When traditional leaders attended an ICAP-supported gay pride parade in Moletsi, Limpopo this past October, it marked an important moment for one of South Africa’s most religious districts, and perhaps a sign that the traditionalist stance against same-sex sexual behavior is waning. Limpopo, a rural and culturally conservative community, is one of five provinces in South Africa where ICAP is working with local health departments and non-governmental organizations to implement and scale up HIV prevention interventions targeting men who have sex with men (MSM).

“There is still a lot of stigma and discrimination against MSM in society and in health services,” says Lindiwe Mothemane, ICAP’s key population regional manager in Limpopo. “As a result, many men choose not to engage in care and are ultimately at great risk.”

To address these challenges, ICAP, began the Mosaic Men’s Health Initiative (MOSAIC) with support from PEPFAR through the U.S. Centers for Disease Control and Prevention (CDC). ICAP is working to advance PEPFAR’s goal of an AIDS-free generation by addressing gaps in knowledge about MSM through the development and implementation of sensitization and clinical competency trainings aimed at addressing heterosexist-driven stigma and discrimination in health care settings and improving clinical competency among health providers.

“The health care system is still working from a hetero-normative stance,” said Xander Flemming, key population program manager at ICAP. “Lots of education is needed to shift the health care system from a system in which the attitudes and bias of health care workers favors opposite-sex sexuality and relationships.”

Prevention of new infections among MSM relies on a culturally and clinically competent cadre of health care workers ready and capable of providing a comprehensive package of health services to the MSM population.

To transform government clinics into more welcoming settings for key populations, ICAP worked with a consortium of organizations to develop and facilitate integrated sensitization training in which health care workers explore their personal values, attitudes and prejudice and identify how it may impact their ability to provide services to key populations, explore human sexuality and sexual behavior, and identify risk factors and vulnerabilities among key populations.

In addition, ICAP developed a clinical competency training to teach nurses and HIV counselors additional clinical skills to provide comprehensive services to MSM. The trainings are mandatory for all health care workers providing services at ICAP-supported health facilities, and also now include the needs of sex workers and people who inject drugs, as these key populations cannot always be viewed as separate.

Since 2012, over 2,000 health care workers have received sensitization training and over 260 clinicians across five regions have received competency trainings through ICAP. The Mosaic Men’s Health Initiative has expanded HIV prevention services to over 14,000 MSM, and over 650 MSM learned they were HIV positive, many of whom have been successfully linked to ICAP-supported facilities to access care and treatment.

“Through this initiative, ICAP is contributing to South Africa’s national strategic plan to reduce new HIV infections by at least 50 percent,” said Dr. Sandile Buthelezi, ICAP’s country director in South Africa. “The sensitization and clinical trainings are creating a more inclusive health care system that will ensure that MSM and other vulnerable populations have access to holistic health care services.”

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