title: The distribution of new HIV infections by mode of exposure in Morocco.
abstract: OBJECTIVE
  Building on a wealth of new empirical data, the objective of this study was to estimate the distribution of new HIV infections in Morocco by mode of exposure using the modes of transmission (MoT) mathematical model.
  
  
  METHODS
  The MoT model was implemented within a collaboration with the Morocco Ministry of Health and the Joint United Nations Programme on HIV/AIDS. The model was parameterised through a comprehensive review and synthesis of HIV and risk behaviour data in Morocco, mainly through the Middle East and North Africa HIV/AIDS Synthesis Project. Uncertainty analyses were used to assess the reliability of and uncertainty around our calculated estimates.
  
  
  RESULTS
  Female sex workers (FSWs), clients of FSWs, men who have sex with men (MSM) and injecting drug users (IDUs) contributed 14%, 24%, 14% and 7% of new HIV infections, respectively. Two-thirds (67%) of new HIV infections occurred among FSWs, clients of FSWs, MSM and IDUs, or among the stable sexual partners of these populations. Casual heterosexual sex contributed 7% of HIV infections. More than half (52%) of HIV incidence is among females, but 71% of these infections are due to an infected spouse. The vast majority of HIV infections among men (89%) are due to high-risk behaviour. A very small HIV incidence is predicted to arise from medical injections or blood transfusions (0.1%).
  
  
  CONCLUSIONS
  The HIV epidemic in Morocco is driven by HIV incidence in high-risk population groups, with commercial heterosexual sex being the largest contributor to incidence. There is a need to focus HIV response more on these populations, mainly through proactive and sustainable HIV surveillance, and the expansion and increased geographical coverage of services such as condom promotion among FSWs, voluntary counselling and testing, harm reduction and treatment.
authors: Infectious Disease Epidemiology Group, Weill Cornell Medical College-Qatar, Cornell University, Qatar Foundation, , Education City, Doha, Qatar.
authors: Ghina R
authors: GR
authors: Mumtaz
authors: Silva P
authors: SP
authors: Kouyoumjian
authors: Nahla
authors: N
authors: Hilmi
authors: Ahmed
authors: A
authors: Zidouh
authors: Houssine
authors: H
authors: El Rhilani
authors: Kamal
authors: K
authors: Alami
authors: Aziza
authors: A
authors: Bennani
authors: Eleanor
authors: E
authors: Gouws
authors: Peter Denis
authors: PD
authors: Ghys
authors: Laith J
authors: LJ
authors: Abu-Raddad
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009018:Morocco / Q000453:epidemiology; D015995:Prevalence; D018571:Sentinel Surveillance; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*