Men who have sex with men (MSM) face increased risk of HIV infection. Effective HIV prevention, care, and treatment programs for MSM need to be tailored to the unique needs of this population. In Rwanda, cultural resistance to homosexuality and a widespread belief that homosexuality does not exist in the country have, until recently, hindered the integration of such tailored services into the country’s HIV program.
Since 2010, ICAP has collaborated with the Government of Rwanda and its Rwanda Biomedical Center (RBC) on an innovative project to increase MSM’s access to and utilization of quality, MSM-friendly HIV prevention, care, and treatment services in the nation’s capital, Kigali. Following a rapid assessment of Kigali health facilities and the MSM-related knowledge, attitudes, and practices among health workers at these facilities, three clinics—Kabusunzu, Rugarama, and Carrefour— were selected to pilot a multi-pronged intervention focused on MSM.
To improve the quality of clinical services available to MSM, health workers at these clinics were sensitized and trained to provide HIV-related services tailored to the specific needs of MSM, including diagnosis and treatment of sexually transmitted infections. Monthly visits were also conducted to provide continued mentorship and support to the clinic’s health workers as they provided these services.
A key challenge was the reluctance of MSM to seek services due to their fear of being stigmatized and discriminated against. To increase the number of MSM accessing services at these clinics— which was exceedingly low at the start of the project—ICAP supported targeted outreach activities that proved crucial to the project’s success. An MSM focal person was identified at each clinic and connected with leaders of the local MSM community to plan and organize outreach activities. These included holding community meetings with MSM to disseminate information about the availability of MSM-friendly services, to deliver HIV prevention and care messages, and to encourage HIV testing. In addition, a network of MSM peer educators were recruited and trained to conduct outreach, lead support groups, and provide peer support to other MSM.
Since the project began, the three pilot clinics have seen a significant increase in the number of MSM accessing services, with over 140 MSM being reached with prevention and care messages and 120 MSM accessing HIV testing at the three clinics during the first quarter of 2013. As one client explained, “Before, we were frustrated and had fear seeking health services. Now we are welcomed and comfortable to discuss our sexual activities with health care workers.”
This pilot project highlights the promise of targeted interventions tailored to meet the specific needs of MSM. Through its work in Rwanda and beyond, ICAP will continue to prioritize projects aimed at providing key populations with accurate information and support, and with the highest quality health services.