Promoting the health of men who have sex with men worldwide

2. Promoting the health of men who have sex with men worldwide A training curriculum forproviders

3. Background and Context • Gay men and other men who have sex with men (MSM) around the world face significant challenges to accessing healthcare services • Knowledge, skill, and sensitivity needs among healthcare providers inadequately addressed by general medical education curricula

4. The MSMGF-JHU Curriculum for Providers • Arms local community groups with the ability to independently implement training programs to build cultural and clinical competency among healthcare providers

5. What are the nine modules? Understanding Gay Men and Other MSM Sexuality and Health Barriers to Health Creating a Friendlier Environment Promoting Mental Health Taking a Sexual History Supporting Gay Men and other MSM Who Use Drugs and Alcohol Interventions for HIV and STI Prevention Clinical Care for HIV and other STIs

6. Are there any accompanying materials? • Participant’s guide and deck of PowerPoint slides to accompany each module are available for download from www.msmgf.org/promotinghealth • Instruments to evaluate the process and outcomes of the training are also provided. The evaluation tools are designed to assess: • Learning needs assessment. • Pre- and Post- Assessment • Process Evaluation (Overall Satisfaction) • Follow-up Surveys • Providers • Clients

7. Pilot Test with GALZ, Zimbabwe

8. Pilot Training Design • Of the nine modules, five of the curriculum’s nine modules were presented over 1.5 days, including: • Module 1: Understanding Gay Men and Other MSM. • Module 2: Sexuality and Health • Module 3: Barriers to Health • Module 4: Creating a Friendlier Environment • Module 6: Taking a Sexual History

9. Evaluation Results

10. Evaluation Results

11. Evaluation Results

12. Evaluation Results

13. Guiding Framework • Sexual Health Framework • Move away from a disease model • Focus on strengths-based approaches and sexual harm reduction • Designed for easy adaptation • Modular facilitating use of specific modules; Offers flexible training options • Complements local training efforts and tools • Knowledge, Attitudes, Skills

14. Each Module • Robust and detailed technical content: Topline messages around each sub-topic • What you need to know about x topic • Facilitator’s Tips: To enhance the training process/experience • 2 Group Activities: To ensure learning is experiential and to instigate attitudinal change • 1 Case Study: To contextualize learning • Pre-Assessment Questions • To customize the training to learning needs of providers and see where participants are • Post-Assessment: To verify if learning has occurred • Pre-Reading Assignment: To encourage self-reflection among participants • e.g. a media/news piece by Ugandan tabloid • Additional Reading: To help interested participants to delve deeper on relevant topics

40. Promoting the health of men who have sex with men worldwide A training curriculum for providers

41. Module 1:Understanding Gay Men and Other MSM

42. Learning Objectives 1 Define MSM and common sexual practices 2 Identify unique health issues faced by gay men and other MSM Discuss provider roles in addressing the health needs of gay men and other MSM 3

43. Module Overview 1 Definition of key terminology including gay men and other MSM 2 Common sexual practices of gay men and other MSM 3 Unique health needs of gay men and other MSM Current global HIV and health trends among gay men and other MSM 4 5 Sexual health promotion with gay men and other MSM 6 The importance of focusing on gay men and other MSM

44. Introduction 1 • Gay men and other MSM: • Experience significant barriers to accessing quality healthcare • Are disproportionately burdened with HIV and other STIs • Health providers: • Have knowledge gaps concerning MSM-related health issues • Play a crucial role in mitigating health risks 2 3 Appropriate care is sensitive, responsive, and non-judgmental

45. Who are MSM? MSM are men who have sex with other men • Not all MSM identify as ‘gay,’ or bisexual • There is great diversity within gay-identifying and non gay-identifying MSM, socially and culturally defined sub-groups and sub-cultures • MSM may be married, have children, and have sex with women • MSM are often hidden within their communities • MSM cannot be identified by clothing, mannerisms, or social roles

46. Evidence of Male-to-male Sex Same-sex behavior exists globally • In a recent study in the United States, 3.8% of Americans identified as lesbian, gay, bisexual, or transgender (LGBT), and 8.2% engaged in same-sex behavior • Other studies show varied prevalence of MSM in E Asia, S and SE Asia, E Europe, Latin America, and Africa • Most study findings are underestimates because of underreporting: • Fear of stigma and discrimination • Criminalization of same-sex behaviors (77 countries) • Subsequently, gay men and other MSM can remain invisible in the healthcare system, hindering their healthcare provision

47. Key Terminology Homosexual or same-sex behavior Sexual orientation Sexual identity Gender Gender identity Gender expression Transgender

50. Summary Gay men and other MSM: 1 Exist in all societies and locations 2 Include a variety of sexual orientations and identities 3 Have unique health needs 4 Are at increased risk of HIV and other STIs 5 Face barriers to accessing health services at all levels Providers play a critical role in mitigating barriers to healthcare services. Focusing on gay men and other MSM has many benefits.