Ending HIV among Men who have Sex with Men (MSM) in Kenya


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  • So what is the feedback of the community on priority interventions to ending HIV?
  • To challenge stigma, discrimination and prejudicial treatment.
    Targeted at national and county leadership, community and religious leaders
  • This improves ownership and meaningful engagement in fighting HIV
  • Ending HIV among Men who have Sex with Men (MSM) in Kenya

    2. 2. Why a MSM HIV Community Brief? Under leadership of NACC and NASCOP and with the support of Ishtar MSM, IAVI, LVCT Health, MSMGF and NOPE, community discussions began in an MSM Pre-Summit to the 2013 National HIV Prevention Summit. First ever publication of participatory community discussions among national MSM-serving organizations and MSM activists and MSM-led HIV organisations on HIV prevention among MSM To advise planning, coordination and evaluation of HIV prevention responses targeting MSM in Kenya To advise the development and implementation of the Kenya National AIDS Strategic Plan IV (2014-19)
    3. 3. Key Recommendations •Definition and implementation of an MSM HIV Prevention combination prevention package •Existing national and county laws and policies should be aligned to the constitutional right to health •MSM should be meaningfully engaged in critical decision making on service delivery, advocacy and implementation of HIV research •Increased funding and technical support to MSM community organisations
    4. 4. Some numbers for context on HIV among MSM NASCOP 2012 Report
    5. 5. Community Recommendations OPTIMAL STRATEGIES TO ENDING HIV AMONG MSM
    6. 6. HIV Testing and Counseling (HTC) MSM need to know their HIV status. For efficiency and sustainability, testing and retesting strategies among MSM must be managed by MSM. HIV testing outreach and messaging should use peer approaches in safe and familiar meeting spaces, hotspots and community venues and events.
    7. 7. HIV Care and Treatment Stigma and discrimination in public health centers prevent HIV-infected MSM to take up and stay in HIV treatment. Of every 3 HIV-infected MSM, 2 have not yet taken a HIV test (NASCOP 2012 Report). Therefore, community HIV testing strategies should be scaled up. MSM should access HIV treatment, regardless of CD4 count, at every point of HIV testing. This will improve their health, while reducing community viral load. HIV treatment must be accompanied by structured, MSM-targeted psychosocial support. Psychosocial support should include education on means to cope with stigma and discrimination, safe sex, adherence and disclosure to sex partners.
    8. 8. STI Prevention Messaging, Screening and Treatment Comprehensive genital and anal STI prevention messaging, screening and treatment should accompany all MSM HIV testing and treatment visits. Screening must include half-yearly anorectal examinations and routine blood testing for asymptomatic STIs such as syphilis, gonorrhea and chlamydia. Ideally, should include lab testing, treatment ad vaccination for Hepatitis B. NASCOP should prioritize development of comprehensive national STI Guidelines that include care for MSM, in line with WHO Guidelines. There is a need for community education among MSM on dangers of HIV and STI co-infection, of cancer causing STIs and the need for anorectal examinations.
    9. 9. Condoms and condom-safe Lubricants 4 out of every 5 MSM had condomless anal sex in the last 30 days (NASCOP 2012 Report) Condom promotion messaging among MSM should address community-specific barriers to condom use: pleasure, intimacy, love, safety, trust and power NASCOP should increase access to free and subsidized condom-safe lubricants. Condoms and lubricants should be distributed together to emphasize their complementarity. Messaging should address the dangers of oil-based lubrication and improve condom negotiation skills.
    10. 10. Post Rape Care (PRC) and PEP Sexual violence among MSM is rarely reported due to public stigma and Kenya’s criminalization of same-sex sexual activity. MSM are hence not always able to access PRC and PEP in time to prevent HIV. PRC messaging and counseling should include information relevant to same-sex experiences of sexual violence. Messaging should raise awareness among MSM on their rights and mechanisms for legal redress. MSM should also be educated on the dangers of abusing PEP.
