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
Ending HIV among men
who have sex with men
MSM COMMUNITY BRIEF
PETER NJANE,DIRECTOR-ISHTAR MSM
6TH INTERNATIONAL CONFERENCE ON PEER EDUCATION, SEXUALITY AND HI V/AIDS
FRIDAY 20TH JUNE
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)
•Definition and implementation of an MSM HIV Prevention combination
•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
Some numbers for
context on HIV
NASCOP 2012 Report
OPTIMAL STRATEGIES TO ENDING HIV AMONG MSM
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.
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
Psychosocial support should include education on means to cope with stigma
and discrimination, safe sex, adherence and disclosure to sex partners.
STI Prevention Messaging, Screening and
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.
4 out of every 5 MSM had condomless anal sex in the last 30 days (NASCOP 2012
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
Messaging should address the dangers of oil-based lubrication and improve
condom negotiation skills.
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.
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
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.
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
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.
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.
Alcohol and Substance Abuse Recovery
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
Clinical spaces that support MSM should include or link to social spaces for
Drop-in spaces should be inviting and non-judgmental.
Drop-in spaces should implement outreach meetings, social dialogue and
Policy engagement, advocacy and public
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
MSM HIV Prevention Funding and
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
Community organisations have vast community familiarity and grassroots
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
For feedback contact the MSM community co-conveners: