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

• Published in: International journal of behavioral medicine Vol. 32; no. 4; pp. 597 - 607
• Main Authors: Phatak, Gauri, Johnston, Lisa G., Khoudri, Ibtissam, Rhilani, Houssine El, Kettani, Amina El, McLaughlin, Katherine R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2025; Springer Nature B.V
• Subjects: Adolescent; Adult; Aggression; Behavior; Data collection; Disease prevention; Disease transmission; Domestic violence; Family Medicine; Female; Full Length Manuscript; General Practice; Health Knowledge, Attitudes, Practice; Health Psychology; Health services; HIV; HIV Infections - psychology; HIV Infections - transmission; Human immunodeficiency virus; Humans; Knowledge; Medical tests; Medicine; Medicine & Public Health; Middle Aged; Morocco; Prostitution; Regression analysis; Sex industry; Sex Workers - psychology; Sex Workers - statistics & numerical data; Sexually transmitted diseases; Social Stigma; STD; Stigma; Syphilis; Trends; Violence - psychology; Young Adult; Morocco; Kenya; Female sex worker; Discrimination; Morocco; Violence; Respondent-driven sampling
• ISSN: 1070-5503; 1532-7558; 1532-7558
• DOI: 10.1007/s12529-023-10237-3

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.