Reporter’s Notebook: Morocco Battles HIV, Stigma Through Mosques

BY Ray Suarez  December 21, 2011 at 1:48 PM EDT

Ray Suarez with Imam Mohamed Ziani, who helps train other imams to talk about HIV in their communities. The first report in the NewsHour’s Morocco series airs on Wednesday night’s broadcast. Watch a video preview of the stories.

Many of the countries we’ve visited to report on global health over the past three years have terrifying rates of HIV infection: South Africa, 30 percent; Mozambique, 12.5 percent; and Tanzania, 6.2 percent. The infection rate in Morocco is an estimated one tenth of 1 percent, or 0.1 percent. Yet journal article after journal article written for and read by infectious disease specialists and people combating AIDS say ignorance carries with it the threat of a future rate many times higher. The NewsHour’s global health unit went to Morocco to see the state of AIDS prevention in the country, and look at how people who are already HIV positive are treated.

Unlike those other countries I mentioned, Morocco is almost entirely Muslim, and discourages open discussion or popular depiction of human sexuality. Unlike those other countries, you won’t find cookie jars full of condoms on clinic counters in Morocco, or HIV-positive characters in popular soap operas, or downtown billboards in big cities urging smiling couples to use condoms when they have sex, or know their HIV status.

Dr. Hakima Himmich, who founded and runs Morocco’s oldest anti-HIV organization, ALCS, said she and her workers and volunteers have to be a lot more creative and a lot less overt. The government doesn’t deliver open, frank messages on HIV prevention, but is glad Dr. Himmich’s organization is doing it.

Government organizations are reluctant to put the authority of the establishment and the king behind education that makes sex before marriage, extra-marital or homosexual sex safer. It’s a Moroccan version of the arguments we have here in the United States over whether making a dangerous or illegal activity safer is equivalent to condoning or encouraging it.

And the complications of spreading a prevention message are clear in the wide range of relationships on display in Morocco. In cities you can see modestly dressed conservative couples share quiet conversations in cafes and restaurants, their legs touching underneath the table if they dare. Often in those same restaurants and cafes, young couples in Western dress, the young woman with uncovered hair, the men in jeans and sunglasses, snuggle over coffee, sitting side-by-side on the same side of similar tables.

Secrecy provides a perfect petri dish for cultivating the HIV virus. With sex workers driven to the margins of society, gay sex entirely underground and intravenous drug use attracting restless young users among the urban unemployed, Morocco can’t take that very low rate of infection for granted.

One morning, we headed out to a truck stop in Casablanca with a mobile testing unit. The beautifully equipped big white truck pulled into a parking space, rolled out its stairways, and sent workers into the neighborhood with brochures and offers of a free AIDS test.

Through much of Africa, long-haul truckers have been efficient spreaders of the virus. They visit cities and towns large and small, routinely cross international borders, are away from home and family for long stretches, and have access to anonymous or commercial sex in the places they stay. But the volunteers found plenty of takers. The test involves a simple needle-stick, and the short wait for the results allows doctors who staff the truck to deliver prevention messages and advice face-to-face.

A tougher nut to crack are sex workers. In a society as firmly against sex outside marriage as Morocco, it’s difficult for sex workers to show themselves in any organized way. As in many societies, they are beyond the reach of even non-governmental organizations. But ALCS runs workshops, tests for the virus, gives exams and prevention training without judgment or punishment.

However, the most interesting program we observed involves the country’s imams. An innovative educational program spearheaded by an Islamic think tank teaches leaders of congregations and religious teachers about the biology of HIV and AIDS, and training in ministering to the infected. We turned up for Friday prayers at a big mosque in a Casablanca suburb. Thousands of men and women squeezed through the entrance gates and into the worship space at prayers floated on the warm, dry winter air into the surrounding neighborhood.

Imam Mohamed Ziani welcomed us into his home, made a few last notes and put the finishing touches on his sermon, slipped his feet into lemon yellow slippers, and headed over to the next-door mosque. He and the thousands of other imams across Morocco are encouraged not only to give frank advice to worshipers about avoiding the virus, but to ask for compassion and mercy for those already infected.

World AIDS Day was just a day before Imam Ziani stood to talk to the thousands at the mosque. After urging Moroccans to talk openly about the disease and to stop its spread, he was thronged by worshipers who came to thank him for the message.

When I met Dr Ahmed Abbadi, president of the think tank called the Mohammedia League of Moroccan Ulama, he explained his support for AIDS education in the context of Islam. Mercy for the sick is a central idea for Muslims, Abbadi said, then added that compassionate treatment of the HIV positive and limiting the future spread of the virus is “the highest form of patriotism.”

I hadn’t really thought of it that way before. In a developing country, each person whose HIV infection eventually segues into AIDS, every person who has to spend the rest of their lives on anti-retroviral medication, every person whose future as a worker is compromised holds the country back. Lowering the disease burden, heading off new infections, figuring out who’s infected and keeping them from passing HIV, doesn’t just reduce the toll of human suffering. It is, as Abbadi notes, a benefit to all Moroccans.

Imams taking the training at a recent workshop in Rabat credited Islam for its endorsement of valuing every person. But at the same time, people known to be HIV-infected face isolation, social sanction, and cruelty. At ALCS we met a woman who only consented to an interview once her face and head were completely covered. HIV positive for decades, she lost her young husband and baby to AIDS around the same time she learned she was infected. Her status is known to only a few friends and family. She can’t take the risk of letting more people know, she told me, because her family would be cut off by neighbors and friends.

She paused, and enormous tears soaked her veil. Her husband was the only sex partner she’s ever had, and he’s been dead for 20 years. This was not the life she had ever imagined for herself, a middle-aged woman with no husband and no children in a culture that places heavy emphasis on both. Off-camera she’s vivacious, outgoing, and friendly — her life saved by anti-retrovirals — but at the same time constantly confronted by the virus her husband brought into their home.

Her fear is a reminder of how far Morocco still has to go. In many ways the country is on the road to a successful response to AIDS. There are still thousands of new infections annually in this country of more than 30 million, guaranteeing the response to HIV must stretch for decades into the future.