Background Countries in the Middle East and North Africa are experiencing emerging HIV epidemics in high-risk populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSWs). This study was initiated by the Morocco Ministry of Health to identify the key modes of exposure to HIV infection among the Moroccan population and to provide recommendations for national HIV prevention strategies for the coming years. This work represents the second national modes of transmission (MoT) analysis in Morocco after the 2010 MoT study. Methods The MoT mathematical model developed by the Joint United Nations Programme on HIV/AIDS was used to update the 2010 model results. The model was parameterized based on recent integrated bio-behavioral surveillance survey (IBBSS) studies and quality data provided by the Morocco Ministry of Health and through a comprehensive review and synthesis of HIV and risk behavior data in Morocco. Uncertainty analyses were used to assess the reliability of, and uncertainty around, our calculated estimates. Results FSWs, clients of FSWs, MSM, and PWID contributed 11.1%, 24.7%, 22.4%, and 4.8% of new HIV infections, respectively. More than two-thirds (70%) of new HIV infections occurred among FSWs, clients of FSWs, MSM, and PWID, or among the stable sexual partners of these populations. Casual heterosexual sex contributed 8% of HIV infections. About half (44%) of HIV incidence was among females, but 73% of these infections were due to an infected spouse. The vast majority of HIV infections among men (92%) were due to high-risk behavior. A very small HIV incidence was predicted to be arising from medical injections or blood transfusion (0.1%). Conclusions The HIV epidemic in Morocco is driven by HIV incidence in high-risk groups, with commercial heterosexual sex networks being the leading driver of the epidemic, and MSM networks contributing to a larger share of new HIV infections than the 2010 model estimates (24% versus 14%). There is a need to further focus HIV response on high-risk populations through scaling up of prevention services such as condom promotion among FSWs and their clients, voluntary counseling and testing, harm reduction, and expanded treatment coverage. It is also essential to continue with repeated rounds of IBBSS studies among these population groups.


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