    11. 11. PrEP, Rectal Microbicides and Vaccines Prevention technologies (in various stages of research and implementation) offer additional protection to condoms especially when condom use is low and inconsistent. Research that aims to demonstrate the efficacy and feasibility of introducing PrEP, vaccines and rectal microbicides as part of a package of HIV prevention services to MSM must engage MSM in all stages of decision making throughout the research lifecycle: from research design to eventual scale up modeling. NASCOP should promptly develop delivery guidelines for these prevention options when local evidence supports their efficacy and feasibility.
    12. 12. Peer Education and Outreach Community mapping should be by peer leaders, linked to community zones where contact and follow up is continuously done. MSM-targeted National HIV Peer Education Standards, Peer Education Curriculum and Peer Education Quality Monitoring Framework, developed in consultation with MSM should guide MSM peer education. Peer education should be anchored in the National Community Health Strategy. MSM should drive national processes of identifying, adapting, implementing and reviewing individual level and community level MSM Evidence-Based Behavioral Interventions (EBIs)
    13. 13. Information-Education-Communication (IEC) Strategies These strategies should leverage cellphones and social media. IEC should include print, audio-visual, web and cellphone strategies and a branding of MSM venues and events. These strategies should address all forms of stigma –in clinical and public settings– to improve public knowledge and attitudes on MSM and HIV. HIV Communication Guidelines should be developed, and in consultation with MSM, and include regulations on appropriate content.
    14. 14. Positive Health, Dignity and Prevention HIV treatment must include MSM targeted individual and group level counseling to support treatment uptake, adherence and retention. Prevention with Positives Curriculum should be reviewed to include MSM. MSM-identifying HIV-infected peer leaders should have their capacity developed to support peer counseling for Positives.
    15. 15. Alcohol and Substance Abuse Recovery Therapy There is need for research to describe the role of mental health in MSM HIV health, including the role of alcohol and substance abuse. MSM should be engaged in developing and continuously evaluating brief alcohol and substance abuse recovery interventions implemented at HIV testing and treatment visits.
    16. 16. Drop-in Centers Clinical spaces that support MSM should include or link to social spaces for psychosocial interventions. Drop-in spaces should be inviting and non-judgmental. Drop-in spaces should implement outreach meetings, social dialogue and community-building activities.
    17. 17. Policy engagement, advocacy and public dialogue NACC should finalise and disseminate the Key Populations HIV Policy Kenya should engage MSM in strengthening their own advocacy capacities: ◦ targeting the larger MSM community with civic education on their rights and healthcare access options ◦ targeting public audiences and service providers with dialogue on human rights and dignity Human rights promotion dialogue should target opinion leaders (religious, political leaders) and service providers (health care, police, prison authorities) Should include advocacy on the need to align existing laws and policies to the constitutional right to health
    18. 18. MSM HIV Prevention Funding and Capacity Strengthening Recognising the power and effectiveness of community-led organizations, there should be increased financial and technical support to them to improve their capacity for advocacy as well as for integrating and scaling up biomedical interventions. Community organisations have vast community familiarity and grassroots outreach strategies
    19. 19. Acknowledgments GALCK, NYARWEK, KESWA Kenya MSM HIV Prevention Network HOYMAS, Ishtar MSM, HAPA Kenya, K-YDESA MAAYGO, MPEG, PEMA, Q-Initiative, Tamba Pwani Technical Advisors to the Network IAVI, LVCT Health, NOPE Other MSM-serving HIV Organisations Kisumu Shinners, PLAG-IT, The Eagles for Life, UKWELI URM, KAVI, KEMRI/Welcome Trust, NEPHAK, UON-CHPVR, SWOP, BHESP, ICRH-Kenya Supporting Ministry of Health Agencies NACC, NASCOP
    20. 20. Thank You! For feedback contact the MSM community co-conveners: Ishtar MSM communications@ishtarmsm.org HOYMAS hoymas4@yahoo.com
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