Service Delivery for Vulnerable Groups Health4Men

1. Service Delivery for Vulnerable GroupsHealth4Men Helen Struthers, PHRU

2. Death Rates by age per 100,000 by sex: 1997 and 2004 Source: Statistics SA: Adult Mortality (age 15-64) based on death notification data in South Africa: 1997-2004

3. Constitution and HIV/AIDS Strategic Plan • South African Constitution – Bill of Rights • The equality clause states: “The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth” Chapter 2, Clause 9(3)). • Operational Plan for Comprehensive HIV and AIDS Care and Treatment for South Africa - 2003 • Universal care and equitable access regardless of “race, colour, gender and economic status • National Strategic Plan for HIV/AIDS and STI’s (2007 – 2011) • expands on the 2003 plan with guiding principles including promoting social change and cohesion, talking inequality and poverty, promoting equality for women and girls, recognising diversity, ensuring equality and non-discrimination and personal responsibility. Through these principles the vulnerability of women and girls, gender violence, male sexual health and high-risk groups are addressed.

4. HIV prevalence among ANC attendees PHRU Soweto PMTCT service, 1987 - 2008 South Africa National Survey, 1990 to 2007 100 fold increase: from 1 in 300 to 1 in 3 over 20 years Source: 1] PHRU, 2] SA Dept. of Health, 2008

5. MSM Prevalence studies in Soweto • Soweto MSM Study: Respondent driven sampling design • 368 Soweto resident MSM • HIV prevalence 25.3% overall – 49% in MSM 20 - 49 • 33.1% of men who reported women among their last 5 partners report unprotected anal intercourse (UAI) with other men (54/163) • >90% of UAI among MSM+W is reported as insertive, but 39.6% reported unlubricated UAI Source: Lane, Dladla, Struthers & McIntyre, AIDS Priorities Conference, 2008

6. HIV among Youth in South Africa Source: 1] HIV Prevalence, Incidence, Behaviour and Communication Survey 2005, HSRC, Nelson Mandela Foundation. 2] Soweto Men’s Study, Lane, T. et al, ICASA 2008

7. Prevention and treatment initiatives for MSM playnice Health 4 Men An innovative, multimedia campaign promoting safe sex, health sexuality, HIV counselling and testing and care and treatment to MSM of all races and ages in South Africa A comprehensive HIV and STI testing, and HIV/AIDS care and treatment clinical service, predominantly aimed at MSM, in male friendly dedicated public sector facilities.

8. The range of PHRU activities Community prevention strategies Individual prevention strategies VCT PMTCT Medical care and monitoring OI prevention & treatment Antiretroviral treatment PREVENTION TREATMENT CARE Impact of HIV & national and international policy and advocacy Psychosocial care and support: PLWA and families

9. Health4Men Services • Risk assessment • Sexual behaviour • Drug use • Specific at-risk MSM (Sex workers, discordant couples) • Sexual health assessment • Clinical STI screening including assessment of anal and prostatic health • VDRL • Hepatitis A antibodies • Hepatitis B antibodies (and antigen if HIV positive) • VCT (with CD4 and appropriate linkage to care)

10. Health4Men Services • Mental health assessment • Double stigma and discrimination due to MSM and HIV status • High depression rates (gay teenage suicide rates...) • Relationship and support issues • Risk reduction measures • Counselling and referral (drug and alcohol) • Hepatitis A and B vaccination • Condoms and lube for Africa

11. Health4Men Services • HIV assessment • Huge variation in knowledge • Huge variation in expectations of treatment • Specific HIV treatment issues among MSM • D4T is often not acceptable • Recreational drugs • Anabolics

12. Thanks!