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Brian Kanyemba, Research Assistant/AVAC Fellow/IRMA Advocate

Brian Kanyemba, Research Assistant/AVAC Fellow/IRMA Advocate. PrEP and Criminalization of Men who Have sex with Men in Africa. Overview. General Definition. Chemoprophylaxis before Exposure * Oral Prep: TDF/FTC - Currently used as part of treatment.

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Brian Kanyemba, Research Assistant/AVAC Fellow/IRMA Advocate

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  1. Brian Kanyemba, Research Assistant/AVAC Fellow/IRMA Advocate

  2. PrEP and Criminalization of Men who Have sex with Men in Africa

  3. Overview M2012 Presenation by Brian Kanyemba

  4. General Definition Chemoprophylaxis before Exposure * Oral Prep: TDF/FTC - Currently used as part of treatment. - Can be prescribed by private physician as PrEP (MSM, Sero-discordant couples) - Waiting for FDA Licensure * (Topical PrEP) Medicated lubrication Tenofivir gel MTN007, incoming MTN017 M2012 Presenation by Brian Kanyemba

  5. Global iPrEX Results 2010 iPrEX study showed that taking the study medication daily reduced HIV infection among MSM by an average of 43.8% overall. Was combined with standard prevention tools (condoms, risk reduction, HCT) M2012 Presenation by Brian Kanyemba

  6. iPrEx Open Label Studies iPrEx Ole • iPrEx Open Label Extension will provide unique opportunities to address questions on PrEP safety and how efficacy might affect risk behavior and pill use. • Results expected in 2013 HPTN 067 • Phase II, Randomized, Open-Label, Pharmacokinetic and Behavioral Study of Intermittent use of Prep • Among MSM in Thailand and WSM in South Africa. M2012 Presenation by Brian Kanyemba

  7. PrEP as Comprehensive Package of Care • Consistent use of condoms • Lubrication use/water based lubricants • Risk reduction counseling • Regular HCT M2012 Presenation by Brian Kanyemba

  8. Men Who Have Sex With Men MSM = Men who have sex with men • Includes: gay-identified, bisexual, transgendered (male to female), straight-identified • Any individual who was born male and has sex with other men. M2012 Presenation by Brian Kanyemba

  9. Epidemiology of HIV of MSM in Africa M2012 Presenation by Brian Kanyemba

  10. HIV Prevalence among MSM in Africa 6.2% (267) Egypt 21.5% (463) 21.8% (501) 9.3% (713) 7.3% (406) 25.0% (N/A) 13.4% (1,125) Senegal Sudan 4.9% (1,778) 4.4% (90) Nigeria 24.6% (285) Ghana Tunisia Morocco Legend 5.7% (259) 5.9% (262) Kenya Tanzania 12.3% (509) 21.4% (201) 2002 2003 17.2% (1,291) 12.4% (218) Malawi 2004 19.7% (117) 13.3% (215) 2005 Namibia 28.9% (249) 2006 The Gambia Botswana 13.2% (306) 2007 25.0% (200) Uganda Soweto 2008 10.6% (538) Cape Town (Township) Cape Town 40.7% (285) 2009 2010 2011 M2012 Presenation by Brian Kanyemba Modified From : van Griensven, Baral, et al. The Global Epidemic of HIV Infection among Men who have Sex with Men. Curr Opinion on HIV/AIDS, 2009

  11. Data Quality M2012 Presenation by Brian Kanyemba

  12. Sources of HIV Infection • 1. Low risk heterosexual 57.6% • 2. Casual heterosexual 7.5% • 3. Partners of casual heterosexual 18.8% • 4. Clients of heterosexual 6.4% • 5. Men who have sex with men (MSM) 4.0% • 6. Male partners of MSM 2.7% • 7. Female partners of MSM 0.4% • 8. Sex workers 1.4% • 9. Injecting Drug Users (IDU) 1.1% • 10. Partners of IDU 0.1% • Medical Injections 0.1% • Interestingly ZNASP II has targeted MSM as a key population • Prevention strategies such as condoms,HCT and prevention and control of STIs are not available or easily accessible for this community. • A need of acceleration of education and awereness. • Source: ZNASP 2011-2015

  13. Level of Risks Stage of Epidemic Public Policy Community Network Individual Ecological Model for HIV Risk in MSM HIV Epidemic Stage Exclusion from National Surveillance, Criminalization, Human Rights Contexts, Sexual Health Education Access to preventive services, Stigma, VCT Access, ARV Access STI Prevalence, Condom knowledge, IDUs, MSW, Transgenders Unprotected Receptive Anal Intercourse, GUD, frequency of male partners, high lifetime partners, IDU, NIDU M2012 Presenation by Brian Kanyemba Source: Baral and Beyrer, 2006

  14. Crimilization of MSM in Africa M2012 Presenation by Brian Kanyemba

  15. The Challenge of Politics and Discrimination • Homosexuality is outlawed in 38 African countries. • In 13 nations homosexuality is either legal or there are no laws pertaining to it. • Providing MSM focused services, or enrolling MSM into studies in these countries becomes a major challenge M2012 Presenation by Brian Kanyemba

