1 / 31

Public Health: MSM and HIV

Public Health: MSM and HIV. Brian White February 13, 2013. “Sex between men occurs in every culture and society, though its extent and public acknowledgement vary from place to place ” UNAIDS 2006. AMSHeR African Men for Sexual Health and Rights.

prosper-dillard
Download Presentation

Public Health: MSM and HIV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Public Health: MSM and HIV Brian White February 13, 2013

  2. “Sex between men occurs in every culture and society, though its extent and public acknowledgement varyfrom place to place” UNAIDS 2006

  3. AMSHeR African Men for Sexual Health and Rights Regional coalition of MSM/LGBT led organizations and other organizations that work to address the vulnerability of gay and bisexual men, Male-to-female transgender women and other MSM, to HIV. www.amsher.net

  4. AMSHeR African Men for Sexual Health and Rights 18 organizations in 15 countries: Burundi, Cameroon, Cote d'Ivoire, Ghana, Kenya, Malawi, Mozambique, Namibia, Nigeria, South Africa, Tanzania, Togo, Uganda, Zambia and Zimbabwe.

  5. Definition: “Men who have sex with men” is an inclusive public health construct used to define the sexual behaviours of males who have sex with other males, regardless of the motivation for engaging in sex or identification with any or no particular community

  6. A very diverse grouping of men: race culture education classreligion age health income physical Only one factor in common sexual behaviour! But even here they differ in: Who they have sex withWhat type of sex they have

  7. Myths & stereotypes: All MSM … … are transgender (want to be women) ... were abused as children... are sexually interested in children... are promiscuous or highly sexed ... are unAfrican/Christian/Natural... are effeminate, visibly identified... 'chose' their orientation... are failed heterosexuals

  8. In low- and middle-income countries, MSM are 19 times more likely to be living with HIV than people in the general population and they represent an estimated 10 percent of new infections each year. Yet for decades the epidemic among MSM was officially ignored by governments, donors, and whole societies. amFAR & Johns Hopkins Achieving an AIDS-free Generation

  9. AFRICAN MSM ARE: • Hidden • Do not identify with “gay culture” • Also having sex with women • Not assessing their own HIV risk (lack of education and prevention) • Often stigmatized and judged • Not being identified in existing client cohorts • Not identified and cared for by health care providers due to lack confidence and skills

  10. HIV Prevalence: • Recent studies from sub- Saharan Africa report HIV prevalence among MSM ranges from 6% to 31% • HIV incidence of 21.7 per 100 person years among MSM in a small cohort from coastal Kenya • Little data from Africa on HIV in diverse MSM populations, or by risk factor

  11. HIV Prevalence in MSM in Africa: Sanders, E. HIV epidemic among MSM in Africa. Technical consultation on MSM, WHO, Geneva, 15-17 September, 2008, Bongaarts J et al, 2008

  12. Criminalization in Africa: Homosexuality is outlawed in 38 African countries. In 13 nationshomosexuality is either legal or there are no laws pertaining to it. Same-sex sexual activity legal Same-sex marriage recognized Other type of partnership (or unregistered cohabitation) recognized No recognition of same-sex couples Same-sex sexual activity illegal Penalty Life in prison Death penalty http://en.wikipedia.org/wiki/LGBT_rights_in_Africa

  13. Government response: In Mozambique, MSM remain uncounted, unrepresented, and underserved in the HIV epidemic; there are no official government programs for MSM despite the millions of dollars in donor aid for HIV; and stigma and discrimination keep MSM from obtaining healthcare.

  14. In Ethiopia, the government openly refuses to recognize, track, or provide services to MSM; the few organizations that work with MSM remain silent for fear of official persecution; and many MSM forego seeking medical care because of discrimination.

  15. In Nigeria, MSM-targeted programs are donor-driven, with limited government buy- in; the few programs that exist are aimed at largely urban populations; and same-sex sexual practices, which are punishable by death in parts of Nigeria, remain highly stigmatized.

  16. Ghana, which condemns homosexuality, is distinguished from most countries in sub-Saharan Africa by the level of activity addressing HIV among MSM. With donor support, HIV programming for MSM has been developed in the country. Although the Ghanaian government has not publicly embraced these efforts, officials have also not prevented the development of these interventions despite the legal prohibition of homosexual behavior.

