008) and methadone maintenance treatment (since 2010)  On behalf of positive outputs from evaluation of the first national Harm Reduction strategic plan (2008-2011), decision to scale up access to harm reduction services

3. The challenge of Human Rights • Legal obstacles (including drug use criminalization) are a main barrier for • Access to care and treatment • Access to prevention and Harm Reduction*Strathdee and all. The Lancet, 2010 • Assumption endorsed at high level: • Vienna Declaration • Global commission on drug policy*Report of the Global Commission on Drug Policy, June 2011 • Human Rights of people using drugs are neglected despite those evidences • Need to asses legal and social barriers in Morocco and to design a more comprehensive approach to mitigate and reverse HIV/ HCV infections among PUD • ALCS, with the support of OSF, cross sectional study project

4. Design • Sites: 3 cities of the north of the country (Tangiers, Tetouan, Nador) • 10 inquirers recruited among outreach teams and trained • Structured questionnaire • Administred to 300 PUD recruited through outreach programs, in 2011 • 21 questions investigating 4 dimensions: • Sociodemographic profile • Drug use • Inmate story • Human right violations from law enforcement, health professional and closed environment • Data completed with: • 3 focus groups (one per site) • Individual incident reports collected among PUD (408 reports)

5. General profile

6. Drug use • Heroin: 97% / Two thirds are injecting • Injection (any drug) • in timelife: 81% • last month: 64% • Multiple use: 94% • Cannabis: 84% • Benzodiazepines: 45% • Cocaine: 38% • Alcohol consumption higher among women (39%) than men (13%)

7. Prison • 82% have been incarcerated • Average number of prison stays: 4 (1- 30) • Life setting (cf. income source) seems play a major role:

8. Human rights violations / Overview • 9 specific situations were investigated to assess the level of human rights violations • 3 associated to law enforcement officers behaviors & practices • 3 associated to health professionals behaviors & practices • 3 associated to behaviors & practices of people from close environment • Only 0.6% had never face any of those 9 situations

9. Human right violations / Law enforcement officers

10. Human right violations / Health professionals

11. Human right violations / Close environment

12. Self perception of people using drugs « There is no place for us in community except prison or death » Key words used by PUD: Injuries, physical and psychological violence, rudiness, denial of care and treatment, stigmatization, rape, forced closing, racketeering, denial of basic rights, extortion, etc.

13. Conclusion • This study has clearly assessed violations of human right among PUD due to the fact they intake illegal drugs • It is worth to raise that this break in basic human rights’ respect are wider that the ones generated by drug offences: • HR violation due to activities generating incomes • Denial of health services • Stigmatization from famillies • Those legal and social barriers counteract with real and enhanced access to harm reduction services in Morocco. National Harm Reduction strategy should include a core action plan regarding human right issue .