More than half of new infections could be avoided Prevention benefits observed in long term Optimal future outcome cannot rely on treatment alone or any single intervention Treatment immediate impact on AIDS death Prevention make treatment more affordable & sustainable
Prevention Continuum Awareness HIV Treatment HIV Testing Condom Use Adherence to ART
Recommendations Short term Provide information on being HIV positive & treatment Mid term Strengthen PLHIV support services & networks Long term Treatment support for PLHIV Treatment = HIV Prevention?
Australia’s Syphilis Action Plan Screening for syphilis should be routine with HIV management & testing (men with more than 20 partners per 6 months should be tested twice per year) Promote condom use Increased education about syphilis to decrease stigma; easier ways to notify sexual partners discreetly Test sexually active gay men who have never previously been tested Priority 1 Priority 2
Recommendations Develop MSM STI Plan Develop programme to educate on syphilis + integrate syphilis information into relevant programmes Develop secondary prevention programme at point where MSM tests positive for syphilis Syphilis = HIV Prevention?
Most people think that prostitutes are disease-carrying people. Sex Worker As someone who has worked in the sex trade, I keep it a secret a lot. Because even when I meet new friends, sometimes they’ll sat comments about working girls. They treat you like you’re a rat. Like you’re this small. Like you belong in a sewer. Sex Worker
In Swaziland, if you are straight lesbian, straight gay, you don’t even exist. There is nothing like that. They call it demonic, something very, very bad. African bisexual woman I’m from Jamaica. If you’re gay, lesbian, bisexual, or queer, and you’re HIV positive, and you come out, you will be killed because it’s like you’re the one who start the virus. Because they see you being queer as being demonic or evil. Caribbean queer woman
Just being strong. You just have to think positive. South Asian woman I always live with hope. African woman
Groups to help each other; I think that’s really important and to stand against the stigmatisation of ourselves and discrimination. You have the rights of a person just like everyone else. Francophone African woman Stick together to fight the stigmas surrounding HIV individuals and fight for change. Transgender woman Sometimes the things that you have to face, you become so suicidal at many points in your life that you want to just end it yourself. But then you meet your friends, there are groups that can really help you to pull through. They give you strength. African queer woman
Community Strengthening Systems The Global Fund
Sustainability ability for communities to be able to provide direct services, advocate for improved programming & improve policies Strengthen the capacity of organisations working at community level to deliver services Enhance roles of communities to design, deliver, monitor & evaluate services aimed at improving health outcomes Proposal to include of initiatives that contribute to development and/or strengthening of CBOs
Community Strengthening Sustainability of financial & other resources for community interventions implemented by community based organisations & networks Develop enabling & responsive environment through community-led documentation, policy dialogue & advocacy Networking, coordination & partnerships Capacity building for staff of CBOs & networks & for other community workers, such as community care workers & community leaders Strategic planning, monitoring & evaluation Support core funding for CBOs & networks, including organisational overheads, staff salaries, stipends
Recommendations Align strategic funding priorities to community engagement programmes Provide funding for through NGOs for community-led initiatives Build capacity of community & evaluate community-led initiatives Community Engagement
Resources <ul><li>Community Systems Strengthening </li></ul><ul><ul><li>http://www.theglobalfund.org/documents/rounds/8/R8CSS_Factsheet_en.pdf </li></ul></ul><ul><ul><li>http://physiciansforhumanrights.org/hiv-aids/globalfund_round9.html </li></ul></ul><ul><ul><li>http://physiciansforhumanrights.org/library/documents/reports/technical-support-for-hss.pdf </li></ul></ul><ul><ul><li>http://www.aidsalliance.org/includes/document/CSS_framework.pdf </li></ul></ul>
Unlikely or very unlikely contract HIV in lifetime Experienced coercion & sexual abuse at time of sexual initiation Knowledge of HIV discounted as irrelevant Sex education in school excludes gay sex Do not have identifiable gay role models Lack of social cues Lack of mentors
Young PLHIV MSM Says: Targeted & inclusive sex education at early age Sophisticated prevention strategies that incorporate technology in developing positive approaches to sexuality Peer or gay mentored interventions Increase parental education related to sexual coercion & encourage supportive parent-child relationships Young MSM want to recognise themselves in campaigns – how does this speak to me? Peer Engagement?
