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Trends and Factors Affecting Knowledge of and Stigma and Violence Towards Female Sex Workers in Morocco

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Abstract

Background

We investigate factors affecting HIV knowledge, stigma, and violence among female sex workers (FSW) in Agadir, Rabat, Fes, and Tangier, Morocco, over three rounds of HIV surveillance surveys (2012, 2016, and 2019) conducted using respondent-driven sampling (RDS). Multivariable analyses from RDS studies examining the relationships between variables are under-utilized, particularly analyses that combine multiple locations and years of data together in a principled manner.

Method

We fit three weighted logistic regression models for HIV transmission knowledge, having been denied service (experienced stigma), and having been hit (experienced violence) in the last 12 months, and perform model selection using 41 possible explanatory variables.

Results

Variables significantly associated with higher risk included reasons for sex work, how FSW solicit clients, if female family members are also involved in sex work, ever being forced to have sex, and ever being arrested or jailed. There were also significant differences between cities and in trends over time, with HIV transmission knowledge increasing and having been denied health services and having been hit decreasing.

Conclusion

We found associations indicating that some particularly vulnerable FSW may be subject to multiple intersecting risks related to HIV knowledge, stigma, and violence which may decrease their agency to receive proper HIV testing, care, and treatment. Although Morocco has made excellent progress in providing HIV services to vulnerable populations, this additional analysis will be useful as Morocco makes programmatic decisions related to ending HIV by 2030.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors thank the Institut National d’Hygiène (INH) in Rabat for processing the biological samples and the Association de Lutte contre le Sida (ALCS), Organisation Panafricaine de lutte contre le sida (OPALS), and Association Sud contre le Sida (ASCS) teams who implemented the surveys in field.

Funding

No funding was received to assist with the preparation of this manuscript. The studies were funded by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), and technical assistance was funded by UNAIDS and GFATM.

Author information

Authors and Affiliations

  1. Department of Statistics, Oregon State University, 239 Weniger Hall, Corvallis, OR, 97331, USA

    Gauri Phatak & Katherine R. McLaughlin

  2. LGJ Consultants, Inc., Valencia, Spain

    Lisa G. Johnston

  3. Ministry of Health, Rabat, Morocco

    Ibtissam Khoudri & Amina El Kettani

  4. UNAIDS, Rabat, Morocco

    Houssine El Rhilani

Authors
  1. Gauri Phatak
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  2. Lisa G. Johnston
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  3. Ibtissam Khoudri
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  4. Houssine El Rhilani
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  5. Amina El Kettani
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  6. Katherine R. McLaughlin
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Corresponding author

Correspondence to Katherine R. McLaughlin.

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Ethics Approval

Ethical approval for the questionnaire and methodology for this study was approved by the committee of Faculty of Medicine of Casablanca, Morocco.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Phatak, G., Johnston, L.G., Khoudri, I. et al. Trends and Factors Affecting Knowledge of and Stigma and Violence Towards Female Sex Workers in Morocco. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10237-3

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