SAMAR: Strengthening community-based anal health services in Morocco

The community–based research project SAMAR (ANRS 0682), launched in March 2026, aims to improve anal health services in Morocco for men who have sex with men (MSM) and sex workers (SW), whether or not they are living with HIV. It forms part of the work of the sexual and reproductive health clinics (CSSR) run by the Association for the Fight against AIDS (ALCS), where anal health has been integrated since 2022 in response to growing needs observed during consultations.

The aim of the project is to assess the acceptability of these services among all stakeholders, to integrate screening for high-risk human papillomavirus (HR-HPV) infection, and to adapt the services to the needs of those concerned.

Background to the SAMAR project

A health need that remains inadequately addressed

Anal cancer remains rare in the general population (0.35 per 100,000 person-years in men and 0.57 in women), but the risk is significantly higher in certain populations. It is 85 times higher in MSM living with HIV and eight times higher in HIV-negative women, suggesting high exposure among sex workers.

In 90% of cases, this cancer is linked to infection with high-risk human papillomavirus (HR-HPV), a sexually transmitted infection that can occur despite condom use and is more common among people living with HIV. Regular screening, including a proctological examination with anoscopy and biopsies if necessary, is therefore essential among at-risk populations.

However, access to these services remains limited by multiple barriers: taboos surrounding anal health, stigmatisation of at-risk groups, a lack of knowledge about anal cancer and its screening, and limited experience among doctors with proctological examinations.

A project rooted in the Moroccan context

In Morocco, the stigmatisation of people living with HIV is a major barrier to accessing healthcare services. While the epidemiology of HPV is well documented in women, it primarily concerns cervical infection and remains poorly understood in men and regarding anal localisations.

ALCS activities reveal an increasing prevalence of anal conditions during STI consultations at CSSRs. This trend has led to the training of doctors in anal health and the integration of this aspect into prevention and care services.

SAMAR is part of this initiative, helping to strengthen and adapt it, in particular by incorporating HPV screening via anal self–sampling (APA).

Objectives of the SAMAR project

A mixed-methods approach

The project is based on three complementary components:

• Qualitative component: to understand the motivations and barriers to accessing anal health services among MSM and TS attending ALCS CSSRs, whether or not they are living with HIV, as well as the perceptions of doctors and community health workers. Combining these perspectives will help identify the adjustments needed to provide appropriate care within a community setting.
• Clinical component: to describe the epidemiology of anal HPV infections among MSM and TS living with HIV, as well as the symptoms and anal conditions observed during proctological consultations, including the use of anoscopy.
• Quantitative component: collect sociodemographic, economic and psychosocial data; explore healthcare uptake, knowledge of HPV, history of anal conditions, and aspects of sexual health and life; and assess the retrospective acceptability of the proposed anal healthcare services among participants (self-sampling screening and proctology consultation).

Expected benefits for care

The SAMAR project will generate unprecedented data on anal HPV infection among MSM and TS living with HIV in Morocco, in a context where such information is currently lacking. It will also enable the assessment of the acceptability of anal consultations and anal self-sampling in a Global South country, as well as the value of a community-based approach.

Finally, SAMAR will help to establish a referral and care pathway tailored to the needs of the populations concerned, by strengthening links between the ALCS’s CSSRs and the national healthcare system.