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.

1. A STRATEGIC RESPONSE:
MOSAIC MEN’S HEALTH
INITIATIVE
ETHEKWINI MUNICIPALITY METRO, KWAZULU NATAL
JUL 2012

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. HIV prevalence among MARPS in
South Africa
Source: SANAC. Key Populations, Key Solutions Gap analysis. 2011.

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. 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. 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. 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. 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. • 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. 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. 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. 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. 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. 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. 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