Universal access to sexual and reproductive health services among women affected by HIV in Morocco: What reality?

Background: HIV remains a major global public health problem, resulting in 40.1 million deaths since the beginning of the epidemic. In 2021, 38.4 million people were living with HIV, 54% of who are women and girls. In Morocco, the number of people living with HIV (PLHIV) is 23,000 of which 63% of cases have been reported in three regions (Souss Massa, Casablanca and Marrakech). The objective of this study describe the barriers to access sexual and reproductive health for women living with HIV in Marrakech, Morocco. Methods: This study is a mixed quantitative and qualitative descriptive study. The study population is composed of women living with HIV receiving health services in the prefecture of Marrakech. A questionnaire survey and interviews were conducted to gather descriptive data on this population, as well as to collect information on the accessibility of sexual and reproductive health care for this category of women. Results: The average age of the women interviewed was 38.64 +/- 8.58 (20 to 58 years). The majority of the women (89%) were from Marrakech with a clear predominance of urban areas (72%). The difficulties in accessing reproductive health services were reported by women surveyed, particularly for gynecological examinations (66.70%), family planning (33.30%) and psychosocial support (66.70%). The results of this study showed that HIV-positive women's access to reproductive health services depends on several barriers at different levels. Stigma and discrimination are still the main concerns of HIV-positive women in our context in addition to economic barriers. Conclusion: Measures to improve access to and utilization of reproductive health services for women living with HIV must integrate all the biological, psychological and social (attributes) of these women with a change in provider behavior and a reorganization of services to ensure more integration and coordination of care between different levels of care.