North Africa and Near East Regional Programme

Analysis of the results of the participatory community assessment

In 2005, 64,000 people were newly infected with HIV in North Africa and the Middle East. Some 440,000 adults and children in the region are now living with HIV, up from 380,000 in 2003. Despite HIV prevalence being relatively low in this region (0.2%), experts agree that there is great potential for a massive increase in the number of people infected if the epidemic spreads from its concentration among men who have sex with men (MSM) to the general population:

  • In the Maghreb, as in Lebanon, many men who have sex with men also have sex with women. Most of the time, these sexual relations are not protected, which places their female partners (and any future children) at risk.
  • The social and religious taboos linked to sex between men and the risk of discrimination lead many to conceal their sexual orientation and/or practices, particularly from health professionals. This makes the screening and treatment of HIV and other sexually transmitted infections difficult. Because of this, there are few prevention and care programmes in the region specifically for MSM.
  • The political and social instability that occurred during and following the civil wars in Algeria and Lebanon may also have prevented the full development of HIV prevention and awareness raising programmes among the general public.

Considered together, these characteristics of the Maghreb and Lebanon make a strong case for starting prevention and support programmes targeted at the region’s men who have sex with men.

What we do

The North Africa and Near East regional programme aims to respond to the sexual health needs of gay men and other men who have sex with men in Algeria, Morocco, Tunisia and Lebanon. The Alliance implements this programme through six organisations:

  • Association de lutte contre le SIDA (ALCS) and Association Marocaine de Solidarité et Développement (AMSED) in Morocco
  • SIDC and Helem in Lebanon
  • ATL in Tunisia
  • APCS in Algeria

All are involved in HIV programmes and in supporting vulnerable and stigmatised populations in their respective countries.

The programme has developed in two key stages. Firstly, participatory community assessments (PCAs)were carried out in each country and site with local community groups to mobilise MSM and identify their sexual health needs. The results of these PCAs then informed the design of the regional and country prevention programmes for men who have sex with men.

Building on the principle of community participation, and the success of the PCA process, the main strategies adopted by these projects in their countries and sites include:

  • community mobilisation
  • outreach work and peer education
  • participatory development of educational materials
  • setting up specialised communication and support services such as telephone hotlines and safe spaces/drop-in centres
  • referral systems to help provide access to medical and support services for sexually transmitted infections, voluntary counselling and testing centres, psychologists
  • small scale advocacy activities.

Regional meetings involving all the partners have promoted exchange of good practice and learning. Other regional activities have included exchange visits between the partners, the sharing and development of regional resources and tools, and development of a regional communication strategy.

What the Alliance has achieved

The Alliance has developed partnerships with six new implementing organisations in three new countries in the region: Algeria, Lebanon and Tunisia (it has been working with AMSED for a number of years already). The participatory community assessment (PCA) process has been successful in mobilising and involving the men who have sex with men community, identifying their sexual health needs and planning how to meet them. Each project has a coordinator employed by the implementing organisation, and in three out of four countries the coordinator was recruited from the community of men who have sex with men.

Groups of men who have sex with men (MSM) have been given basic HIV/STI information aimed at addressing their specific needs, they have also been trained as peer educators and outreach workers. Sessions have been held to develop participatory tools and several information, education and communication materials have been developed in French and Arabic. These resources have now been tested and are now available to use (see links under related resources).

The Alliance secretariat has provided technical and financial support to assist the partners to integrate these new projects into their existing work. For example, new administrative and financial systems have been set up, as well as staff recruitment, volunteer training, and monitoring and evaluation systems.

The project has enabled the strengthening of solidarity and support within the MSM community across the region, creating a regional network of MSM individuals and organisations to promote a focus on the sexual health needs of MSM, valuing the community’s input and leadership and affiliating them to local civil society organisations.

Linkages have been developed between the partners and local health services in all four countries, and voluntary counselling and testing and psychosocial support services are now part of an effective referral system for MSM.

8,292 MSM and health providers have been reached with health promotion outreach activities and targeted trainings.

Future plans

A workshop involving all Alliance partners took place between the 13th and 15th December 2007 in Tunis. The first objective of the meeting was to review and reflect on the successes, opportunities, challenges and lessons learnt from implementing the North Africa MSM regional programme. The second objective was to reflect on future priorities and opportunities for addressing the sexual health needs of men who have sex with men in the region.

The final evaluation report, which will be the output of the regional evaluation process that started in June 2007, is expected to be completed and disseminated by the end of 2008.