  17. Donor response: • GLOBAL FUND: • Population officially a priority • Infrequently addresses MSM needs • 2009: Sexual Orientation and Gender Identities (SOGI) strategy • 10% of all Global Fund money was directed to MARPs and 2% to MSM • MSM activities are deprioritized during grant negotiations • Program attritionrates higher

  18. PEPFAR: • Funds to MSM increased in most of the eight countries studied • Funding remains limited and inadequate • 2011 PEPFAR issued field guidance on addressing HIV among MSM • governments may still restrictMSM-related services • Four countries that criminalize same-sex sexual practices proposed far fewer MSM-related activities and dedicated smaller percentages of their country budgets to them

  19. Others: Embassy of Netherlands SIDA Schorer COC International HIV/AIDS Alliance Hivos Atlantic Philanthropies And many more…

  20. MSM Sexual Behaviour: • Diverse circumstances • Experiences, lifestyles, behavioursand associated risks for HIV vary greatly • MSM may also have sex with women: • HIV+ = risk to woman • HIV- = risk to man • Often married • Adolescent males experiment • In all-male environments, such as prisons

  21. Why sexual behaviour matters: • Unprotected anal sex is main risk for MSM • (Most anal sex occurs between men and women!) • Previous health & risk reduction messaging has not targeted MSM & is largely silent about anal sex • Anal walls are not adapted for sex: • Thin mucosal surface • Not self lubricating • Mucosal tears are HIV entry-point • Need condoms & LUBE

  22. An Integrated Response: • Evidence for promising biomedical interventions to reduce HIV risk • No “magic bullet” • Treatment IS prevention • Combination HIV prevention have synergistic impacts on incidence

  23. Combination prevention:

  24. An Integrated Response: PEPFAR: core elements of comprehensive HIV-prevention services for MSM and their partners to be: • Community-based outreach• Condoms and condom- compatible lubricants• HIV counseling and testing• Active linkage to health care and antiretroviral treatment (ART)• Targeted information, education and communication (IEC)• Sexually transmitted infection (STI) prevention, screening and treatment PEPFAR: Techncal Guidance on Combination Prevention May 2011

  25. Other opportunities: • Nation-wide HIV preventionmessages targeting unprotected anal intercourse • Expand biomedical prevention – ART as prevention in PEP and PrEP and early treatment for high risk populations • Integrate MSM package within general prevention to address stigma • Focused interventions on positiveprevention • Utilise social media and new technologies

  26. Integrating Structural and Biomedical • STRUCTURAL • Decriminalization • Government-sponsored anti-homophobia policy • Mass media engagement • Male engagement programs • Community systems strengthening • Health Sector Interventions BIOMEDICAL • Condoms & lube • Behavioural • VCT • STI treatment • Circumcision • ARV strategies • Rectal microbicides

  27. Sex Positive: • Alienating effect of hetero- normative messaging • Gay/msm-friendly messaging to normaliseand celebrate male-to-male sexuality • Recognisethe effects of homoprejudice • Instill a sense of respect for self and others • Identifies a paradigm for messaging ‘resistant’ MSM • Does not alienate MSM+ Health 4 Men Program South Africa

  28. “There is progressamong national and multilateral systems in addressing the needs of MSM, but also reveals a public health response that remains dangerously inadequate, stymied, and ultimately undermined by stigma and discrimination. Still, the examples of positive change combined with scientific advances and increased awareness about the needs of MSM, give hopefor a more equitable response to the AIDS epidemic among MSM worldwide.” amFAR & Johns Hopkins Achieving an AIDS-free Generation

  29. Resources: Internet: • AMSHeRwww.amsher.net • International HIV/AIDS Alliance www.aidsalliance.org • AIDSTAR-Onewww.aidstar-one.com • PEPFAR www.pepfar.gov • Global Forum on MSM & HIV www.msmgf.org • Hivoswww.hivos.nl/english • Schorerwww.schorer.nl • OUT www.out.org.za • Health 4 Men www.health4men.co.za

  30. Questions?

  31. With many thanks! Brian Whitebrian@amsher.netwww.amsher.net+27 72 270 9577

More Related