Recommendations Engage & capacity build existing volunteers to initiate & lead projects Co-fund existing interest groups for their activities Conduct discussion sessions to recruit peer influencers Peer Engagement – How?
The Gay Men’s Health Agenda Longings for intimacy Meanings of anal sex Emotions, pleasures & wounds Resilience, creativity, determination, humour & playfulness Support healing of all kinds of trauma Transgression, risk & the taboo interact with gay men’s sexual desires, practices & subcultures Privileged masculinities of youth Revive & recreate communities & social structures
Recommendations Understand culturally appropriate needs & lived contexts of MSM, according to the life cycle Strengthen the mental well being of MSM to adopt health promoting behaviours Engage & involve MSM to develop programmes relevant to their needs MSM in Focus = HIV Prevention?
Resources <ul><li>CDC: Lesbian, Gay, Bisexual and Transgender Health </li></ul><ul><ul><li>http://www.cdc.gov/lgbthealth/ </li></ul></ul><ul><li>Gay Men’s Health Agenda </li></ul><ul><ul><li>http://www.scribd.com/doc/12186690/Gay-Mens-Health-Agenda-2009 </li></ul></ul><ul><li>Gay Men’s Health Crisis </li></ul><ul><ul><li>http://www.gmhc.org/ </li></ul></ul>
Awareness - knowledge Peer Engagement Awareness - of self, past experiences, coping mechanisms, social understanding Psychosocial dimensions – self esteem, acceptance Motivation Attitude Community Engagement Environmental Modification HIV Treatment HIV Testing Condom Use Awareness - Knowledge Attitude Change Behaviour Change – Condom Use, HIV Testing Reduce HIV transmission Coming out Group sex Open relationship Many sex partners First boyfriend First sex Older Chinese Drug use Closeted & married Bisexual Male sex workers & clients Foreign Malay Sustainable Community Engagement Peer Engagement Mental Health Secondary Prevention Life Cycle Approach MSM 360º Engagement Action for AIDS Oogachaga DSC Clinic Community Facilitators
Men-who-have-sex-with-men 1 3 5 2 4 Coming out Group sex Open relationship Many sex partners First boyfriend First sex Older Chinese Drug use Closeted & married Bisexual Male sex workers & clients Foreign Malay Action for AIDS Oogachaga Community Facilitators Life Cycle Approach Secondary Prevention MSM 360º <ul><li>MSM Community Engagement </li></ul><ul><li>Clubs & pubs </li></ul><ul><li>Saunas </li></ul><ul><li>MSM-affiliated companies </li></ul><ul><li>Religious organisations </li></ul><ul><li>Peer Engagement </li></ul><ul><li>Interest groups </li></ul><ul><li>Peer influencers </li></ul>Sustainable Community Approach <ul><li>Non-MSM Community Engagement </li></ul><ul><li>Healthcare </li></ul><ul><li>Allied-healthcare </li></ul><ul><li>Academic </li></ul><ul><li>Other NGOs </li></ul><ul><li>Online Engagement </li></ul><ul><li>Online portals & social networking sites </li></ul><ul><li>Chatrooms </li></ul><ul><li>Mobile platforms </li></ul>Fridae Trevvy <ul><li>Mental Health </li></ul><ul><li>Stigma & discrimination </li></ul><ul><li>Self esteem </li></ul><ul><li>Acceptance </li></ul><ul><li>Depression </li></ul>DSC Clinic Mental Health
Other Resources <ul><li>Gay Men’s Sex Survey 2008 </li></ul><ul><ul><li>http://www.sigmaresearch.org.uk/go.php/quests/quests29/ </li></ul></ul><ul><li>Relative Safety 1 </li></ul><ul><ul><li>http://www.sigmaresearch.org.uk/files/report1999e.pdf </li></ul></ul><ul><li>Relative Safety 2 </li></ul><ul><ul><li>http://www.sigmaresearch.org.uk/files/report2009d.pdf </li></ul></ul><ul><li>Gay and Bisexual Men Resources (Sigma Research) </li></ul><ul><ul><li>http://www.sigmaresearch.org.uk/go.php/gay </li></ul></ul>