  16. Zimbabwe • No data in HIV prevalence among MSM • Advocates and activists struggling advocate for condom use and other safe HIV prevention methods for the community. • Any interference from any funder towards prevention is deemed political. M2012 Presenation by Brian Kanyemba

  17. ZIMBABWE • Mugabe said gays are "worse than pigs and dogs because pigs know there are males and females. I won’t even call him (gay) a dog because my own dog will complain." • Mugabe, according to Daily Mail, made it clear in the speech broadcast by the country's state-owned television network that his country Zimbabwe, would never tolerate homosexuality or give support to gay rights. M2012 Presenation by Brian Kanyemba

  18. ZAMBIA Legislation • Zambian penal code explicitly criminalizes same sex sexual relations between men …..Or any person who has carnal knowledge of any person against this order of nature” . • MSM, who lack accurate prevention strategies and information, engage in unsafe sex practices and thus risk being at the forefront of further spreading the epidemic. One common misapprehension is that HIV cannot be transmitted through anal intercourse”. For more details on these and other statement, see HRBA Helpdesk: http://msc.st/ThemeLGBT.html#BF M2012 Presenation by Brian Kanyemba

  19. Zambia • No data exists. • Friends of Rainka again attempted an MSM research/ prevalence study in August 2010 but this attempt has failed. • The National Aids Council has refused to endorse such a study because it states that a Christian nation cannot condone such activity. • Created a gap in the proposed National Health Strategic Plan of 2011, MSM will not be included in the National Prevention/Intervention rollout programmes. M2012 Presenation by Brian Kanyemba

  20. Malawi, May, 2011 M2012 Presenation by Brian Kanyemba

  21. Arrests in Malawi M2012 Presenation by Brian Kanyemba

  22. David Kato in Uganda (1969-2011) M2012 Presenation by Brian Kanyemba

  23. Uganda, May, 2011 We also know of efforts by some MPs to turn it around and get rid of the bill in favor of the gays.” Pastor Martin Ssempa PEPFAR Sub-Grantee of PSI, 2004 http://www.pepfar.gov/partners/76136.htm M2012 Presenation by Brian Kanyemba

  24. Anti-Homosexuality Bill Uganda 2009-to date • Increased criminalization of MSM, Death. • Removal of Support structure by demanding relatives and friends report. • Criminalizing Services and support programs as ‘Promotion of Homosexuality’ M2012 Presenation by Brian Kanyemba

  25. Kenya • Laws criminalizing the MSM have stiff Human Capital and Financial Price tag. • Criminalization of MSM undermines Cost Efficiency and Effectiveness of HIV Response. • Strategies for Decriminalization with Reduced Political and Social Cost Source: Breaking the Wall of Criminalization, David KuriaMbote M2012 Presenation by Brian Kanyemba

  26. Perspectives from African Countries • Advocacy for PrEP as 'immoral', encouraging homosexuality, encouraging illegal sex. • iPrex study done on MSM as immoral, against cultures and values. • Why PrEP for MSM, talk about Malaria for the whole Population. • Issue of diversion of resources to an 'illegal group' • - Funding does not reach the group - Funds diverted for other issues • MSM, Illegal, thus invisible M2012 Presenation by Brian Kanyemba

  27. PrEP and MSMWay Forward M2012 Presenation by Brian Kanyemba

  28. South African Model • Laws protects MSM • Successful MSM studies done.(DTHF) • Community engagement towards PrEP information dissemination(DTHF,AVAC) • Data disseminated and influenced NSP and Prep Guidelines. • More information please see poster 147 • Challenges? Change of community perspectives. M2012 Presenation by Brian Kanyemba

  29. PrEP, MSM and Crimilization • Set a stage of an ongoing advocacy to condone Crimilization. • Hold governments accountable on what they mean as MARPs/Key Populations, where funding is going. • More research in MSM is needed as an evidence base to influence changes of policies on HIV prevention. • Beyond Crimilization. M2012 Presenation by Brian Kanyemba

  30. The Champions-A team of ex-presidents and states persons that are on a crusade to influence African governments to decriminalize homosexuality if countries were to see a reduction in HIV infections by 2015. M2012 Presenation by Brian Kanyemba

  31. Acknowledgements • Stefan Baral, Baltmore • David Kuria Mbote, Nairobi • Paul Semugoma, Cape Town/Kampala • Samuel Matsikure, Harare • Lundu Mazoka, Lusaka • Lloyd Rugara,Cape Town • Ben Brown and DTHF Study • Manju Chatani and AVAC family • Alliance Nikuze, Stockholm M2012 Presenation by Brian Kanyemba

  32. Contact details Desmond Tutu HIV Foundation Men’s Research Division Brian.Kanyemba@hiv-research.org.za +27 21 650 6969 www.desmondtutuhivfoundation.org.za M2012 Presenation by Brian Kanyemba

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