Men who have sex with men (MSM) in sub-Saharan Africa are disproportionately at risk for HIV infection compared to the general male population. While many African countries continue to work toward stemming the spread of HIV and increasing access to HIV testing, prevention, care, and treatment services, the high HIV prevalence among the MSM population is fueled by the paucity of MSM-specific prevention efforts, as well as pervasive stigma and discrimination against MSM. ICAP has worked to expand HIV services for this at-risk population in Mali, South Africa, and Rwanda by partnering with local organizations to develop programs that are sensitive to the population’s needs.
In Bamako, the capital of Mali, MSM often are hidden due to cultural and religious beliefs and stigma. Covert same-sex practices have kept these men from accessing HIV services and have also kept Mali health officials from having an accurate estimate of the size of the MSM population. In partnership with the Centers for Disease Control and Prevention and local organizations, ICAP is developing a survey of the MSM population in Bamako that aims to estimate the size of the population. The survey and resulting estimate is a first step to understanding how to improve outreach and prevention efforts for these men.
“This project brings great hope for Mali as it enables us to better understand the HIV/STI risk behaviors among this population and quantify the number of MSM in Bamako. The results from this survey will start us on the path to improving our HIV services for this at-risk population,” said Malik Kone, Country Director in ICAP’s Mali office.
In South Africa, where 10 percent of the MSM population is HIV-infected, the MOSAIC Men’s Health Initiative, led by ICAP, is implementing new strategies to promote MSM use of HIV testing and treatment services. Supported by the Centers for Disease Control and Prevention under the U.S. President’s Emergency Plan for AIDS Relief, this five-year project is customizing community resources and proven intervention strategies, such as peer counseling, mobile HIV testing centers, and social networking strategies, which are aimed at increasing HIV testing and linkage to care for MSM.
MOSAIC also focuses on strengthening the skills of local organizations to address this population. The program brings together a broad spectrum of implementing partners from the Eastern Cape, Kwazulu Natal, Free State, Northern Cape, and Limpopo to share knowledge on common MSM programming challenges and pursue joint solutions. Partners also ensure that MSM-specific activities are developed and implemented in collaboration with mainstream community-based organizations, which are critical to ensuring that the HIV services are appropriate and accessible for MSM in different communities. By reducing transmission among this key population, MOSAIC aims to contribute to South Africa’s national goal of reducing new HIV infections by 50 percent by 2016.
In Rwanda, ICAP and the Rwanda Nurses and Midwives Association have partnered to improve MSM-tailored HIV services in the country. Three sites—Rugarama Health Centre, Kabusunzu Health Centre, and Carrefour Clinic—were selected to provide MSM-friendly services including peer education and counseling. Eugenie Ingabire, adherence and community support specialist at ICAP in Rwanda, explains that these efforts have led to a more open environment for MSM: “The program offered this key population an important opportunity to access HIV clinical services and created an environment in which MSM are comfortable discussing issues related to their sexual life with health care providers. Now they meet on a monthly basis to share experiences and this enables them to attend health facilities for clinical services, which was not the case before the program was initiated. MSM are now using the freely available HIV services like any other members of the public.”
Health systems that are responsive to MSM needs can support the empowerment of this key population to access comprehensive and appropriate HIV prevention, care, treatment, and support services. Though unique in their approach and partners, these three ICAP-led programs are addressing barriers that have kept MSM from accessing life-saving information and treatment. ICAP is also working to engage national and provincial health systems to support these activities so institutions are able to sustain, expand, and improve HIV programs for MSM.