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MRC/info4africa KZN Community Forum | July 2012

Zukiswa Fipaza of the International Centre for AIDS Care and Treatment Programmes (ICAP) highlighted the activities of the Centre's MOSAIC Men’s Health Initiative and its role in supporting the Implementation of the National Strategic Plan for HIV and AIDS, STIs and TB (NSP). MOSAIC utilises an integrated and co-ordinated approach that aims to provide a tailored package of prevention, treatment, care and support services for men who have sex with men (MSM). By scaling up HIV-related services  and support mechanisms for the MSM community, MOSAIC contributes towers South Africa’s national goal of reducing new HIV infections and strengthens health, whilst providing a model for expansion to other districts and service areas.

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MRC/info4africa KZN Community Forum | July 2012

  2. 2. Background • MARPs = Most At-Risk Populations • Include the following key populations: Men who have sex with men (MSM), Sex workers (SWs) and Injecting Drug Users (IDUs) • Why? These key populations are not only more likely to be exposed to or transmit HIV, but are at increased vulnerability because of the particular practices they engage in. • Their vulnerability is further compounded by various structural, social and individual risk factors, including stigma and discrimination.
  3. 3. HIV prevalence among MARPS in South Africa Source: SANAC. Key Populations, Key Solutions Gap analysis. 2011.
  4. 4. Responding to the health needs of men who have sex with men From Results to Practice The model and approach adopted in the MOSAIC Men’s Health Initiative is based on three considerations: • Recommendations from the Rapid Situational Assessment • Continuum of care model • Recommended minimum and enhanced service packages
  5. 5. Responding to the health needs of men who have sex with men Recommendations from the Rapid Situational Assessment General Recommendations (a recap): • Increase reach of communication strategies • Increase access to male and female condoms with compatible lubrication • Increase access to PEP • Promote uptake of HIV/STI/TB screening at facilities • Strengthen the link between substance use treatment services and HIV prevention • Establish and support community structures for MSM
  6. 6. Responding to the health needs of men who have sex with men Recommendations – cont. • Integrate MSM package within general prevention package to reduce stigma • Provide direct services in underserved areas, starting in KZN and Eastern Cape, with the goal of supporting a centre in each province by 2016 • Support the development of accessible and competent HIV/STI/TB treatment services responsive to the needs of MSM • Support a mimimum package of services for MSM living with HIV
  7. 7. Responding to the health needs of men who have sex with men Service Packages Minimum Service Package Enhanced Service Package Appropriate messaging & communication Specialised MSM centres Provision of male & female condoms/ lube Provision of syndromic STI treatment Provision of community-based peer outreach activities Provision of complex STI treatment Provision of HCT Provision of HIV treatment and care Provision of STI and TB screening Provision of substance abuse treatment Mobile HIV prevention services Provision of psychosocial support Referral for HIV treatment, care and support Hepatitis A and B screening and vaccination Referral for STI/TB treatment Provision of PEP Referral for substance abuse treatment Provision of PrEP (according to SA guidelines once published) Referral for psychosocial support National HIV-prevention messaging campaign Referral for PEP Coordination of national health workers sensitivity training, advocacy and M&E efforts
  8. 8. Model and Approach of MOSAIC Men’s Health Initiative The particular approach adopted depends on: Context Package Time Frame Site Resource constrained: limited resources, infrastructure, organisation, implementing partners and expertise Basic Phased approach Polokwane Intermediate: somewhere between resource constrained and resource enabled Basic to enhanced Phased approach Kimberley Bloemfonetin Port Elizabeth Resource enabled: available resources, infrastructure, organisation, implementing partners and expertise Enhanced Accelerated approach Durban
  9. 9. • Programme implementation commenced in April 2012 • Key Stakeholder Meetings:  District Health to discuss and get input on the planned programme  TBHIV Care Association to share best practices and discuss possible areas for collaboration • Established the Community of Practice and disseminated findings from the needs analysis • Developed tools for implementation ( logical framework, activity matrix etc) • Follow up CoP meeting held in June • Launch in June • Supported mobile testing at Durban Pride Implementing the enhanced package in Durban
  10. 10. Organization Activity Description Target Population Status CoP Membership Durban Gay and Lesbian Centre Provides, personal, HIV/AIDS, sexual health and legal education, counselling and advise. LGBT Active, MOU signed Pietermaritzburg Gay and Lesbian Network Responds to psychosocial needs of LGBTIs including support to LGBTIs living with HIV LGBTI Active, MOU signed National LGBTI Health Campaign HIV prevention campaigns LGBTI Active, MOU signed SANCA, Durban Prevention and treatment of drug related addictions/abuse General Active, MOU signed Lifeline Durban HIV testing and counselling, psychosocial support (telephonic, face to face) including for survivors of violence & abuse General Active, MOU signed National Association of People living with HIV and AIDS (NAPWA) Psychosocial support for people living with HIV and AIDS General Discussion with Head Office Hope Clinic Treatment and support for people living with HIV and AIDS General Discussions - little progress AIDS Foundation Provides grants to CBOs & NGOs and capacity building General ??? Lovelife, Durban HIV prevention initiative for young people Youth Discussions with Head Office HIV 911 Directory of Services covering prevention, treatment and support across South Africa General Active, No MOU Provincial & District Health PEPFAR
  11. 11. Peer Outreach Activities • Two organizations were identified to conduct Peer Outreach Activities: - Pietermaritzburg Gay and Lesbian Network - Durban Gay and Lesbian Centre •Both organizations have started with recruitment of 6 Peer Outreach Workers and 2 Lay Counsellors – ICAP is providing technical support •Training manual for building the Capacity of Peer Outreach workers is being developed • Monitoring tools for data collection are under development • Working tool kit (stationery, protective clothing) is currently being procured
  12. 12. HCT Readiness Assessments & Set-Up • Two organizations assessed: - National LGBTI Campaign (no resources available for operation and activities) - Durban Gay and Lesbian Centre - (has resources for operations and current programmes but space not suitable to set-up a clinic) • Nurse Clinician and Programme Manager currently being recruited • Space for the MSM clinic identified, Durban Gay and Lesbian Centre
  13. 13. Pride Mobile Testing • OUT LGBTI Well - Being Conducted HIV Testing and Counselling on behalf of ICAP • Approximately 300 people participated Demographics HIV Testing Number of individuals Tested HIV positive Males Females <15 years 0 0 15 - 24 years) 4 0 <25 years 6 0 <15 years 0 0 15 - 24 years 0 0 <25 years 3 0 13
  14. 14. Training Workshops/Meetings • Two day sensitization training workshop conducted • Training of grantees on Outreach Management Protocol - ICAP’s finance and obligations , procurement process and human resource policies and procedures
  15. 15. Next Steps • Finalise outstanding MOUs • Support the establishment of a clinic within Durban Gay and Lesbian Centre • Meet with PDOH Management team to present and discuss MOSAIC • Meet with DoH district to discuss the proposed clinic, accreditation process, supply of HCT test kits, mapping of DOH facilities, and services available for MSM • Conduct zoning exercise in collaboration with THCA • Conduct organizational assessments to understand the capacity building needs of each partner • Begin outreach services, and provision of commodities and BCC materials • Support training - M&E, Outreach, sensitisation, clinical competency etc • Support newly appointed staff with setting-up the office • On going technical support programme implementation